Standardized Patient Examination Research Articles

ОСОБЕННОСТИ ТЕЧЕНИЯ ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИИ И ОЦЕНКА ЭФФЕКТИВНОСТИ КОМПЛЕКСНОЙ ТЕРАПИИ

Introduction. Community-acquired pneumonia is an urgent problem of our time due to its high prevalence, increasing resistance of microflora to antibacterial therapy, a large number of complications and high mortality. Aim. The aim of the study was features of the course of community-acquired pneumonia and evaluation of the effectiveness of complex therapy. Material and methods. A survey of 120 patients was conducted, with a diagnosis of moderate and severe pneumonia. The patients were divided into 2 groups: group 1 (70 patients), in which, along with the standard therapy of pneumonia, the drug meglumine sodium succinate was included, and group 2 (50 patients), which received standard therapy of pneumonia. In addition to the standard clinical examination of patients with pneumonia, concomitant pathology from other organs and systems was studied. In addition to anamnesis and objective research methods, laboratory and instrumental methods of studying the respiratory and hepatobiliary systems were used. Additionally, procalcitonin was determined in blood serum by immunochromatography, and hepatocyte growth factor and endothelin-1 were determined by enzyme-linked immunosorbent assay. Statistical processing of the results of the study was carried out using parametric and nonparametric methods. Results and discussion. Community- acquired pneumonia is characterized by a moderate course, segmental or lobular lung damage, and the development of a number of complications. With community-acquired pneumonia, the hepatobiliary system is affected and often community-acquired pneumonia occurs against the background of cardiovascular pathology. Conclusion. When meglumine sodium succinate was included in the complex therapy of community-acquired pneumonia, in addition to the positive dynamics of the clinical and laboratory picture of the underlying disease, and a significant reduction in the average duration of hospitalization. In the course of therapy of patients with community-acquired pneumonia with meglumine sodium succinate, a significant decrease in inflammation indicators and an increase in hepatocyte growth factor concentration were observed. When meglumine sodium succinate was included in the therapy of patients with pneumonia, there was a tendency to increase the number of endotheliocytes and a significant increase in the content of endothelin-1, which may reflect an increase in the sanogenetic ability of the body to systemic inflammation in community-acquired pneumonia.

Enhanced Learning Using Digital Recordings with Integrated Standardized Patient Examinations (ISPEs) in Physical Therapy Education: A Qualitative Pilot Study

(1) Background: Integrated standardized patient examinations (ISPEs) allow students to demonstrate competence with curricular learning and communication. Digital recordings of these experiences provide an objective permanent record, allowing students to review and improve their performance. Although recordings have been utilized as a tool in physical therapy education, no studies have described the impact of reviewing recordings of ISPE. This qualitative pilot study aimed to investigate student perceptions and learning after reviewing their recordings of ISPE. (2) Methods: Second-year Doctor of Physical Therapy students (n= 23) participated in the study by completing an anonymous online survey after reviewing their recordings from three ISPEs. Thematic analysis was used to identify codes and central themes from the survey data. (3) Results: The results showed that 95.6% of students found the video review process beneficial. Five themes emerged: (i) digital recordings provide an objective performance assessment, (ii) approaches to self-review vary, (iii) it provides an opportunity for growth, (iv) a holistic review is possible, and (v) students need structure and guidance in the process. (4) Conclusions: Study findings indicate that a review of the recordings of ISPEs facilitates the development of clinical skills for physical therapy students. Implementing an explicit framework for reviewing the recordings may enhance the process and facilitate further promotion of reflection-on-action.

Coronary CT and timing of invasive coronary angiography in patients ≥75 years old with non-ST segment elevation acute coronary syndromes

BackgroundThe ability of coronary CT angiography (cCTA) to rule out significant coronary artery disease (CAD) in older patients with non-ST segment elevation acute coronary syndromes (NSTEACS) is unclear since valid...

The value of coronary computed tomography and very early invasive coronary angiography compared to standard intervention in older patients after non-ST segment elevation acute coronary syndromes

Abstract Background The optimal management of patients with non-ST elevation acute coronary syndromes (NSTEACS) remains a challenge. The merits of both computed tomography angiography (CTA) as a rule-out test for significant coronary artery disease and early invasive coronary angiography (ICA) are debated. Furthermore, there are limited data in older NSTEACS patients, who likely have more coronary artery calcification and are at higher risk of ACS-related complications. Methods This is a post hoc analysis of patients ≥75 years included in the Very Early Versus Standard Care Invasive Examination and Treatment of Patients with Non-ST-Segment Elevation Acute Coronary Syndrome Trial (VERDICT). The diagnostic accuracy of CTA was investigated in patients without previous coronary artery bypass grafting, renal dysfunction, or atrial fibrillation; the presence of a coronary artery stenosis ≥50% determined by ICA was used as reference. Patients were randomised to very early ICA within 12 hours of diagnosis or standard care (ICA within 48–72 hours of diagnosis) and followed for up to five years. The primary endpoint was the composite of all-cause mortality, nonfatal recurrent MI, hospital admission for refractory myocardial ischaemia or hospital admission for heart failure. Results From November 2010 to June 2016, 2147 patients were included in the VERDICT trial. Of these, 452 (21%) patients were ≥75 years of age. Most older patients had a GRACE score >140 (n=388, 88.8%). At the time of admission, older patients had lower levels of haemoglobin, estimated glomerular filtration rate, and left ventricular ejection fraction, and more often displayed elevated troponins and electrocardiogram changes indicating new ischaemia, than those <75 years. Of patients ≥75 years of age, 161 (35.6%) underwent CTA before ICA. Older patients had significantly higher calcium scores than younger patients (1187±1445 vs. 499±858 Agatston units, p<0.001). 19% of CTAs excluded significant coronary artery disease. The negative predictive value of the CTAs was 94 (95% CI 79–99)% and the sensitivity was 98 (95% CI 94–100)%, figure 1. The primary endpoint was observed more frequently in patients ≥75 years as compared to younger patients (n=222, 49% vs. n=390, 23%, p<0.001), even after adjustment for allocated treatment (adjusted HR 2.65, 95% CI 2.25–3.13, p<0.001). Among older patients randomised to very early ICA, there were no differences in the cumulated number of primary endpoints compared to older patients randomised to standard ICA (log-rank p=0.36), figure 2. Conclusion Among patients ≥75 years old with NSTEACS, CTA showed a high diagnostic accuracy. A very early ICA within 12 hours of diagnosis did not improve long-term composite outcome in these older patients with NSTEACS. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Rigshospitalets Research Foundation

The Clinical Microsystems Clerkship at University of California, San Francisco: Integrating Clinical Skills and Health Systems Improvement for Early Medical Students.

Medical educators recognize that partnering actively with health system leaders closes significant health care experience, quality, and outcomes gaps. Medical schools have explored innovations training physicians to care for both individual patients and populations while improving systems of care. Yet, early medical student education fails to include systems improvement as foundational skills. When health systems science is taught, it is often separated from core clinical skills. The Clinical Microsystems Clerkship at the University of California, San Francisco School of Medicine, launched in 2016, integrates clinical skills training with health systems improvement from the start of medical school. Guided by communities of practice and workplace learning principles, it embeds first-year and second-year students in longitudinal clinical microsystems with physician coaches and interprofessional clinicians one day per week. Students learn medical history, physical examination, patient communication, interprofessional teamwork, and health systems improvement. Assessments include standardized patient examinations and improvement project reports. Program outcome measures include student satisfaction and attitudes, clinical skills performance, and evidence of systems improvement learning, including dissemination and scholarship. Students reported high satisfaction (first-year, 4.10; second-year, 4.29, on a scale of 1-5) and value (4.14) in their development as physicians. Clinical skills assessment accuracy was high (70%-96%). Guided by interprofessional clinicians across 15 departments, students completed 258 improvement projects in 3 health systems (academic, safety net, Veterans Affairs). Sample projects reduced disparities in hypertension, improved opiate safety, and decreased readmissions. Graduating students reported both clinical skills and health systems knowledge as important to physician success, patient experience, and clinical outcomes (4.73). Most graduates discussed their projects in residency applications (85%) and disseminated related papers and presentations (54%). Integrating systems improvement, interprofessional teamwork, and clinical skills training can redefine early medical student education. Health system perspectives, long-term outcomes, and sustainability merit further exploration.

OPTICAL-REFLECTION METHOD OF ACCOMMODATIVE FACILITY TRAINING ON MERIDIONAL ACUITY IN TREATMENT OF ASTIGMATS WITH AMBLYOPIA

ackground: The efficacy of accommodative facility training as a method of treatment for meridional amblyopia (MA) in astigmatic children with amblyopia was studied. MA manifests itself as selective alterations in visual acuity (VA), with substantial differences in the ability to resolve contours of different orientations, and may cause impairments in mechanisms of integrated processing of visual stimulus, development of cognitive abilities in children and visual performance. Purpose: To assess the effect of optical-reflection method of accommodative facility training on vernier acuity in meridians (MVA) in the treatment of astigmatic children with amblyopia. Material and Methods: Twenty seven children aged 5 to 12 years, with both refractive amblyopia and with-the-rule hyperopic astigmatism were included in the study, and underwent an examination. The spherical component of refraction ranged from +0.5D to +5.5D, and the cylindical component, from 0.5D to 4.5D. Best-corrected visual acuity (Sivtsev Chart) was assessed. Accommodative facility training was performed monocularly by image defocusing with lenses of a variable power. A +0.5-D sphere was placed just in front of the best correction for the study eye in order to blur this line. The +0.5-D sphere was replaced by a -0.5-D sphere after the optotypes became clearly visible. Thereafter, the training cycle was repeated using a ±0.75-D sphere and, subsequently, a ±1.0-D sphere. Lens power was gradually increased until it could be compensated by accommodation. The treatment course consisted of one training session a day for 10 days. Special computer software was used to determine corrected MVA. Linear objects were presented on the computer screen, and the smallest lateral displacement of one line from another that can be detected by the examinee will characterize the level of MVA. Results: A new algorithm was proposed for assessing the efficacy of treatment of MA in astigmats, with refractive asymmetries and meridional asymmetries in vernier acuity considered as vector quantities. It was demonstrated that a group of amblyops with the same type of astigmatism was not homogeneous. It was found possible to split such a group of patients into three clusters that differ in the type of variation in meridional acuity in the orthogonal meridians compared to refractive asymmetries. One cluster had equal vernier acuities in the vertical and horizontal meridians, the second had vernier acuity in the horizontal meridian better than in the vertical meridian, and the third had vernier acuity in the horizontal meridian worse than in the vertical meridian. MVA was greater in magnitude in one of the orthogonal meridians than in another in the dominant eyes in 37% of study patients, and in the fellow eyes in 50% of study patients. MVA values in the orthogonal meridians were similar in 56.6% of study patients. There was a 15.1-percent increase, from 56.6% to 71.1% in the number of eyes with a similar vernier acuity in the orthogonal meridians after treatment. A positive effect was achieved through elimination of meridional asymmetry in vernier acuity in a portion of patients from clusters that differ in the direction of meridional asymmetry in vernier acuity. In addition, the number of eyes in the category of patients with a visual acuity of 0.75-0.8 (as assessed with complex optotypes) increased by 11.35%. Conclusion: The efficacy of treatment for MA should be assessed in homogeneous clusters with similar direction of meridional asymmetry in visual acuity. Preliminary data on the efficacy of treatment of amblyopia by accommodative facility training allows considering this training as a method of treatment for meridional amblyopia. The method of determination of meridional acuity should be included in the standard examination of patients with amblyopia.

Complex Diagnostics of Non-Specific Intellectual Developmental Disorder.

Intellectual development disorder (IDD) is characterized by a general deficit in intellectual and adaptive functioning. In recent years, there has been a growing interest in studying the genetic structure of IDD. Of particular difficulty are patients with non-specific IDD, for whom it is impossible to establish a clinical diagnosis without complex genetic diagnostics. We examined 198 patients with non-specific IDD from 171 families using whole-exome sequencing and chromosome microarray analysis. Hereditary forms of IDD account for at least 35.7% of non-specific IDD, of which 26.9% are monogenic forms. Variants in the genes associated with the BAF (SWI/SNF) complex were the most frequently identified. We were unable to identify phenotypic features that would allow differential diagnosis of monogenic and microstructural chromosomal rearrangements in non-specific IDD at the stage of clinical examination, but due to its higher efficiency, exome sequencing should be the diagnostic method of the highest priority study after the standard examination of patients with NIDD in Russia.

Repeated Measures of Cognitive and Affective Learning Outcomes in Simulation Debriefing

Introduction. To better support the development of domain expertise, there has been considerable interest in the instructional strategies that afford opportunities for problem solving. Simulation-based learning includes case-based activities that support learners' transition into practice through experience and reflective debriefing. Review of the Literature. Simulation-based learning serves as a means for learners to practice psychomotor, affective, and cognitive skills. Although the literature suggests this is an effective strategy for supporting problem-solving skills, much of the literature is focused on measuring cognitive outcomes within a single case. As such, very few studies have simultaneously investigated (a) how debriefing in simulation-based education supports problem solving and (b) the degree to which cognitive and affective learning outcomes are variable throughout the problem-solving process. Methodology. To address this gap, this repeated-measures study examined the role of debriefing strategies in simulation-based learning experiences, which was designed to practice both cognitive and affective skills. In the control condition, participants were given 2 simulation-based laboratory instructional sessions and then assessed on cognitive (problem representation and solution generation) and affective learning (perceived self-efficacy) outcomes. In the comparison condition, participants engaged in debriefing sessions after each of the 2 simulation-based laboratory instructional sessions. For the cognitive outcomes, participants were assessed using the Think-Aloud Standardized Patient Examination instrument, which measured problem representation and solution generation. Acute care confidence survey was used to measure perceived self-efficacy. Results. The study found statistically significant gaps in early-stage measures of cognitive problem representation, but no difference was found in solution generation or perceived self-efficacy measures. Conclusion. This study reinforces the importance of debriefing in simulation-based education. Specifically, this study suggests that cognitive learning outcomes are variable during the problem-solving process, but affective learning outcomes are more fixed and may need more targeted debriefing.

Diagnostics and methods of solving the reduction of bone mineral density and deformities of the articular cavity of the scapula during reverse shoulder arthroplasty

Background. Reverse arthroplasty is an effective method of treating severe injuries and diseases of the shoulder joint. In cases of severe osteoporosis, defects and deformities of the glenoid, there are risks of incorrect installation and instability of the components of the endoprosthesis. In the literature data, the problem of osteoporosis in the endoprosthetics of the shoulder joint and methods of its solution are rather poorly reflected, which was the reason for this study.The aim: to develop algorithms for diagnosing the state of the bone tissue of the articular cavity of the scapula and methods for solving its deviations during reverse shoulder arthroplasty.Materials and methods. Forty-eight patients who underwent reversible shoulder joint replacement were examined in the Department of Adult Orthopedics of the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics. A standard preoperative examination of patients developed in the department was performed, as well as additional calculations of bone density in Hounsfield units and according to X-ray densitometry were performed. The parameters of bone density of the glenoid (in HU) were compared with the data of densitometry.Results. According to the results of densitometry, the patients were divided into groups. A direct dependence of the bone density of the glenoid and the indicators of densitometry was revealed. Algorithms of treatment and preoperative preparation of patients with bone density deficiency for reverse shoulder arthroplasty have been developed.Conclusions. In the studied groups, 100 % of patients with indicators below 139 HU were diagnosed with osteoporosis or osteopenia, and patients with more than 257 HU had normal bone mineral density.

Diagnostics, Treatment of Tumors of the Urinary Duct (Clinical Observations)

Despite low prevalence in the population, urachus tumors are of clinical interest because some of them may be malignant with a high degree of aggression. The most common malignant tumor of urachus is mucinous adenocarcinoma (MA). In the absence of reliable MA biomarkers, careful evaluation of clinical data is essential to determine the risk of its presence and radical treatment. The objective: a comparative analysis of complaints, symptoms, instrumental / imaging data and treatment results in patients with MA and benign tumor of the urachus. Materials and methods. We report three clinical cases of urachus tumors (2 malignant and 1 benign), which were detected among patients of the Institute of Urology of the National Academy of Medical Sciences of Ukraine for the period from 2016 to 2020. Standard preoperative examination of patients included: collection of complaints, medical history, physical examination (including palpation of the abdomen in the umbilical and hypogastral areas), general clinical laboratory tests, ultrasound, urethrocystoscopy with TUR biopsy (2 patients), imaging (CT in 2, MRI in 1). All patients underwent surgical treatment: laparoscopic removal of urachus with resection of the bladder within the “healthy tissues”. The postoperative follow-up period lasted from 1 to 33 months. Results. In 2 patients (man and woman) according to the results of pathohistological examination of the surgical material was detected MA, in 1 man – leiofibromyoma (LFM). MA was clinically manifested by macrohematuria – 2 (100%) and low back pain – 1 (50%). Pollakiuria and discomfort in the bladder area were observedIn case of LFM. Palpation did not allow to diagnose urachus tumor in any of the patients. On MRI scans, MA was defined as a soft tissue formation with uneven clear contours, with moderate enhancement by contrast, cystic component and calcification, located in the urachus area. On CT scans – as a heterogeneous neoplasm at the apex of the bladder with endo- and exophytic components. Instead, LFM was identified as a soft tissue formation (+34 .. +50 .. +70 units H) with predominantly endophytic growth, which accumulates contrast in the arterial and venous phases. At cystoscopy MA has the form of a papillary neoplasm in the area of the apex of the bladder on the type of “cauliflower”, while LFM has no papillary component. After laparoscopic removal of urachus with wedge-shaped resection of the bladder for a period of 1 to 33 months, cystoscopy did not reveal recurrence of tumors. Conclusions. In the absence of reliable biomarkers, clinical characteristics remain the only “tool” that can predict the risk of MA. Compared with benign tumors of urachus, the characteristic clinical signs of MA are: macrohematuria, exophytic growth, the appearance of “cauliflower” on cystoscopy, the presence of calcifications and cysts in the structure. Even with high aggression potential of MA (low-grade tumors), laparoscopic removal of urachus with resection of the bladder within the “healthy tissues” at an early stage can provide a fairly long recurrence-free period (up to 33 months). Further research is needed to develop MA biomarkers.

Bacterial corneal ulcers in pediatric patients. Algorithms of pharmacotherapy. Part II

Part I of the article presents a review of publications highlighting current exogenous and endogenous risk factors contributing to the occurrence of bacterial corneal ulcers, laboratory diagnostic methods, clinical differential diagnostic features of bacterial corneal ulcers.
 A wide variety of objective symptoms characterizes the clinical picture of bacterial corneal ulcers. Still, objective differential diagnostic signs make it possible with a high degree of probability to assume the etiology of the disease during the first biomicroscopy and immediately begin etiotropic therapy, on the timing of which the outcome of the disease depends.
 Standard laboratory examination of patients with bacterial corneal ulcers includes the bacterioscopic and cultural examination of the contents of the conjunctival sac. However, the absence of etiotropic therapy while waiting for the results of microbiological research methods, which takes from 3 to 7 days, contributes to the rapid progression of the disease, the development of endophthalmitis, and corneal perforation, up to the loss of an eye in children. In this regard, treatment must be started immediately. Therefore, the choice of a drug is determined not only by the causative agent, proven laboratory but, first of all, based on clinical differential diagnostic signs of the disease.
 The traditional, undeniable approach to the conservative treatment of bacterial corneal ulcers is conventional etiotropic therapy using local and systemic antibacterial drugs. In addition, timely intensive specific drug therapy prevents the destruction of all layers of the cornea, and the use of metabolic drugs that improve regeneration and trophism promotes epithelialization of corneal ulcers.
 Attention should be given to the necessity and validity of the choice of antibacterial drugs for various etiological forms of bacterial corneal ulcers in children. An individual approach is a basis for effective antibiotic therapy in pediatric ophthalmology.
 The article presents an up-to-date review of publications and modern algorithms for treating bacterial corneal ulcers in children, the main causative agents of which are: Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Neisseria gonorrhoeae.

Bacterial corneal ulcers in pediatric patients: Clinical and laboratory diagnostics. Part I

Bacterial corneal ulcer is the second most common complication of herpetic ulcer, but it is the most severe complication and has the highest progression rate. The main causative agents of bacterial corneal ulcers are Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Neisseria gonorrhoeae. The frequency of the detection of corneal ulcers caused by gram-negative Pseudomonas aeruginosa has increased, which is characterized by a lightning-fast course and a high frequency of complications and adverse outcomes. Gonococcal corneal ulcer caused by Neisseria gonorrhoeae is less common in pediatric patients than in adult patients, but it has the most aggressive disease course, which does not change with age. Bacterial corneal ulcers are one of the main causes of corneal blindness and can lead to endophthalmitis, corneal perforation, and eye loss within a short time. Clinical differential diagnostic signs allow us to assume, with a high degree of probability, the etiology at the first biomicroscopy and immediately begin etiotropic therapy, which is crucial for the outcomes of bacterial corneal ulcer. The standard laboratory examination of patients with bacterial corneal ulcer includes bacterioscopic and culture examinations of the contents of the conjunctival sac. This paper presents an up-to-date review of publications, clinical features, differential diagnostic criteria, laboratory diagnostic methods of bacterial corneal ulcers in pediatric patients

A Hadoop-Based Online Teaching Model of "VisibleBody"

It is the responsibility of nursing educators to cultivate community nursing professionals who can adapt to the post and meet social needs. However, there exist some problems in current community nursing curriculum education such as inconsistent teaching content and different levels of teachers’ lecturing. In this study, a good educational resource ecosystem was established in virtue of the mighty flexibility and expansibility of hadoop technology, the resources in community nursing teaching courses are stored in the hadoop cloud resource library. At the same time, community nursing online course resources were newly designed and improved through HdoopYarn resource scheduling algorithm, thereby realizing the establishment of a virtual experimental environment for nursing major. VisibleBody virtual medical software was applied to the internship and practical training, specifically in 12 knowledge units of 5 modules according to the characteristics of this course, demonstrating a deep-level human body structure and accurate nursing operation. An objective structured clinical examination mode was adopted in the teaching method, which could create a simulated community nursing situation during teaching, so that students could complete standardized patient assessment and examination within the given time, and accept testers’ questions and acquire results. It was found from the teaching practice that the application of teaching model is conductive to enhancing students' academic performance and improving community nursing capabilities, including problem-solving competence, communication skills, teamwork ability, etc.

First results of clinical diagnostic analysis of post-COVID peripheral neuropathy

To study clinical and diagnostic features of post-COVID PNP. We examined 9 female patients aged 32 to 51 years who had suffered an infection caused by SARS-CoV-2 of varying severity. The patients were divided into two groups: the first consisted of 6 patients with clinical manifestations of PNP in the form of neuropathic pain, the second - 3 patients without clinical manifestations. Patients of group 1 underwent comprehensive examination including neurological examination, confocal microscopy of the cornea (in vivo CM), electroneuromyography (ENMG) of the nerves of the upper and lower extremities, quantitative sensory testing in the zone of painful sensations, while patients of group 2 only underwent in vivo CM. All patients of the first group, within 5-40 days after the onset of infection caused by SARS-CoV-2, exhibited symptoms of damage to various parts of the nervous system (peripheral nerves, thoracic spinal roots, trigeminal nerve). The main - and in most cases the only - symptom of the disease was neuropathic pain syndrome. In Guillain-Barré syndrome, for the first time using in vivo CM, the following changes were revealed: enlargement of in Langerhans cells, shortening of CNF and their processes, presence of neuromas. The standard neurological examination of patients with post-COVID neuropathy should be supplemented with special diagnostic methods for assessment of structural and functional state of the peripheral nerves. The in vivo CM method is capable of non-invasive assessment of changes in thin CNF and, with accumulation of empirical data, can be included in the algorithm for diagnosing post-COVID PNP.

11q23/MLL rearrangements in adult acute leukemia.

To detect the frequency, diagnostic and prognostic significance of 11q23/MLL rearrangements and to determine the chromosomes that are most frequently involved in 11q23/MLL abnormalities in adult acute leukemia (AL). Cytogenetic investigations of bone marrow and/or peripheral blood cells from 140patients with acute myeloid leukemia (AML) and 57patients with acute lymphoblastic leukemia (ALL) were performed. The methods of conventional cytogenetics (GTG-banding) and fluorescence in situ hybridization were used. Chromosomal abnormalities in leukemia cells were found by conventional cytogenetic methods in 80 (57%) and 37 (65%) adult patients with AML and ALL, respectively. 11q23/MLL rearrangements were found in 7 (5%) and 8 (14%) patients with AML and ALL, respectively. Among them, 8 (53.4%) patients had translocations, 2 (13.3%)- had deletions and 5 (33.3%) patients had trisomies or tetrasomies of chromosome 11. With respect to the distribution of partner chromosomes involved in 11q23/MLL translocations chromosome 4was found to participate in 3 (37.5%) cases of 11q23/MLL translocations, 9- in 2 (25%) cases and chromosomes 10, 14and non-identified chromosome were involved in 1 (12.5%) case each. Nine patients (60%), besides abnormal ones, had 9-86% normal metaphases in their karyotypes. Of 15patients with 11q23/MLL rearrangements, 5 (33%) patients had only 11q23/MLL rearrangements, whereas other 10 (67%)- had additional cytogenetic abnormalities, besides 11q23/MLL rearrangements. Chromosomal abnormalities of various kinds were found in 57% and 65% adult patients with AML and ALL, respectively. The frequency of 11q23/MLL rearrangements in patients with AML and ALL was 5% and 14%, respectively. Since AL patients with 11q23/MLL rearrangements are attributed to cytogenetic categories of AL with a poor or intermediate risk prognosis, cytogenetic methods should be included in the standard examination of AL patients for diagnosis, prognosis and selection of the optimal treatment strategy.

Hypodiploidy in patients with acute lymphoblastic leukemia

Background. Acute lymphoblastic leukemia (ALL) is characterized by different clinical course and different sensitivity to therapy. Taking into consideration their significant prevalence an intensive search for new prognostic criteria is conducted that may determine individual prognosis and choose the most appropriate treatment approach for patients with ALL, who often require transfusion therapy and replacement therapy with blood components.
 Objective. To detect the frequency, diagnostic and prognostic significance of hypodiploidy in patients with ALL.
 Materials and methods. Standard cytogenetic investigation of bone marrow and/or peripheral bloodcells was performed according to the standard techniques from 57 adult patients with ALL.
 Results and discussion. Chromosomal aberrations of various kinds were found in 37 (65 %) patients with ALL. Among them presence of one karyotype abnormality was established in 9 (24 %) patients, two abnormalities – in 10 (27 %) and multiple structural and/or numerical changes (≥3) – in 18 (49 %). Samples from 20 (35 %) patients showed a normal female or male karyotype without cytogenetically visible changes. The most common abnormalities in ALL were: trisomy 8, rearrangements of 7q, 17p and 11q23, translocations t(4;11)(q21;q23), t(9;22)(q34;q11), marker chromosomes, acentric structures, hypodiploidy, hyperdiploidy, complex karyotype (≥3 changes) etc. Hypodiploidy was found in 2 (4 %) patients with ALL. One patient, except for abnormal ones, had normal metaphases in him karyotype. Of two patients with hypodiploidy, one had only numerical abnormalities, whereas other one had also structural cytogenetic aberrations, except the numerical changes, namely t(1;6)(q32;q27), add(12)(q24), del(17)(p11), r(17)(p13q25). Hypodiploidy is an unfavorable marker in ALL and a near haploidy is an extremely unfavorable factor.
 Conclusions. Cytogenetic abnormalities of various kinds were found in 37 (65 %) patients with ALL. The frequency of hypodiploidy was 4 %. ALL patients with hypodiploidy were classified into cytogenetic categories of ALL with a poor risk prognosis. Thus, cytogenetic investigations should be included in the standard examination of patients with ALL for diagnosis, prognosis and selection the optimal treatment strategy.

Gonadal Steroids and Sperm Quality in a Cohort of Relapsing Remitting Multiple Sclerosis: A Case-Control Study.

Introduction: Evaluation of the hypothalamic-pituitary-testicular axis and sperm analyses are not a standard examination of patients with Relapsing-Remitting Multiple Sclerosis (RRMS).Methods: This is a prospective-case-controlled study. Patients, aged 18–55, with a confirmed diagnosis of RRMS, naïve to any DMT were enrolled. Controls were men with normal evaluation who acceded to the Andrology Center of Catania in a contemporary matched randomized fashion to the group of RRMS patients. The aim of the study is to evaluate gonadal steroids and sperm quality in men at the time of RRMS diagnosis and 12 months following the first disease modifying treatment (DMT).Results: Out of 41 patients with RRMS, 38 were included in the study (age 40.3 ± 12.3) to be compared with matched controls. Patients with RRMS showed no differences in gonadal steroids or sperm parameters, except for free testosterone (fT) plasma levels, which were lower in RRMS patients than controls (median 0.09 vs. 1.4, p < 0.0001). The correlation analyses, corrected for age and Body Mass Index, did not reveal any correlation between hormonal/sperm parameters and level of disability or disease activity at onset. Additionally, 12 months following the start of DMT, there were no differences in gonadal steroids and sperm quality compared to baseline.Conclusions: Results suggest that RRMS may not have an impact on fertility status but prospective long-term studies are needed.

The ordinal scale of X-ray assessment of venous congestion in chronic heart failure

Aim. To develop an ordinal scale for x-ray assessment of venous congestion in chronic heart failure based on the results of the standard assessment of chest radiographs.&#x0D; Methods. The ordinal assessment on the scale consists of a numerical expression of four radiological symptoms: cardiomegaly, pleural effusion, and changes in the pulmonary pattern due to vascular and interstitial components. The presence of each of these symptoms corresponds to a score of 1 point. In the result, ordinal X-ray assessment varies from 0 to 4 points. Simultaneously objective clinical, instrumental and laboratory measures of the severity of congestive heart failure were recorded in patients.&#x0D; Results. Cardiomegaly, the presence of pleural effusion and changes in the pulmonary pattern due to vascular and interstitial components was numerically estimated according to the standard assessment of chest X-rays for the scale of radiological assessment of venous congestion. Correlation between numerical estimates of the ordinal scale and objective clinical, instrumental and laboratory measures of venous stasis in the sample of 225 patients showed the validity of the assessment. The statistically significant direct relationships between value of the ordinal scale for X-ray assessment of venous congestion with functional class and stage of chronic heart failure, the level of NT-terminal fragment of brain natriuretic peptide, the frequency of respiratory movements, the scale of clinical state, the index of the left atrium, the systolic pressure in the pulmonary artery, as well as an inverse dependence with the 6-minute walk test values were proved. Sufficient internal consistency of the ordinal scale was demonstrated (Cronbach's alpha 0.73). We also found that the scale demonstrated predictive informativeness, which was manifested by a significant increase in the mortality of patients with chronic heart failure in cases where the scale values increase to 2.&#x0D; Conclusion. The proposed ordinal scale for x-ray assessment of venous congestion has sufficient reliability (internal consistency) for practical application, as well as criteria and prognostic validity; the scale can be considered as a simple, accessible and informative addition to the standard examination of polymorbid patients with chronic heart failure, which may be useful for advanced assessment of the patient's condition and risk of death within the next year.

Association of polymorphic variants of ADRB1 gene with contractile myocardial dysfunction and erythrocyte adrenoreactivity in patients with rhythm disorders

Aim. To study the association of the rs1801252 (A145G, Ser49Gly) and rs1801253 polymorphic variants (G1165C, Gly389Arg) of the p1-adrenoreceptor ADRB1 gene with the clinical manifestations of chronic heart failure (CHF) and the adrenoreactivity of their erythrocyte membranes in patients with cardiac arrhythmias. Material and methods . The study included 47 patients with atrial fibrillation and I-III FC CHF. A standard clinical examination of patients was performed, including a six-minute walk test and an echocardiographic study. The rs1801252 (A145G, Ser49Gly), rs 1801253 (G1165C, Gly389Arg) polymorphic variants of the p1-adrenoceptor ADRB1 gene and p-adrenoreactivity of erythrocyte membranes were determined. Results. A statistically significant inverse correlation of p-adrenoreactivity of erythrocyte membranes with the left ventricular ejection fraction (r=-0,336, p=0,021) and a direct correlation with the end-systolic volume (r=0,320, p=0,039) were defined. Depending on the FC of CHF, there was a pronounced tendency (p=0,058) of p-adrenoreactivity increasing. In patients with I FC — 25,88 (12,07; 46,37) relative units, II FC — 30,54 (14,50; 43,36) relative units, III FC — 3774 (33,67; 41,81) relative units. Diastolic dysfunction in patients was combined with a decrease in the adrenoreactivity of the organism. The median of p-adrenoreactivity of erythrocyte membranes in the group of patients with diastolic dysfunction was significantly (p=0,021) higher (33,04 (16,30; 4729) relative units) than in the group without diastolic dysfunction (15,91 (11,10; 26,47) relative units). In the studied sample, there were no statistically significant differences in the frequency of diastolic dysfunction in carriers of different genotypes of the rs1801252 and rs1801253 polymorphic variants of the ADRB1 gene (p=1,0 and p=0,058, respectively). An association (p=0,042) of a carrier of the homozygous 145AA rs1801252 genotype with high p-adrenoreactivity of erythrocyte membranes (32,5 (14,6; 473) relative units) was detected in comparison with the heterozygous 145AG genotype (16,3 (11,7; 31,5) relative units). In the studied sample, there was no statistically significant association of p-adrenoreactivity with the carrier of homozygous and heterozygous genotypes of the rs1801253 variant of the ADRB1 gene. Conclusion. The studied rs1801252 and rs1801253 variants of the ADRB1 gene have different associations with impaired diastolic function of the myocardium and desensitization of erythrocyte p-adrenoreceptors.

Investigation of satisfaction on practical skills in graduation examination of resident training in Liaoning Province

Objective To get well-informed of the practical skills examination of residents’ standardized training in order to detect problems and improve the quality of training. Methods A total of 4 484 clinical medical examinees from 2010, 2013 and 2017 in Liaoning province were investigated by questionnaire, from which 4 412 valid questionnaires were collected and the total survey efficiency was 98.39%. The survey included the standardized patient (SP) examination, the small station test, the computer simulated case (CCS) examination and the clinical skill operation test station with parts 20 projects. Excel was used to sort and record the data. SPSS 10.0 software was used for statistical analysis. Results All parts of the practical skill assessment was reasonable. The examinees’ satisfaction with the test is showing an upward trend year by year, up to 73.93% in 2017. In the standardized patients examination, the key points of the role play (including the fidelity and simulated authenticity of the physical signs) need be strengthened (14.84% in 2010). Examinees thought the difficulty of computer simulation case examination is increasing year by year. More than 2/3 examinees evaluated the clinical skill operation test station set was reasonable and the difficulty was moderately. Conclusions We should further deepen the exploration of standardized patients assessment model; strengthen the medical humanities in training; improve the residents’ clinical thinking; take examination as the guidance and standardize clinical training. Key words: Resident standardized training; Practical skills examination; Degree of satisfaction