Implementation of blended learning technologies in training CNC machine operators in the enterprise training center

В статье определены основные условия, необходимые для подготовки операторов станков с ЧПУ в условиях учебного центра предприятия с применением технологии смешанного обучения. Описана разработанная педагогическая модель, раскрыт её организационно-процессуальный блок. Проведен сравнительный анализ интернет-платформ для размещения электронного курса.The article defines the basic conditions necessary for the training of CNC machine operators in the conditions of an enterprise training center using blended learning technology. The developed pedagogical model is described, its organizational and procedural block is disclosed. A comparative analysis of Internet platforms for placing an electronic course has been carried out

Comparative assessment of aortic valve stenosis using two-dimensional, three-dimensional transesophageal echocardiography, computed tomography and cardiac catheterization

Aim. To compare effectiveness of ultrasound, radiological and invasive methods for assessing aortic valve (AV) stenosis.Material and methods. This study included 33 patients with AV stenosis. The mean age of the patients was 71,8±6,8 years. All patients underwent standard and three-dimensional echocardiography, computed tomography, and cardiac catheterization.Results. According to two-dimensional echocardiography, the AV area averaged 0,58±0,21 mm2, according to cardiac catheterization — 0,61±0,17 mm2, according to three-dimensional transesophageal echocardiography — 1,13±0,42 mm2, and according to multislice computed tomography 0,88±0,48 mm2. The difference between the values was significant (p<0,05).Conclusion. For routine diagnosis of AV stenosis, two-dimensional echocardiography is the optimal research method. With indications for radical treatment methods, three-dimensional echocardiography or multislice computed tomography should be performed

КТ-денситометрия как дополнительный метод в диагностике легочной гипертензии: проспективное исследование

INTRODUCTION: This article presents the results of application of CT densitometry in the computed tomography (CT) of the chest to diagnose various forms of pulmonary hypertension.OBJECTIVES: To determine the diagnostic value of CT densitometry using comparative analysis of lung tissue density in patients with various forms of pulmonary hypertension.MATERIALS AND METHODS: The study included 528 patients diagnosed with pulmonary hypertension by means of right heart catheterization (RHC) of the National Research Cardiac Surgery Center, Republic of Kazakhstan. All patients were divided into 4 groups according to the classification of pulmonary hypertension of the World Health Organization (ESC/ERS Guidelines) from 2015. The first group included 254 patients with pulmonary hypertension pulmonary hypertension due to left heart disease (PHLHD). The second group included 210 patients with pulmonary arterial hypertension (PAH). The third group included 49 patients with chronic thromboembolic pulmonary hypertension (CTEPH). The fourth group — 15 patients with pulmonary hypertension due to respiratory disease (PHDRD). The mean age of the patients was 52.15±16.75 years. Contrast-enhanced chest CT imaging performed with a 64-slice multislice computed tomography system (Somatom Definition AS, Siemens) with post-processing to assess the lung tissue densitometric parameters, analyse the diameters of the pulmonary trunk and its main branches. The CT examination was carried in accordance with an «Embolism» protocol with intravenous administration of a contrast agent according to indications. Statistics: analysis was conducted using the Statistica 10 software. To quantitatively compare the two groups nonparametric Mann-Whitney test and the Kruskal-Wallace test were applied. Mean value and standard deviation in the format of «M±S» were used for quantitative parameters. Correlation analysis was carried out using Spearman’s nonparametric rank correlation.RESULTS: In patients with severe pulmonary hypertension a tendency for fibrotic changes was most clearly observed in cases of pulmonary hypertension due to left heart disease (–809.92±26.52), and emphysematous changes in the pulmonary arterial hypertension group (–843.27±43.88).CONCLUSION: CT lung densitometry should be performed in all patients with suspected pulmonary hypertension as an additional method of examination.ВВЕДЕНИЕ: Легочная гипертензия (ЛГ) — это состояние, осложняющее различные по своей природе заболевания, приводящее к бивентрикулярной сердечной недостаточности, а затем к преждевременной смерти. В данной статье представлены результаты компьютерной томографии (КТ) органов грудной клетки с применением КТ-денситометрии, используемой в диагностике различных форм легочной гипертензии.ЦЕЛЬ: Определение диагностической ценности КТ-денситометрии путем сравнительного анализа плотности легочной ткани у пациентов с различными формами легочной гипертензии.МАТЕРИАЛЫ И МЕТОДЫ: В исследование вошли 528 пациентов с диагностированной легочной гипертензией посредством катетеризации правых отделов сердца (КПОС) Национального научного кардиохирургического центра, Республики Казахстан. Все пациенты были разделены на 4 группы, согласно классификации легочной гипертензии Всемирной организации здравоохранения (Руководство ESC/ERS) 2015 г. Первая группа — 254 пациента с легочной гипертензией, обусловленной патологиями левых отделов сердца (ЛГПЛС). Вторая группа — 210 пациентов с легочной артериальной гипертензией (ЛАГ). Третья группа — 49 пациентов с хронической тромбоэмболической легочной гипертензией (ХТЛГ). Четвертая группа — 15 пациентов с легочной гипертензией, обусловленной патологией дыхательной системы (ЛГПДЛС). Средний возраст пациентов составил 52,15±16,75  года. КТ-исследование огранов грудной клетки с  контрастом проводилось на мультиспиральном 64-срезовом компьютерном томографе (Somatom Definition AS, Siemens) с постпроцессинговым определением денситометрических показателей легочной ткани, анализом диаметров легочного ствола и главных ветвей. КТ-исследование проводилось по программе Embolism с внутривенным введением контрастного препарата по показаниям. Статистика: проводилась с использованием пакета программ Statistica 10. Сравнения двух групп по количественным шкалам проводились на основе непараметрического критерия Манна–Уитни и критерия Краскела–Уоллеса. Для описания количественных показателей использовались среднее значение и  стандартное отклонение в  формате «M±S». Корреляционный анализ проводился на основе непараметрической ранговой корреляции по Спирмену.РЕЗУЛЬТАТЫ: У пациентов с тяжелой легочной гипертензией наиболее четко наблюдалась тенденция к формированию фибротических изменений в группе ЛГ, обусловленной патологиями левых отделов сердца (–809,92±26,52), эмфизематозных изменений в группе легочной артериальной гипертензии (–843,27±43,88).ЗАКЛЮЧЕНИЕ: КТ-денситометрию легких необходимо проводить всем пациентам с подозрением на ЛГ в качестве дополнительного метода исследования.

Intravenous sodium nitrite in acute ST-elevation myocardial infarction: a randomized controlled trial (NIAMI).

AIM: Despite prompt revascularization of acute myocardial infarction (AMI), substantial myocardial injury may occur, in part a consequence of ischaemia reperfusion injury (IRI). There has been considerable interest in therapies that may reduce IRI. In experimental models of AMI, sodium nitrite substantially reduces IRI. In this double-blind randomized placebo controlled parallel-group trial, we investigated the effects of sodium nitrite administered immediately prior to reperfusion in patients with acute ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: A total of 229 patients presenting with acute STEMI were randomized to receive either an i.v. infusion of 70 μmol sodium nitrite (n = 118) or matching placebo (n = 111) over 5 min immediately before primary percutaneous intervention (PPCI). Patients underwent cardiac magnetic resonance imaging (CMR) at 6-8 days and at 6 months and serial blood sampling was performed over 72 h for the measurement of plasma creatine kinase (CK) and Troponin I. Myocardial infarct size (extent of late gadolinium enhancement at 6-8 days by CMR-the primary endpoint) did not differ between nitrite and placebo groups after adjustment for area at risk, diabetes status, and centre (effect size -0.7% 95% CI: -2.2%, +0.7%; P = 0.34). There were no significant differences in any of the secondary endpoints, including plasma troponin I and CK area under the curve, left ventricular volumes (LV), and ejection fraction (EF) measured at 6-8 days and at 6 months and final infarct size (FIS) measured at 6 months. CONCLUSIONS: Sodium nitrite administered intravenously immediately prior to reperfusion in patients with acute STEMI does not reduce infarct size

COPD’s early origins in low-and-middle income countries: what are the implications of a false start?

[Excerpt] The Global Initiative for chronic Obstructive Lung disease (GOLD)guideline of 2018 describes COPD as‘the result of a complexinterplay of long-term cumulative exposure to noxious gases andparticles, combined with a variety of host factors includinggenetics, airway hyper-responsiveness and poor lung growthduring childhood’.1Tobacco smoking is traditionally viewed as themain contributing factor to the development of COPD. However,COPD also occurs among non-smokers, especially in low-incomeand middle-income countries (LMICs).2,3Notably, more than 90%of COPD-related deaths occur in LMICs.4For these countries, otherrisk factors, such as ambient, occupational and household airpollution play a significant role in the development of COPD.1,2,5–7Does COPD in these settings have a different pathophysiologicaltrajectory compared to COPD in high-income countries, and if so:what does this imply?In normal lung development, airway branching is completed bythe 17th week of gestation, after which airways increase in volumeuntil young adulthood. Alveoli are present at birth and developfurther during childhood. Lung volume and airflow continue toincrease as the thorax grows, influenced by age, sex, and ethnicity,reaching a peak at young adulthood. Lung function then remainsconstant for about 10 years (the plateau phase), after which itgradually declines.8In the‘classic’COPD patient, the decline inlung function is more rapid than in healthy individuals. However,in a considerable proportion of COPD patients, lung function doesnot decline rapidly, but reaches a lower plateau phase in earlyadulthood instead. For these patients, a completely differentpathophysiological trajectory seems to lead to the diagnosis ofCOPD: the decline in lung function follows a normal pattern, yetthey seem to have a‘false start’by attaining a lower maximumlung function. [...

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection