Assessment of Pre-test and Clinical Probability in the Diagnosis of Chronic Coronary Syndrome — What's New?

In the 2019 European Society of Cardiology (ESC) guidelines, the diagnostic algorithm for chronic coronary syndrome (CCS) was significantly changed, a significant revision of the pretest probability assessment scale (PTP) was made, an assessment of the clinical probability of obstructive coronary artery disease was proposed, the recommendations on the use of diagnostic tests in various groups of patients were updated. Such a radical change in approaches to the diagnosis of CCS raised many questions that had to be answered by further studies conducted in the past two years. The review provides data on the validation of the new PTP scale and the proposed assessment of the clinical probability of obstructive coronary artery disease, taking into account risk factors and with the additional inclusion of information on the calcium index of coronary arteries. The proposals of experts on new algorithms for the choice of non-invasive / invasive examination of this category of patients were also considered. Overall, the new PTV rating scale (ECS 2019) has been validated and validated in retrospective analyzes of cohort studies. The scale for assessing the clinical likelihood of obstructive coronary artery disease makes it possible to classify 3.8-5 times more patients as a low probability of coronary artery disease compared to the assessment of PTP alone. Assessment of the post-test probability of coronary artery disease does not allow to confirm the presence of obstructive lesion and was not used. The experts proposed new modifications of the diagnostic algorithm (with a detailed assessment of the clinical probability, as well as without taking it into account), which require verification in further studies. Therefore, it is advisable to conduct prospective studies to confirm the possibility of reducing the total number of non-invasive and invasive studies in patients with suspected coronary heart disease, as well as the safety of such a decrease in diagnostic procedures

Outpatient management of patients with peripheral artery disease by cardiologists or surgeons: influence on the prognosis and prevalence of surgical interventions

Highlights. The study shows for the first time that during the three-year follow-up of patients with diseases of the arteries of the lower extremities in the observation groups of a general surgeon and a cardiologist, adverse events (myocardial infarction, stroke, amputation, disability) and deaths occurred more often in a surgeon than a cardiologist. The study proves the correctness and real benefit of such an approach with the involvement of a cardiologist to the outpatient stage of management of a complex cohort of patients with atherosclerosis of the vessels of the lower extremities.Aim. To study the effect the outpatient observation of patients with peripheral arteries disease (PAD) by cardiologists and surgeons has on timing and prevalence of reconstructive surgery and the prognosis of patients. Methods We analyzed the data on 585 PAD patients who underwent outpatient observation from 2010 to 2017, dividing them into 2 groups. The first group (131 patients) managed by an surgeon; the second (454 patients) managed by a cardiologist. Since the groups were not comparable in terms of the initial parameters, the comparability of patients in the groups (observation by a surgeon or by a cardiologist) was achieved using pseudorandomization. The follow-up period was three years; we assessed the incidence of deaths, adverse events, and the prevalence of reconstructive operations.Results. During a three-year follow-up the 1st group, compared with the 2nd, had more deaths in general (p<0.001), death from cardiac causes (p = 0.045), from stroke (p><0.001), as well as the total number of adverse events (p><0.001) and disability (p = 0.065). Indications for reconstructive surgery on the lower extremities arteries (LEA), and operations frequency were comparatible in groups. Amputation history, taking diuretics, presence of rhythm disturbances, and management by a surgeon increased the risk of adverse outcomes. Management by a cardiologist, reconstructive LEA surgeries, female sex improved the prognosis of patients. Conclusion Observation of PAD patients by a cardiologist contributes to a higher frequency of optimal drug therapy by patients and can reduce the number of adverse events in patients and improve their survival without affecting the timing and frequency of reconstructive LEA surgeries. Keywords Peripheral atherosclerosis • Outpatient follow-up • Optimal drug therapy • Reconstructive surgery>˂ 0.001), death from cardiac causes (p = 0.045), from stroke (p˂ 0.001), as well as the total number of adverse events (p˂ 0.001) and disability (p = 0.065). Indications for reconstructive surgery on the lower extremities arteries (LEA), and operations frequency were comparatible in groups. Amputation history, taking diuretics, presence of rhythm disturbances, and management by a surgeon increased the risk of adverse outcomes. Management by a cardiologist, reconstructive LEA surgeries, female sex improved the prognosis of patients.Conclusion. Observation of PAD patients by a cardiologist contributes to a higher frequency of optimal drug therapy by patients and can reduce the number of adverse events in patients and improve their survival without affecting the timing and frequency of reconstructive LEA surgeries.Highlights. The study shows for the first time that during the three-year follow-up of patients with diseases of the arteries of the lower extremities in the observation groups of a general surgeon and a cardiologist, adverse events (myocardial infarction, stroke, amputation, disability) and deaths occurred more often in a surgeon than a cardiologist. The study proves the correctness and real benefit of such an approach with the involvement of a cardiologist to the outpatient stage of management of a complex cohort of patients with atherosclerosis of the vessels of the lower extremities.Aim. To study the effect the outpatient observation of patients with peripheral arteries disease (PAD) by cardiologists and surgeons has on timing and prevalence of reconstructive surgery and the prognosis of patients. Methods We analyzed the data on 585 PAD patients who underwent outpatient observation from 2010 to 2017, dividing them into 2 groups. The first group (131 patients) managed by an surgeon; the second (454 patients) managed by a cardiologist. Since the groups were not comparable in terms of the initial parameters, the comparability of patients in the groups (observation by a surgeon or by a cardiologist) was achieved using pseudorandomization. The follow-up period was three years; we assessed the incidence of deaths, adverse events, and the prevalence of reconstructive operations.Results. During a three-year follow-up the 1st group, compared with the 2nd, had more deaths in general (p<0.001), death from cardiac causes (p = 0.045), from stroke (p><0.001), as well as the total number of adverse events (p><0.001) and disability (p = 0.065). Indications for reconstructive surgery on the lower extremities arteries (LEA), and operations frequency were comparatible in groups. Amputation history, taking diuretics, presence of rhythm disturbances, and management by a surgeon increased the risk of adverse outcomes. Management by a cardiologist, reconstructive LEA surgeries, female sex improved the prognosis of patients. Conclusion Observation of PAD patients by a cardiologist contributes to a higher frequency of optimal drug therapy by patients and can reduce the number of adverse events in patients and improve their survival without affecting the timing and frequency of reconstructive LEA surgeries. Keywords Peripheral atherosclerosis • Outpatient follow-up • Optimal drug therapy • Reconstructive surgery>˂ 0.001), death from cardiac causes (p = 0.045), from stroke (p˂ 0.001), as well as the total number of adverse events (p˂ 0.001) and disability (p = 0.065). Indications for reconstructive surgery on the lower extremities arteries (LEA), and operations frequency were comparatible in groups. Amputation history, taking diuretics, presence of rhythm disturbances, and management by a surgeon increased the risk of adverse outcomes. Management by a cardiologist, reconstructive LEA surgeries, female sex improved the prognosis of patients.Conclusion. Observation of PAD patients by a cardiologist contributes to a higher frequency of optimal drug therapy by patients and can reduce the number of adverse events in patients and improve their survival without affecting the timing and frequency of reconstructive LEA surgeries

Clinical symptoms and ECG data in women with acute coronary syndrome

Background. There are many differences in chest pain symptoms between men and women in terms of location, nature, and additional symptoms. The issue of describing the differences in chest pain in men and women with acute coronary syndrome (ACS), as well as their correlation with changes in the electrocardiogram (ECG) and coronary angiography (CAG) remains relevant.Methods. The study included 588 patients of the cardiology department of the Novokuznetsk City Clinical Hospital No. 1 from 2013 to 2017 with a diagnosis of ACS. Depending on the gender, the subjects were divided into two groups: Group I – 330 men; Group II – 258 women.Results. ACS with ST elevation was more common in men (45.8 %) than in women (33.3 %; p = 0.002). There were no pathological ECG changes in women in 58.1 % of cases, in men – in 45.5 % (p < 0.001). ECG type Q/ST elevation was detected more often in men (45.8 %) than in women (33.3 %; p = 0.002). The absence of coronary artery lesions was observed in 27.9 % of men and 44.2 % of women (p < 0.001). Hemodynamically significant coronary artery stenosis was more common in men (57.6 %) than in women (38.7 %; p < 0.001). In a typical angina clinic, hemodynamically significant coronary artery disease in patients with Q/without ST elevation ACS was detected in 40.2 % of men and in 58.5 % of women (p = 0.002). In the atypical angina clinic, hemodynamically significant lesions of coronary artery were more common in men (40.6 %) than in women (34.1 %; p = 0.02).Conclusion. In women atypical chest pains and intact coronary arteries were detected more often than in men, and hemodynamically significant coronary artery stenosis were found less often than in men. In men, a more pronounced pathology of the coronary arteries in ACS was revealed, in women – great difficulties in diagnosing ACS

Neuromuscular disorders in chronic alcohol intoxication

The paper reviews the present-day Russian and foreign literature on neuromuscular disorders in chronic alcohol intoxication. The most common manifestations of alcohol disease include alcoholic polyneuropathy (PNP) and alcohol-induced skeletal muscle injury. The clinical polymorphism of alcoholic PNP is discussed. The paper considers a chronic sensory automatic form due to the direct toxic effects of ethanol and its metabolites during long-term alcohol intoxication, as well as acute/subacute sensorimotor neuropathy, the basis for the pathogenesis of which is B group vitamins, predominantly thiamine, deficiency that develops in the presence of drinking bouts concurrent with malnutrition and/or alcohol-related gastrointestinal tract diseases. In addition to nonuse of alcohol and a properly balanced diet, antioxidant therapy with alphalipoic acid and neurotropic B group vitamins is considered to be pathogenetic therapy for neuropathy. The most common and least studied clinicalform of alcohol-induced musculoskeletal injury is chronic alcoholic myopathy (AM), the diagnostic standard for which is morphometricand immunohistochemical examination of a muscle biopsy specimen. The morphological base for this form of myopathy is predominantly type 2 muscle fiber atrophy caused by impaired protein synthesis and a decreased regenerative potential of muscle fiber. The efficacy of antioxidants and leucine-containing amino acid mixtures in the treatment of chronic AM is discussed

Моделирование профилактических и защитных мер от инсайдерской угрозы

Проведено исследование эффективных мер по предотвращению саботажа на ядерных объектах и хищения радиационных материалов. В исследовании используются эффективные превентивные и защитные меры, которые были реализованы в институте, чтобы показать надежность гипотетического объекта. Цепи Маркова, которые представляют собой комбинацию вероятностей и матричных операций, моделируют превентивные и защитные меры на гипотетической ядерной установке. Результаты реализуются в процессе оценки реализованных стратегий. Некоторые из процессов оценки включают разработанные алгоритмы предотвращения длительных и / или внезапных краж, саботажа и сговора между внутренними нарушителями. Следовательно, эффективность превентивных и защитных мер против злоумышленников также зависит от эффективности процесса оценки, проводимого экспертами

How to Attract Women in STEM and Help Them Become Successful: The Review of Practices of Overcoming Gender Stereotypes

Gender imbalance among students in STEM (Science, Technology, Engineering and Mathematics) is a worldwide problem leading to negative social and economic consequences. Despite the widespread “myth of gender equality” in Russia, this problem is also relevant for our country. The share of male students in most STEM fields in Russian universities significantly exceeds the share of female students, especially in engineering and technical fields. The article is aimed at analyzing the existing experience of combating gender stereotypes in STEM educational programs. It provides an overview of seven types of practices: 1) informing girls about gender stereotypes and their negative consequences; 2) practices aimed at developing “growth mindset”; 3) influence through “role models” and the formation of friendship networks based on interest in STEM; 4) class composition management; 5) organization of active learning; 6) emphasis on the public benefit of career in STEM; 7) creating a positive climate through working with stereotypes of male teachers and students. The article also discusses the applicability of these practices in the Russian educational context

Clinical and psychological correlations with type D personality in patients with chronic coronary syndrome

Recently, it has become common to identify type D personality, which is predisposed to the development of psychological distress. Negative behavioral characteristics of individuals with type D personality contribute not only to the development of cardiovascular diseases, but also to  other comorbid pathologies that can influence the progression and prognosis of coronary heart disease. The aim of the study. To identify clinical and psychological correlations with type D personality in patients with chronic coronary syndrome. Methods. The study included 113 patients (68 men and 45 women; median age – 64 years) admitted for planned percutaneous coronary intervention at the Research Institute for Complex Issues of Cardiovascular Diseases (Kemerovo, Russian Federation). Based on the results of the DS-14 test, patients were divided into two groups: patients with type D personality (n = 40) and patients without this type (n = 73). Results. In patients with chronic coronary syndrome with type D personality, compared with patients without this type, concomitant diabetes mellitus (35 % and 15 %, respectively; p = 0.018), signs of diastolic dysfunction of left (Е/е’ ratio 7.1 [6.48; 8.0] and 5.0 [4.55; 5.74], respectively; p = 0.0038) and right (Et/At ratio – 0.8 [0.66; 1.35] and 1.38 [1.28; 1.63], respectively; p = 0.014) ventricles were more often diagnosed. Correlation analysis revealed associations of diabetes mellitus with type D personality (r = 0.243; p = 0.011), severity of negative excitability (r = 0.253; p = 0.008) and social suppression (r = 0.224; p = 0.020), as well as association of ankle-brachial index (ABI) with the severity of negative excitability (r = 0.393; p = 0.004) and social suppression (r = 0.414; p = 0.002). Conclusion. In patients having chronic coronary syndrome with type D personality, concomitant diabetes mellitus, as well as left and right ventricular filling disorders are  more often detected. Correlation analysis revealed associations of diabetes mellitus with type  D personality and its subscales; the ABI level was associated with subscales of type D personality, but not with the level of anxiety and depression

Assessment of the student’s educational experience as a tool for making management decisions in the university

This article draws attention to students’ educational experience at a Russian regional university. Such experience is based on two aspects: on the one hand, it is a result of abilities integration, and on the other, it is an ability to act in a context of uncertainty. The latter aspect in understanding students’ experience is the most important for the personality formation in today’s complex world. Within the context of the higher education transformation, experience as an ability to act plays a significant role in individual development. That is why this study is aimed at analyzing the educational experience of first-year students and university graduates. Their educational experience is assessed based on their involvement in educational practices in class, in research activities at the university, and in self-educational activities. The results show that the first-year students’ experience and the graduates’ one at the university have functional differences. The first-year students’ academic engagement is higher as compared to the graduate students’. The research experience of both is expressed in a low degree. The self-educational experience at the university is not strategically formed. Comparing the first-year students’ and the graduates’ educational experiences, one can conclude that the structure of the latter is more functional due to the graduates’ limited involvement in educational activities. This means that the educational experience varies during the period of studies mainly in individual competencies, which are not connected with each other. The low level of the students’ involvement in educational practice reflects the weak development of their experience as an ability to act. It is the structure of a student’s motives that can be one of the main factors of his/her involvement in the learning process. Our findings contribute to the design of educational practices at the university and suggest the strong demand for a more responsible approach to designing the educational environment and educational practices at all university levels.В данной исследовательской статье предлагается обратить внимание на образовательный опыт студентов в региональном университете. Образовательный опыт можно понимать в двух аспектах: и как результат интеграции способностей, и как способность к действию в условиях неопределенности. Последний аспект в понимании опыта является наиболее важным для формирования личности в условиях сложного мира. В ситуации трансформации высшего образования опыт как способность к действию играет значимую роль в развитии личности, поэтому цель проведенного исследования состояла в анализе образовательного опыта студентов первого и выпускного курсов. Образовательный опыт студентов оценивался по их вовлеченности в образовательные практики непосредственно в аудитории, а также в научную деятельность в университете и самообразовательную деятельность. Результаты показали, что опыт студентов первого курса и выпускников в данном региональном университете имеет функциональные различия. Студенты первого курса проявляют более высокую образовательную активность по сравнению со студентами, обучающимися на выпускном курсе. Научно-исследовательский опыт обеих когорт студентов выражен в низкой степени. Опыт самостоятельных активностей в вузе или опыт самообразования целенаправленно не формируется. Сравнивая образовательный опыт студентов первого и выпускного курсов, можно заключить, что для выпускников структура опыта выглядит более функционально, такой вывод следует из их невысокой вовлеченности в образовательные практики по сравнению с первокурсниками. Это означает, что образовательный опыт от курса к курсу меняется преимущественно в отдельных компетенциях, не связанных друг с другом. Низкая вовлеченность студентов в образовательные практики говорит о слабом развитии у них опыта как способности к действию. Установлено, что одним из важных факторов вовлеченности в образовательный процесс, а значит, и формирования образовательного опыта студента выступает структура его мотивов. Полученные результаты вносят определенный вклад в проектирование образовательных практик в университете и говорят о необходимости более ответственного подхода к проектированию образовательной среды и образовательных практик на всех уровнях университета

Models of Organization of Teaching Students at the University: Basic Assumptions, Advantages and Limitations

Оценка качества высшего образования и управления им невозможна без четких ответов на три вопроса: чему университет должен учить студентов; как должен быть устроен учебный процесс для достижения образовательных результатов; какую роль в образовательном процессе играет студент. Некоторые исследователи предпринимали попытки ответить на указанные вопросы путем разработки концептуальных положений о том, как следует выстраивать процесс обучения в университете. Однако на сегодня так и не представлено комплексного анализа предлагаемых концептуальных моделей организации учебного процесса, что затрудняет их сравнение и выбор оптимальной для вуза модели исходя из его внешних условий и ресурсов. Данная обзорная статья посвящена анализу моделей организации обучения в университете и выстраивания отношений между преподавателями и студентами. В ней представлены модели, в которых студенты рассматриваются в качестве потребителей; активных учащихся; партнеров в образовательном процессе. Помимо этого предложена классификация моделей по двум основаниям: 1) активность студентов в учебном процессе и 2) участие студентов в принятии решений и создании образовательных продуктов. Излагаемая в статье информация помогает понять, какими принципами руководствуются зарубежные вузы при разработке как методов работы со студентами и преподавателями, так и образовательной политики. В практическом плане статья будет полезна руководителям российских вузов для определения образовательной стратегии, а преподавателям – для более глубокого понимания отношений, выстраиваемых в вузе со студентами.Assessment of the quality of higher education and its management is not possible without answers to the following questions: what students should learn at the university; how the studying process at the university should be organized to achieve certain educational outcomes; what the role of students in the educational process is. Some researchers attempted to answer these questions through developing conceptual assumptions related to building student-university relationships. However, today there is no systematic analysis of such conceptual models, which makes it difficult to compare them and choose the optimal one for the university according to its external conditions and resources. The article aims to analyze the models of organization of learning at the university and building relations between teachers and students. There are presented models, conceptualizing students as consumers, active learners, and partners. We also suggest the classification of the models by two criteria: 1) students’ activity in the learning process and 2) students’ participation in decision-making and creating educational products. The paper provides understanding which principles foreign universities use to interact with students and teachers as well as to develop educational policy. The article might be practically useful for the executives of Russian universities to help them decide on the educational strategies; of no less use would it be for the teachers to make them deeper understand their relations with students.Исследование выполнено при финансовой поддержке РФФИ в рамках научного проекта № 19-113-50049.The reported study was funded by RFBR, project number № 19-113-50049

Assessment of left ventricular diastolic dysfunction following anthracyclinebased chemotherapy in breast cancer patients

Cardiotoxicity is a side effect of anthracycline-based chemotherapy. Clinical and prognostic significance of left ventricular diastolic dysfunction in heart failure patients is undeniable.The aim. To assess dynamic changes in the left ventricular diastolic function after anthracycline-based chemotherapy (ANT) in breast cancer patients.Material and methods. The study included 40 women aged 35 to 72 years with breast cancer (BC) undergoing ANT chemotherapy. The main group (n = 40) consisted of women with breast cancer examined at admission, after 6 months the same women (n = 37) were examined again. Women without breast cancer (n = 25) were used as the control group.Results. Dynamic changes in mitral annular velocities were revealed by Doppler tissue imaging. Lateral early diastolic mitral annular velocity (e’ lateral) was significantly lower in breast cancer patients as compared to the control group (p = 0.031). Six months after ANT chemotherapy, there was a definite increase in the lateral late diastolic mitral annular velocity (a’ lateral) (p = 0.033). Average early diastolic transmitral flow velocity to early diastolic velocity (E/e’ lateral) ratio was within the normative values in all groups, but E/e’ lateral in the main group was higher compared to the control group (p = 0.003). In the main group, septal early diastolic mitral annular velocity (e’ septal) was lower compared to the control group (p = 0.0005). Moreover, an increase in the septal mitral annular velocity (a’ septal) (p = 0.01) and higher E/e’ septal ratio (p = 0.011) were revealed during dynamic observation. Multiple logistic regression disclosed that E/A, e’ lateral, e’/a’ lateral, and E/e’ lateral were affected by heart rate, psychological status, age, hypertension, and body mass index, but not anthracycline chemotherapy. The total dose of anthracycline was independently associated with e’ septal and E/e’ septal: F(4.18) = 16.466 (p < 0.001; R2 = 0.775) and F(3.16) = 7.271 (p = 0.004; R2 = 0.627).Conclusion. Left ventricular diastolic function worsens in women undergoing anthracycline-based chemotherapy for breast cancer (lower e’, e’/a’ lateral, and e’ septal, higher E/e’ septal ratio). However, anthracycline does not significantly affect LVEF and LV deformation indicators. E/e’ septalande’ septal are independently associated with the total dose of anthracycline