Features of civil liability for damage caused to the life or health of a citizen when providing him with medical services

The aim of the study - defined as the disclosure of the conditions of civil liability of medical organizations for harm caused to the patient's health when providing him with medical services.Цель исследования - раскрытие условий гражданско-правовой ответственности медицинских организаций за вред, причиненный здоровью пациента при оказании ему медицинской услуги

Effects of alpha fetoprotein on escape of Bel 7402 cells from attack of lymphocytes

BACKGROUND: Involvement of AFP against apoptosis of tumor cell has been implicated in its evasion of immune surveillance. However, the molecular events of immune escape mechanisms are still unknown. The major observations reported here relate to a possible mechanism by which heptoloma Bel 7402 cells escape immune surveillance in vitro. METHODS: Western blotting and a well-characterized cofocal scanning image were performed to analyze the expression of Fas/FasL and caspase-3 in co-cultured Bel 7402 and Jurkat cells. RESULTS: After co-culture with Jurkat cells, up-regulated Fas and reduced FasL expression could be observed. Treatment with AFP could remarkably inhibit the elevated Fas and, whereas, induce the FasL expression in co-cultured Bel 7402 cells. Cells co-culture could induce the expression of caspase-3 in both cells line. The elevated caspase-3 in Bel 7402 cells was abolished following the treatment of AFP. The expression of caspase-3 was elevated in co-cultured Jurkat cells treated with AFP. No detectable change on the expression of survivin was examined in both cells line. Monoclonal antibody against AFP treatment alone did not obviously influence the growth of cells, as well as the expression of Fas/FasL and caspase-3. However, the effect of AFP could be blocked by antibody. CONCLUSIONS: our results provide evidence that AFP could promote the escape of liver cancer cells from immune surveillance through blocking the caspase signal pathway of tumor cells and triggering the Fas/FasL interaction between tumor cells and lymphocytes

Сердечный индекс и вариация ударного объема на основе анализа времени транзита пульсовой волны в сравнении с производными анализа контура пульсовой волны после коронарной реваскуляризации на работающем сердце

The objective was to validate cardiac index (CI) and stroke volume variation (SVV) measured by pulse wave transit time (PWTT) technology  using estimated continuous cardiac output (esCCO) technique, with pulse contour analysis (PCA) after off-pump coronary artery bypass grafting  (OPCAB)Materials and methods. The study involved 21 patients after elective OPCAB. In all patients, CI and SVV were measured with both esCCO technique  (CIesCCO and esSVV) and PCA (CIPCA and SVVPCA). The agreement between methods was analyzed using correlation analysis and Bland-Altman  analysis. In addition, the trending ability of esCCO technique to control changes in CI during dynamic tests was investigated.  Results. During the study, 178 pairs for CI and 174 pairs for SVV were collected. The mean bias between CIesCCO and CIPCA was 0.06 L·min–1 m–2 with limits of agreement of ± 0.92 L·min–1 m–2 and a percentage error of 35.3%. The concordance rate of CIesCCO was 70%. The mean bias between  esSVV and SVVPCA achieved – 6.1% with limits of agreement of ± 15.5% and percentage error of 137%.Conclusions. The coherence of CIesCCO and esSVV based on PWTT in comparison with PCA is not appropriate. Further development of this  monitoring algorithm may be required for more correct measurement of cardiac output and fluid responsiveness  Цель – провести валидацию сердечного индекса (СИ) и вариации ударного объема (ВУО), измеренных с помощью метода анализа  времени транзита пульсовой волны (ВТПВ) с использованием технологии estimated continuous cardiac output (esCCO), с показателями, полученными на основе анализа контура пульсовой волны (АКПВ), после аортокоронарного шунтирования на работающем  сердце (АКШ).Материалы и методы. В исследование был включен 21 пациент после планового АКШ. Всем пациентам была выполнена оценка СИ и ВУО  как с помощью технологии ВТПВ (СИВТПВ и ВУОВТПВ), так и на основе АКПВ (СИАКПВ и ВУОАКПВ). Согласованность между методами была  оценена с помощью корреляционного анализа и анализа Бланда – Альтмана. Кроме того, была произведена оценка способности технологии  esCCO контролировать изменения СИ на фоне динамических тестов.Результаты. В ходе исследования было получено 178 пар данных для СИ и 174 пары данных для ВУО. Средняя разница между СИВТПВ  и СИАКПВ составила 0,06 л∙мин–1∙м–2 с границей согласованности ± 0,92 л∙мин–1∙м–2 и процентной ошибкой 35,3%. Показатель конкордантности  для СИВТПВ составил 70%. Средняя разница между ВУОВТПВ и ВУОАКПВ достигла 6,1% с пределом согласованности ± 15,5% и процентной  ошибкой 137%. Заключение. Показатели СИ и ВУО, полученные с помощью анализа ВТПВ, обладают недостаточной согласованностью в сравнении c  АКПВ. Необходимо дальнейшее совершенствование данного алгоритма мониторинга для более точной оценки сердечного выброса и восприимчивости к инфузионной нагрузке.

The Apoptosome: Emerging Insights and New Potential Targets for Drug Design

Apoptosis plays a crucial role in tissue homeostasis, development and many diseases. The relevance of Apaf1, the molecular core of apoptosome, has been underlined in mitochondria-dependent apoptosis, which according to a growing body of evidence, is involved in various pathologies where the equilibrium of life-and-death is dysregulated, such as heart attack, stroke, liver failure, cancer and autoimmune diseases. Consequently, great interest has emerged in devising therapeutic strategies for regulating the key molecules involved in the life-and-death decision. Here we review recent progress in apoptosis-based pharmacological therapies and, in particular, we point out a possible role of the apoptosome as an emerging and promising pharmacological target

Risk factors of atherosclerosis and clinical and morphological comparisons in systemic vasculitides

Objective: to study the incidence rates of angina, myocardial infarction (MI), stroke, and the frequency of endovascular interventions in patients with systemic vasculitides, and the incidence rate of atherosclerosis according to autopsy data. Subjects and methods. Three hundred and twenty-one patients with systemic vasculitides: Wegener's granulomatosis (n = 138), Takayasu's arteritis (n = 79), polyarteritis nodosum (n = 55), and Churg-Strauss syndrome (n = 49) were examined; 55 autopsies were analyzed in patients with the above diseases. Results. Fifty-one (15.6%) of the 321 patients were diagnosed as having cardiovascular diseases (CVD): angina pectoris (7.1%) and MI (3.1%) and endovascular interventions (0.9%). The risk of cardiovascular events was found to be associated with traditional risk factors, such as male gender and age. Arterial hypertension, hypercholesterolaemia, and increased serum creatinine were more frequently detected in the CVD group that showed no significant differences from the non-CVD group. According to autopsy results, atherosclerosis was identified in the patients with Wegener's granulomatosis (52%), Takayasu's arteritis (50%), polyarteritis nodosum (52.6%), and Churg-Strauss syndrome (57.1%). Conclusion. CVD and atherosclerosis are common in systemic vasculitides, which requires the traditional risk factors of atherosclerosis to be actively corrected

Evaluation of the short-term efficacy and safety of biological agents in different rheumatic diseases: a multidisciplinary therapeutic hospital"s experience

There has been a substantial expansion in the possibilities of current therapy for rheumatic diseases (RD) primarily due to the use of genetically engineered biological agents (GEBA). Objective: to evaluate the short-term efficacy and safety of GEBA in patients with different RD. Subjects and methods. The trial included all RD patients receiving GEBA: rituximab (RTM), infliximab (INF), adalimumab, etanercept, tocilizumab, abatacept in 2009-2012. Therapeutic efficiency and safety were evaluated 6 months later. The effect of GEBA was determined as “remission”, “improvement”, and “no response”, by using the parameters peculiar to specific diseases (such as BVAS, DAS28, BASDAI). Results. The trial enrolled 107 patients (49 men and 58 women; mean age 41.5 years) with rheumatoid arthritis (n=34), ANCA-associated vasculitis (n = 34), systemic lupus erythematosus (n=16), cryoglobulinemic vasculitis (n=11), ankylosing spondyloarthritis (n = 8), systemic vasculitis with large artery involvement (n=6), and other RD. All the cases showed severe systemic autoimmune disease refractory to standard immunosuppressive therapy. RTM (n=66) and INF (n = 31) were most frequently used. The high rate of RTM prescription was due to the fact that this drug was given to all patients with ANCA-associated vasculitis, systemic lupus erythematosus, and cryoglobulinemic vasculitis who totaled more than half of the patients included into the trial. The vast majority of them received GEBA for the first time. After the treatment, there was remission in 62 (57.9%) and improvement in 42 (39.3%) cases. Mild or moderate adverse reactions were observed in 22 (20.6%) patients and severe ones were seen in 6 (5.6%). Conclusion. GEBA therapy ensures a significant improvement in a substantial proportion of patients with different RD refractory to standard immunosuppressive therapy