Resolution on the results of the First All-Russian Forum "Therapeutic Education in Endocrinology"

According to the decision of the WHO, therapeutic education (TE) of patients is an independent branch of medicine and an essential component of the treatment of chronic diseases, primarily diabetes mellitus and obesity. TE is implemented through the creation of “Schools for patients with diabetes mellitus” and “Schools for patients with overweight” (“Schools”) as a structural unit of a medical institution. On April 25–26, 2022, the First All-Russian Forum «Therapeutic Education in Endocrinology» was held online, organized by the Public Organization «Russian Association of Endocrinologists», which was attended by leading experts in this field. As a result of its work, this Resolution was adopted by the experts. It discusses the methodological and pedagogical foundations of TE, it is proposed to make changes related to the organization of the work of «Schools», tariffing in the obligatory health insurance system, and training of personnel, including nurses

Recommendations from the European Working Group for Value Assessment and Funding Processes in Rare Diseases (ORPH-VAL)

International audienceAbstractRare diseases are an important public health issue with high unmet need. The introduction of the EU Regulation on orphan medicinal products (OMP) has been successful in stimulating investment in the research and development of OMPs. Despite this advancement, patients do not have universal access to these new medicines. There are many factors that affect OMP uptake, but one of the most important is the difficulty of making pricing and reimbursement (P&R) decisions in rare diseases. Until now, there has been little consensus on the most appropriate assessment criteria, perspective or appraisal process. This paper proposes nine principles to help improve the consistency of OMP P&R assessment in Europe and ensure that value assessment, pricing and funding processes reflect the specificities of rare diseases and contribute to both the sustainability of healthcare systems and the sustainability of innovation in this field. These recommendations are the output of the European Working Group for Value Assessment and Funding Processes in Rare Diseases (ORPH-VAL), a collaboration between rare disease experts, patient representatives, academics, health technology assessment (HTA) practitioners, politicians and industry representatives. ORPH-VAL reached its recommendations through careful consideration of existing OMP P&R literature and through a wide consultation with expert stakeholders, including payers, regulators and patients. The principles cover four areas: OMP decision criteria, OMP decision process, OMP sustainable funding systems and European co-ordination. This paper also presents a guide to the core elements of value relevant to OMPs that should be consistently considered in all OMP appraisals. The principles outlined in this paper may be helpful in drawing together an emerging consensus on this topic and identifying areas where consistency in payer approach could be achievable and beneficial. All stakeholders have an obligation to work together to ensure that the promise of OMP’s is realised

Boosting Geranyl Diphosphate Synthesis for Linalool Production in Engineered Yarrowia lipolytica

Linalool is a pleasant-smelling monoterpenoid widely found in the essential oils of most flowers. Due to its biologically active properties, linalool has considerable commercial potential, especially in the food and perfume industries. In this study, the oleaginous yeast Yarrowia lipolytica was successfully engineered to produce linalool de novo. The (S)-linalool synthase (LIS) gene from Actinidia argute was overexpressed to convert geranyl diphosphate (GPP) into linalool. Flux was diverted from farnesyl diphosphate (FPP) synthesis to GPP by introducing a mutated copy of the native ERG20F88W−N119W gene, and CrGPPS gene from Catharanthus roseus on its own and as part of a fusion with LIS. Disruption of native diacylglycerol kinase enzyme, DGK1, by oligo-mediated CRISPR-Cas9 inactivation further increased linalool production. The resulting strain accumulated 109.6 mg/L of linalool during cultivation in shake flasks with sucrose as a carbon source. CrGPPS expression in Yarrowia lipolytica increased linalool accumulation more efficiently than the ERG20F88W−N119W expression, suggesting that the increase in linalool production was predominantly influenced by the level of GPP precursor supply

Regulatory and legal status of clinical guidelines and their role in the quality control of medical care in countries of the European Union, North America and Asia

Introduction. In 2016-2018, the approaches to the development and use of clinical guidelines in the Russian Federation underwent substantial changes. As part of this work, legal aspects of clinical guidelines were modified. The present review, conducted on behalf of the Ministry of Health, is aimed to analyze the international experience regarding the clinical guidelines standards and identify possible obstacles and risks for their implementation.Materials and methods. We reviewed documents and publications related to the development and implementation of clinical guidelines in 2016-2017 in 12 countries from Europe, Asia and North America known for their well established health care systems. The search for publications has been conducted with the help of the PubMed bibliographic database and the Google search engine, using the following requests: «clinical practice guidelines legal status», «clinical practice guidelines + name of the country». The results were updated to 2019.Results. In most of the 12 countries, the clinical guideline development process is coordinated at the national level. However, the implementation of these guidelines by medical professionals is not mandatory, although it is often supported by the regulations of the national health system.Conclusion. The development and implementation of clinical guidelines in the Russian Federation is consistent with the international experience: the development of clinical guidelines is coordinated at the federal level in agreement with the principles of evidence-based medicine; the implementation of guidelines are not mandatory, however, medical organizations and health professionals are expected to provide the medical care by considering the clinical guidelines, approved by the Scientific and Practical Council of the Ministry of Health

Large-scale bioproduction of natural astaxanthin in Yarrowia lipolytica

Astaxanthin is a high-value chemical with strong antioxidant, anti-inflammatory and coloration properties. Here, a set of novel genetic engineering and culturing strategies for efficient astaxanthin bioproduction in Yarrowia lipolytica is reported. Modular pathway engineering and the fusion of two key enzymes (geranylgeranyl pyrophosphate synthase and bifunctional lycopene cyclase/phytoene synthase) yielded a recombinant strain with enhanced β-carotene and astaxanthin production, accumulating astaxanthin up to 131.9 mg/L in small-scale cultures with sucrose and 587.3 mg/L in a 3-L bioreactor with glucose as carbon sources, respectively. Notably, formation of intracellular carotenoid crystals was observed. Addition of oil overlayer at different regimes in 3-L bioreactors promoted secretion of astaxanthin and increased astaxanthin titer up to 973.4 g/L. Lastly, fed-batch fermentation in a 100-L bioreactor with glycerol as the carbon source resulted in a final astaxanthin titer of 812.3 mg/L after 114 h, representing the highest astaxanthin titer reported so far in large-scale cultures

Cold Hardening Prevents H2O2-induced Programmed Cell Death in Maize Coleoptiles

An influence of cold hardening (8 °С, 7 days) on the respiration intensity, the content of reactive oxygen species and DNA fragmentation in coleoptiles of maize etiolated seedlings of different ages and a possibility of the cold hardening to prevent execution of the cell death, induced by treatment with 10 mM H2O2 (for 4 hours) of seedlings have been studied. It has been shown that H2O2induces total DNA fragmentation in coleoptiles of maize etiolated seedlings, and a preliminary cold hardening prevents this process