ПЕРШИЙ ДОСВІД ВИКОРИСТАННЯ СИСТЕМИ СИМУЛЯЦІЙНОГО ІНТЕРАКТИВНОГО НАВЧАННЯ BODY INTERACT ЯК СКЛАДОВОЇ АТЕСТАЦІЇ ЛІКАРІВ-ІНТЕРНІВ

The article presents the first experience of using the Body Interact simulation interactive training system as a stage of interns’ attestation. Descriptions and principles of operation with “virtual patient” system are given. The exam procedure with individual workstations installed on laptops is described. The grading criteria and evaluation principles for work with Body Interact system are defined. Examination results of 47 interns in the specialty “Internal Diseases” and “General Practice – Family Medicine” are analyzed according to virtual clinical scenarios “Acute coronary syndrome with ST segment elevation”, “Pulmonary embolism”, “Acute left ventricular insufficiency”, “Hypoglycemia” and ”Acute disorders of cerebral circulation”. The main mistakes are identified and systematized on the basis of the analysis of individual step-by-step reports of work results on the simulation training system Body Interact. Steps for optimizing the system and expanding the experience of its usage in order to make the attestation of final courses students are suggested.У статті представлено перший досвід використання системи симуляційного інтерактивного навчання Body Interact як етапу атестації лікарів-інтернів. Описано основні принципи роботи із «віртуальним пацієнтом». Викладено методику проведення іспиту з використанням індивідуальних робочих станцій, встановлених на ноутбуках. Визначено критерії та принципи оцінювання роботи на системі симуляційного інтерактивного навчання BodyInteract. Проаналізовано результати іспиту у 47 лікарів-інтернів за фахом «Внутрішні хвороби» та «Загальна практика – сімейна-медицина» за віртуальними клінічними сценаріями «гострий коронарний синдром з елевацією сегмента ST», «тромбоемболія легеневої артерії», «гостра лівошлуночкова недостатність», «гіпоглікемія» та «гостре порушення мозкового кровообігу». Визначено та систематизовано основні помилки лікарів-інтернів на основі аналізу індивідуальних покрокових звітів результатів роботи на системі симуляційного навчання Body Interact. Запропоновано кроки до оптимізації використання системи та розширення досвіду її використання для атестації студентів випускних курсів

Pathogenetic features of morphodensitometric characteristics of cardiomyocytes and marker profile of the left ventricular remodeling in rats with experimental intermittent hypoxia of different duration

Myocardial remodeling is considered as a three-component complex process, including cardiomyocyte hypertrophy, their apoptosis, interstitial and perivascular fibrosis. At the same time, the nature of remodeling and the direction of restructuring in the myocardium depend on the prevalence of one of these processes, the degree of their severity and the impact duration. Therefore, to understand the effect of short- and long-term intermittent hypoxia on the direction of myocardial remodeling and its type, the aim of this study was to determine the pathogenetic features of the morphodensitometric characteristics of cardiomyocytes and the marker profile of left ventricular myocardial remodeling in the rats with experimental intermittent hypoxia durated 15 and 60 days.Material and methods. A total of 30 male Wistar rats aging 6-10 months were used for the experiment and assigned to 3 experimental groups of 10 animals each: control; rats exposed to 15-day hypoxia; rats exposed to 60-day hypoxia. The object of the study was the left ventricular myocardium. The number of nuclei in an image, their average linear size and density (the ratio of the total area of nuclei to the area of the cytoplasm), and the concentration of RNA in the nucleus and cytoplasm were measured in the sections stained by Einarson via morphodensitometric method. An immunofluorescence method was used to study the content of immunoreactive material to markers of remodeling (cardiotrophin-1, type I collagen, titin, annexin V). As a result of the study, it was found that intermittent hypoxia led to a decrease in the number of nuclei in cardiomyocytes in both experimental groups compared to the control. Such changes in the number of nuclei were accompanied by significantly larger nuclear size compared to the control (in rats with 15-day hypoxia by 52.9 %, in rats with 60-day hypoxia - by 153.4 %) and a decrease in the density of nuclei in relation to the cytoplasm by 19.5 % and 21.2 %, respectively. In both groups, a significantly lower control concentration of RNA in the nuclei of cardiomyocytes was found alongside with an increase in their area. Such changes were accompanied by a significantly higher concentration of RNA by 23.2 % in the cytoplasm in case of long-term intermittent hypoxia. The marker profile of remodeling parameters in rats exposed to 15-day hypoxia was characterized by a higher content of cardiotrophin-1 and titin by 11.5 % and 23.1 %, respectively, as compared to the control. The content of type I collagen was 19.9 % higher, while the content of annexin V did not change significantly. In rats with long-term 60-day hypoxia, the content of cardiotrophin-1 was higher by 73.6 %, titin - by 124.9 %, type I collagen - by 41.9 %, and annexin V - by 95.9 % in comparison to the control. When calculating the titin / collagen ratio in rats based on their content, a significant increase in myocardial stiffness was determined in the 60-day hypoxia group which was 1.44, while it was0.91 in the control, and in rats with 15-day short-term hypoxia – 0.93.Conclusions. Intermittent hypoxic effects, regardless of duration, result in morpho-structural rearrangements of the myocardium, are characterized by an increase in viscoelastic mechanical properties and the development of hypertrophy, but with an increase in the duration of exposure (60 days) – by an additional formation of interstitial fibrosis and apoptosis of cardiomyocytes. Short-term hypoxia forms a hypertrophic type of myocardial remodeling with a decrease in the number of nuclei alongside with an increase in their size and a moderate decrease in RNA concentration. The marker profile of remodeling changes in a physiological manner and is characterized by an increase in the content of cardiotrophin-1, type I collagen and titin, while maintaining the titin / collagen ratio and normal apoptotic rate. Long-term hypoxia causes a fibro-apoptotic type of pathological myocardial remodeling including an almost two-fold decrease in the number of nuclei with an increase in their size and a decrease in RNA concentration. The marker profile of remodeling is characterized by an increase in all 4 components, a significant increase in the titin / collagen ratio and high apoptotic rate of cardiomyocytes

The diagnostic value of three-dimensional echocardiography and speckle tracking echocardiography in patients after myocardial infarction with right ventricle involvement (clinical case)

The inferior myocardial infarctions (MI) of left ventricle (LV) are often complicated with right ventricle (RV) involvement. The traditional echocardiographic parameters lack diagnostic accuracy in assessment of RV function. Speckle tracking echocardiography and three-dimensional echocardiography are promising diagnostic tools in quantification of RV. The purpose of the study was to present the role of speckle tracking echocardiography and three-dimensional echocardiography in patients after inferior MI with RV involvement. It was described a clinical case of a 67-year old male after recent inferior MI with RV involvement. The speckle tracking analysis and three-dimensional echocardiography was performed one and six months after coronary event. The initial study revealed decreased longitudinal strain of RV free wall segments, especially in the apical region. The RV global longitudinal strain was -8,8 % (normal range ≤ -20 %). The RV end-diastolic volume index was 100.9 ml/m2 (normal range 45 %).The analysis on the sixth month revealed improvement of RV contractility in all segments with global longitudinal strain of -14.2 %. The RV volumes decreased by 10 % and EF was raised from 31 to 33 %, reflecting positive cardiac remodeling during follow-up period. Conclusions. Speckle tracking echocardiography and three-dimensional echocardiography provide additional diagnostic information in patients after MI with RV involvement and can be used for patients’ follow-up

РОЛЬ СОЦІАЛЬНИХ МЕРЕЖ У ДИСТАНЦІЙНІЙ ОСВІТІ ЛІКАРІВ НА ПІСЛЯДИПЛОМНОМУ ЕТАПІ

 The article presents the experience of social networks using as an interactive platform for training of interns and post-graduates of the Family Medicine, Therapy and Cardiology Department of Zaporizhian State Medical University. The description includes the structure and principles of functioning of created pages in “Facebook” and “VKontakte”, the basic forms and methods of teaching, ways of interactivity, the advantages of this option of distance education in the specialty “General practice – Family medicine” and “Internal medicine” above the other methods of post-graduate stage.Стаття висвітлює досвід використання соціальних мереж як інтерактивної платформи для дистанційного навчання лікарів-інтернів та випускників кафедри сімейної медицини, терапії та кардіології факультету післядипломної освіти Запорізького державного медичного університету. Описано структуру та принципи функціонування створених сторінок у мережах “Facebook” і “Вконтакте”, основні форми та засоби навчання, шляхи інтерактивної взаємодії, переваги цього варіанта дистанційної освіти за фахом “Загальна практика – сімейна медицина” і “Внутрішні хвороби” над іншими на післядипломному етапі

Pathogenetic characteristics of the hormonal profile in rats subjected to restraint stress of different duration

The aim of the work is to ascertain the character of changes in the hormonal profile (concentrations of corticosterone, insulin, and adrenocorticotropic hormone) in conjunction with metabolic alterations and elevated blood pressure, which are induced in rats by restraint stress at 6th, 15th and 21st weeks of environmental space restriction. Materials and methods. A total of 55 normotensive male Wistar rats, aged 6–10 months, were assigned into 4 experimental groups (1 – intact control (10 rats); 2, 3 and 4 (15 rats each exposed to restricted space allowance)). All the animals were subjected to blood pressure (BP), blood glucose level and body weight measurements twice: at the stage of forming groups and at the 6th, 15th and 21st weeks. Plasma hormone concentrations (insulin, corticosterone, and ACTH) were examined by the immunoenzymatic method using commercial kits (Monobind, USA). Results. The body weight of the animals was significantly reduced by 20.72 % after 6 weeks of space allowance restriction, it was restored to baselines by the 15th week and exceeded control values by 26.1 % at the 21st week. BP levels showed an increasing trend, a dynamic increase in systolic pressure by 7 %, 17 % and 26 % was detected, respectively, as well as diastolic from the 15th week to the 21st week by 21.4 % and 37.0 %, respectively. Glucose concentration was within the euglycemic range. Changes in the hormonal profile showed an increase in the concentration of ACTH by more than 50 % and a decrease in insulin – by 34 % at the 6th week with a subsequent twofold decrease in the insulin concentration (at week 15) and a further more than twofold increase in ACTH at the 21st week. As for changes in the concentration of corticosterone, a peak increase of 3.77 times was noticed at the 15th week, followed by a decrease and restoration to the normative values by the 21st week. Conclusions. Even minor and unremarkable continuously acting stressors, which cannot be coped, become important triggers for hormonal profile and carbohydrate metabolism alterations as well as for a persistent increase in blood pressure, which manifest first by hypoinsulinemia, an increase in the level of ACTH, and a constant concentration of corticosterone. Long-term stress exposure contributes to a transient “peak” increase in the corticosterone level, a significant increase in insulin and a sustained increase in ACTH. Multidirectional changes in the levels of the studied hormones occur amidst a gradual increase in blood pressure and a stable increase in the level of glycemia

Long-term restraint stress as a predictor of insulin resistance development in experimental rats

The aim of the work was to define the pattern of changes and pathogenetic mechanisms of glycemic curve shape during a glucose tolerance test in rats at 6, 15, and 21 weeks of environmental space restriction. Materials and methods. A total of 55 male Wistar rats aged 6–10 months were used and divided into 4 groups (1 – intact control, 10 rats; 2, 3 and 4 of 15 rats each, which were in conditions of restricted environmental space for 6, 15 and 21 weeks, respectively). Fasting plasma levels of glucose (test strips Test Strip II on a Glucocard glucometer (ARKRAY Inc., Japan)), insulin and corticosterone (by an immunoenzymatic method using commercial kits for rats from Monobind, USA) were measured, glucose tolerance tests (GTT) were performed, the HOMA index and the insulin/corticosterone ratio were calculated. Results. The 6-week environmental space restriction, immobility and complex communication relations resulted in a hypoinsulinemic-hypoglycemic type of the glycemic curve with high tissue glucose sensitivity in animals which were in the conditions described (the HOMA index was significantly decreased to 0.21 versus 0.55 in the control), the characteristic delayed hyperglycemic peak at the 30th min of the test slowly returned to the euglycemic level by only the 90th min against the 30th min in the controls. The 15-week restriction caused a hypoinsulinemic curve with preserved tissue glucose sensitivity (the HOMA index 0.33 versus 0.55 in the controls). Alterations in postprandial glucose absorption were manifested by the highest glucose concentration at the 15th min of the test, a very slow decrease in the glucose level in the post-absorption period not being restored to baseline values by the 90th min. The 21-week restriction shaped a diabetic type of the glycemic curve, impaired tissue glucose sensitivity (a substantial and significant increase in the calculated HOMA index from 0.55 in the controls to 0.95) and resulted in the development of insulin resistance. Conclusions. The environmental space restriction, immobility and complex communication relations gradually induce a range of disorders in animals and change the glycemic response shape to glucose load, impair prandial insulin secretion, augment hyperglycemic effects of counterinsular hormones (corticosterone), and realize dysfunctional manifestations of prandial/postprandial glycemia. 6 weeks of restrictions and challenges shape the hypoinsulinemic-hypoglycemic type of the glycemic curve with high tissue glucose sensitivity, while 15 weeks result in the hypoinsulinemic curve with preserved tissue glucose sensitivity. 21 weeks show the diabetic type of the glycemic curve with impaired tissue glucose sensitivity and the development of insulin resistance

Experimental study of the pattern of genes activated by multi-day intermittent hypoxia in the rat pancreas

Intermittent hypoxia affects a variety of pathological conditions in the body and is used in medicine to reproduce the sanogenic therapeutic effect. Intermittent hypoxia is used for clinical indications to improve lung function; increase the body’s adaptive capacity; in obstructive sleep apnoea syndrome; in anaemia, diabetes mellitus. In cancer radiotherapy, intermittent hypoxic training helps to increase the sensitivity of the tumour to treatment. Intermittent hypoxia is useful in rehabilitation medicine to improve the physical recovery of patients after surgery or injury to improve the body’s functional capabilities. However, to date, the activity of regulatory genes, that activate the molecular mechanisms of the above-mentioned sanogenic effects of intermittent hypoxia has not been sufficiently studied. The aim of the study: to determine the expression of hypoxia-related genes in pancreas of Wistar rats under intermittent hypoxia. Materials and methods. The CFX-96 Touch™ real-time reverse transcription polymerase chain reaction (PCR) (Bio-Rad, USA) and the RT2 Profiler™ PCR Array Rat Hypoxia Signalling Pathway kit (QIAGEN, Germany) were used to analyse gene expression in experimental animals, where 84 genes involved in the hypoxia signalling pathway identified in the pancreas were studied. Results. According to the results of PCR analysis of pancreatic samples from intact animals and animals exposed to hypoxic training, the activity of the gene panel can be distributed as follows: genes with high expression compared to the intact group of animals, genes with low expression compared to the intact group of animals and genes in which no significant changes were detected in the samples compared to the intact group of animals. We have found, that the genes Cops5, F10, Jmjd6, Lgals3, Rbpjl, Vegfa have high expression activity compared to the intact group of animals. Conclusions. The increase in the expression of Cops5 by 10.29 times, Lgals3 by 2.94 times and Rbpjl by 5.73 times as a result of intermittent hypoxia can be regarded as an activating factor for the increase in the proliferation of endocrine and exocrine pancreatic cells and the growth of their antiapoptotic potential. The 3.20-fold increase in Jmjd6 gene expression under intermittent hypoxia can be interpreted as a regulatory effect through protein dehydroxylation and promotion of antiapoptotic protein activity in endocrine and exocrine pancreatic cells. The 5.99-fold increased level of Vegfa expression may promote angiogenesis in the pancreas under intermittent hypoxia

Pattern of changes in morpho-densitometric parameters of magnocellular neurons of the hypothalamic paraventricular nucleus under restraint stress of different duration

The aim of the work was to define the nature of changes in morpho-densitometric parameters of magnocellular neurons of the hypothalamic paraventricular nucleus in rats at 6, 15 and 21 weeks of restricted living space. Materials and methods. A total of 55 male Wistar rats aged 6-10 months were used and divided into 4 groups (1 – intact control, 10 rats; 2, 3 and 4 – experimental groups of 15 rats each, which were in conditions of restricted environmental space for 6, 15 and 21 weeks, respectively). Morpho-densitometric analysis of 5-μm-thick rat brain sections was performed after preliminary standard histological processing and 48 hours of halocyanine-chrome staining by Einarson using an AxioImager-M2 microscope (Carl Zeiss, Germany). Images of magnocellular neurons of the hypothalamic paraventricular nuclei (PVN), which were topographically identified according to the stereotaxic atlas of the rat brain, were captured using a highly sensitive AxioCam-ERc 5s video camera (Carl Zeiss, Germany) and recorded as a computer file using AxioVision 40 V 4.8.2.0 software (license number 3005339). Quantitative data on the area of neurons, their nuclei and nucleoli, the content of heterogeneous DNA and RNA in the cell cytoplasm, nuclei and nucleoli were obtained in a semi-automatic mode using the open source software ImageJ (National Institutes of Health, USA). Results. Chronic stress condition modelled in rats for 6, 15, and 21 weeks (limited living space, inactivity, and complicated communications) resulted in a decrease in the area of cytoplasm and nuclei of magnocellular neurons of the hypothalamic PVN. The decrease was directly proportional to restrain stress duration: cytoplasm and nuclei by 18 % and 9 % at week 6 and by 40 % and 25 % at week 21, respectively, and only cytoplasm by 23 % at 15 weeks. On the contrary, the area of neuronal nuclei was increased by 31 % at 6 weeks of stress and 33 % at 15 weeks, and by 15 % at 21 weeks of stress compared to the control. The content of nucleic acids in the cytoplasm of magnocellular neurons of the hypothalamic PVN in the group of rats with 6-week restriction was 39 % less than in the control group, 34 % less than that in the group with 15-week restriction, and 42 % less than that in the group of 21-week restrain stress. In the nuclei of cells after 6 and 15 weeks of restriction, the content was decreased approximately equally by 37 % and 35 %, respectively, and long-term restriction (21 weeks) contributed to a 41 % decrease. In the neuron nucleoli, the content of nucleic acids was changed similarly: in the group of 6 weeks, a decrease of 40 % was characteristic, after 15 weeks – by 39 %, and after 21 weeks – by 43 %. Conclusions. Changes in the morphometric parameters of magnocellular neurons of the hypothalamic PVN in rats with long-term limitation of living space are characterized by time dependence and multidirectionality, which is related to the functional features of the neuron structural components (cytoplasm, nucleus and nucleoli). There is a progressive decrease in the cytoplasmic area of PVN neurons and their nuclei, while the nucleolar area increases with increasing length of living space limitation. The content of nucleic acids in the studied structures of the hypothalamic PVN magnocellular neurons after prolonged stress at each time point (6, 15, 21 weeks) becomes less than the control values by more than a third. Comparison of nucleic acid content in the neuron cytoplasm, nuclei, and nucleoli shows a narrow range of variations in the parameters of the experimental group rats between different periods

СТРАТЕГІЯ ВПРОВАДЖЕННЯ КУРСІВ ЗА ВИБОРОМ НА БАЗІ ТЕХНОЛОГІЇ ОНЛАЙН-КУРСІВ НА ПЛАТФОРМІ edX

A sequential strategy of implementation elective online courses at medical university on the basis of distance learning technology is revealed in the article. It is shown that successful implementation of online courses is possible in the presence of such components as academic staff readiness to develop new learning technologies and the acceptance of the fact of their changing role in the educational process; students’ readiness to use distance learning technologies; availability of infrastructure at university that provides distance learning services; presence of a quality assurance system for courses content. Particular attention is paid to the need to change the structural organization of the educational process and the role of instructors in the implementation process. The authors substantiated their choice of the Open edX platform for online courses development based on some criteria.У статті розкрита послідовна стратегія впровадження в медичному університеті курсів за вибором на базі технології дистанційного навчання у вигляді онлайн-курсів. Показано, що успішне впровадження онлайн-курсів можливо при наявності таких складових, як: готовність викладацького складу до опанування нових технологій навчання та зміни своєї ролі в навчальному процесі; готовність студентів до використання дистанційних технологій навчання; наявність інфраструктури в університеті, яка забезпечує сервіси дистанційного навчання; наявність системи перевірки якості контенту онлайн-курсів, які розробляються. Особлива увага звертається на необхідність зміни структури навчального процесу та ролі викладачів при впровадженні онлайн-курсів. Авторами обґрунтовано вибір платформи для розробки онлайн-курсів Open edX за критеріями

Characteristics of the nitric oxide system indicators in the left ventricle myocardium in SHR

The aim was to determine the morpho-functional parameters of the left ventricular myocardium NO system in the rats with essential hypertension (SHR line). Material and methods. We used a combination of modern highly informative methods, namely: research of NOS isoform profie (nNOS, iNOS eNOS) in the myocardial slices along with an assessment of their synthesis and expression of the corresponding mRNA; NO derived nitrites level determination directly in the myocardium homogenates and concentration of nitrotyrosine in blood plasma of rats. The results of the performed studies have shown that high blood pressure in the SHR was accompanied by a signifiant increase in the concentrations of all three NOS isoforms in the myocardium and increased expression of their mRNA. Higher concentration of nitrites by 18.8 % was detected in the SHR group compared with the control animals. The concentration of nitrotyrosine in blood plasma of rats with essential hypertension was also increased by 25 %. Conclusions. The predominance of IRM to constitutive isoforms of NOS with low IRM content to iNOS was noted in the myocardium of the control group rats while in SHR rats higher IRM values were marked for all NOS isoforms. The formation of hypertension is accompanied by high content of NO end metabolites and the development of systemic nitroso-oxidative stress with the increase of nitrotyrosine concentration