[The health capital and efficiency of regional health care systems: The conformances and contradictions].

The article explores relationship between health capital and efficiency indices of regional health systems. The correlation analysis of relationship between individual subjective assessments of health capital and objective indices of health care system functioning in the regions and the Federal Okrugs of the Russian Federation based on application of Minmax technology was carried out. The determination of level of health capital was implemented according to results of population survey and subsequent modeling. The effectiveness of regional health care systems was assessed using indices of healthy life expectancy, percentage of the disabled and per capita health care expenditures in the regions. It is established that 1/3 of subjects of the Russian Federation have high level of health care efficiency. However, the high level of health capital was noted in 12.5% of subjects, while in 40% of them its level was low. There are pronounced regional differences in the stock of health capital. The highest level of health capital was established in the subjects of the North Caucasian Federal Okrug that is conditioned by higher healthy life expectancy and higher efficiency of health care system at lower per capita costs. The statistically significant differences between subjective and objective factors affecting assessment of health capital are presented. The lower per capita health care costs and high percentage of the disabled have no significant impact on health capital of the population in the regions of Russia. The differences between health capital and regional health system performance indices are conditioned by subjective nature of health capital estimates that are determined by individuals within social groups and are characterized by persistent systematic differences between regions.

Corrigendum to "Activation of Melanocortin Receptors MC1 and MC5 Attenuates Retinal Damage in Experimental Diabetic Retinopathy".

[This corrects the article DOI: 10.1155/2016/7368389.].

Activation of Melanocortin Receptors MC 1 and MC 5 Attenuates Retinal Damage in Experimental Diabetic Retinopathy.

We hypothesize that melanocortin receptors (MC) could activate tissue protective circuit in a model of streptozotocin- (STZ-) induced diabetic retinopathy (DR) in mice. At 12-16 weeks after diabetes induction, fluorescein angiography (FAG) revealed an approximate incidence of 80% microvascular changes, typical of DR, in the animals, without signs of vascular leakage. Occludin progressively decreased in the retina of mice developing retinopathy. qPCR of murine retina revealed expression of two MC receptors, Mc1r and Mc5r. The intravitreal injection (5 µL) of the selective MC1 small molecule agonist BMS-470539 (33 µmol) and the MC5 peptidomimetic agonist PG-901 (7.32 nM) elicited significant protection with regular course and caliber of retinal vessels, as quantified at weeks 12 and 16 after diabetes induction. Mouse retina homogenate settings indicated an augmented release of IL-1α, IL-1ß, IL-6, MIP-1α, MIP-2α, MIP-3α, and VEGF from diabetic compared to nondiabetic mice. Application of PG20N or AGRP and MC5 and MC1 antagonist, respectively, augmented the release of cytokines, while the agonists BMS-470539 and PG-901 almost restored normal pattern of these mediators back to nondiabetic values. Similar changes were quantified with respect to Ki-67 staining. Finally, application of MC3-MC4 agonist/antagonists resulted to be inactive with respect to all parameters under assessment.

Eight years of quality control in Bulgaria: impact on mammography practice.

The requirements for quality control (QC) in diagnostic radiology were introduced in Bulgarian legislation in 2005. Hospital medical physicists and several private medical physics groups provide QC services to radiology departments. The aim of this study was to analyse data from QC tests in mammography and to investigate the impact of QC introduction on mammography practice in the country. The study was coordinated by the National Centre of Radiobiology and Radiation Protection. All medical physics services were requested to fill in standardised forms with information about most important parameters routinely measured during QC. All QC service providers responded. Results demonstrated significant improvement of practice since the introduction of QC, with reduction of established deviations from 65 % during the first year to 7 % in the last year. The systems that do not meet the acceptability criteria were suspended from use. Performance of automatic exposure control and digital detectors are not regularly tested because of the absence of requirements in the legislation. The need of updated guidance and training of medical physicists to reflect the change in technology was demonstrated.

[Surgical treatment of 294 patients with invasive cervical cancer].

OBJECTIVE: To establish the indices of surgical treatment (duration of operation--min, blood loss--ml, time to bowel and bladder function recovery--days) in treatment of invasive cervical cancer. MATERIAL AND METHODS: Between 11.2002-11.2011 296 patients with invasive cervical cancer were operated on by the author. 294 were valuable in terms of indices of surgical treatment. The age of patients ranges from 27 to 84 years, median--48 years. 110 women were in stage IB1 (FIGO), 86--in IIB, and 98--in IB2 stage. The surgery in 81% (238 cases) was radical hysterectomy class III (RH) and pelvic lymph node dissection (LND) in 2.7% (8 cases) RH and PLN and paraaortic lymph node dissection (PLD); LEP in 8.2% (24 cases) and RH with transposition of the ovaries and PLD in 5.1% (15 cases). RESULTS: The median duration of operations (only RH and LND) was 124 minutes, the median blood loss--480 ml. Blood transfusion was performed in 37% of cases. The median time for bladder and bowel function recovery was 22 and 3 days, respectively. CONCLUSION: Open surgery performed by experienced teams trained in good technical skills leads to blood loss and recovery of patients comparable with miniinvasive techniques.

[Therapeutic outcomes in patients with cervical cancer FIGO stage IB1].

OBJECTIVE: To establish overall and disease-free survival (OS and DFS) for patients with FIGO IB1 stage cervical cancer for median period of follow-up of 41 months. MATERIAL AND METHODS: Between 11.2002-11.2011 110 women with histologically confirmed cervical cancer IB1 stage were operated on by the author. Surgery was radical hysterectomy class III (Piver) and pelvic lymphonodulectomy (ovariectomy was optionally). 76 patients were submitted to adjuvant RT (TGT- 52 - 54 Gy). The period of follow-up ranges from 2 to 104 monts, median 41 monts. RESULTS: The acturial OS and DFS in patients with cervical cancer IB1 stage were estimated as 90% and 90.9%, respectively. Eleven patients had died for the period of follow-up and in 10 occurred local or distant recurrences. The time to develop recurrences was estimated as 16.81 months. Four patients developed local recurrences and six--distant metastases. CONCLUSION: Surgical and combined therapy of cervical cancer patients IB1 stage leads to high rate OS and DFS--90% and 90.9%, respectively. The incidence rate of distant metastases (5.5%)--in six patients in this stage makes pelvic lymph node dissection crucial and the presence of LM in gluteal and presacral lymph nodes requires paraaortic lymph node dissection.

[Treatment of cervical carcinoma IB2 stage].

OBJECTIVE: To establish the overall and disease-free survival (OS and DFS) in patients IB2 stage FIGO with primary surgical treatment or operated on after preoperative RT. MATERIAL AND METHODS: Between 2003-2011 98 patients (FIGO IB2 stage) were operated on. 83 patients were submitted to primary surgery (radical hysterectomy class III with pelvic lymph node dissection--group 1 and 11 were operated on after preoperative RT - 30 Gy - group 2. All operated patients were submitted to adjuvant RT - 52 Gy. Four patients were operated on after NCT (neoadjuvant chemotherapy). All patients were followed between 2 and 96 months--median period of 45 months. RESULTS: The acturial OS and DFS for all patients were estimated as 73.5% and 75.6% respectively. The OS and DFS for group 1 were estimated as 73.5% and 74.7% respectively. The OS and DFS for group 2 were estimated as 72.8% and 82%, respectively. CONCLUSION: Stage IB2 cervical cancer is related to worse prognosis in comparison to IB1 FIGO stage, because of the higher incidence of distant metastases. Preoperative RT doesn't change the oncological outcomes. There is no statistical difference between group 1 and group 2 in terms of survival. Is important to perform paraaortic lymph node dissection and concurrent radiochemotherapy in these patients.

[Oncological outcomes of combined therapy in patients with cervical carcinoma FIGO stage IIB].

OBJECTIVE: To establish the overall and disease-free survival and the role of surgery as well as in cervical cancer stage IIB (FIGO) patients submitted to combined radiotherapy and surgery. MATERIAL AND METHODS: Between 2003-2011 86 patients with cervical cancer stage IIB had been operated on. Five patients were operated on after neoajuvant chemotherapy. Thirty one women (group 3) had primary pelvic surgery (radical hysterectomy class III and lymphonodulectomy) and adjuvant RT until 52 Gy and 50 women were operated on after preoperative RT (30 Gy) and were submitted to adjuvant RT until 52 Gy (group 4). RESULTS: After median follow of 45 months the acturial overall and disease-free survival (OS and DFS) were estimated as 75.6% and 77.9% respectively for all patients staged IIB (FIGO). In group 3 the incidence of local relapses and distant metastases was 9.7% and 12.9%, respectively and in group 4--local and distant recurrences were 6% and 14%, respectively. The acturial OS and DFS for group 3 were 80.6% and 77.5%, respectively and for group 4--76% and 80% (NS). CONCLUSION: Combinated treatment (RT and pelvic surgery) produce reliable local control of the disease (cervical cancer IIB stage) but is ineffective for metastases outside the small pelvis which is the cause of worse survival of patients with cervical cancer stage IIB (FIGO). Preoperative RT (group 4) doesn't change the OS and DFS significantly. The main indication for surgery in patients with cervical cancer stage IIB is the surgical staging (pelvic and paraaortic lymph node dissection) which enables the appropriate individual treatment planning.

Melanocortin peptide therapy for the treatment of arthritic pathologies.

Arthritic pathologies are a major cause of morbidity within the western world, with rheumatoid arthritis affecting approximately 1% of adults. This review highlights the therapeutic potential of naturally occurring hormones and their peptides, in both arthritic models of disease and patients. The arthritides represent a group of closely related pathologies in which cytokines, joint destruction, and leukocytes play a causal role. Here we discuss the role of naturally occurring pro-opiomelanocortin (POMC)-derived melanocortin peptides (e.g., alpha melanocyte stimulating hormone [alpha-MSH]) and synthetic derivatives in these diseases. Melanocortins exhibit their biological efficacy by modulating proinflammatory cytokines and subsequent leukocyte extravasation. Their biological effects are mediated via seven transmembrane G-protein-coupled receptors, of which five have been cloned, identified, and termed MC1 to MC5. Adrenocorticotrophic hormone represents the parent molecule of the melanocortins; the first 13 amino acids of which (termed alpha-MSH) have been shown to be the most pharmacologically active region of the parent hormone. The melanocortin peptides have been shown to display potent anti-inflammatory effects in both animal models of disease and patients. The potential anti-inflammatory role for endogenous peptides in arthritic pathologies is in its infancy. The ability to inhibit leukocyte migration, release of cytokines, and induction of anti-inflammatory proteins appears to play an important role in affording protection in arthritic injury, and thus may lead to potential therapeutic targets.

Risk and protective factors for development of colorectal polyps and cancer (Bulgarian experience).

BACKGROUND/AIMS: Colorectal cancer takes third place among all malignancies in the Varna region. The present study aims to determine the typical and distinguishing risk and protective factors for colorectal polyps and cancer formation. METHODOLOGY: 166 patients with large bowel polyps and 107 patients with colorectal cancer were questioned, examined endoscopically and histologically. Logistic regression analysis was used to find a possible correlation between alimentary habits, way of life, and risk for colorectal polyps and cancer formation. The latter have been used to define a strategy for their prevention. RESULTS: Our results showed that fried, preserved, and grilled meat, consumption of animal fats, sugar, and being overweight are positively associated with colorectal polyps. In contrast, consumption of fruit, vegetables, rye- and brown bread, green tea, vegetable food, yoghourt, vegetarian food, fish, lamb, hare, garlic, boiled food, and mineral water, have strong protective effect against large bowel polyps. We have confirmed the role of the well-known risk factors for colorectal cancer, and discovered an association between H. pylori infection, age, villous component in the adenomatous polyps, and family history for any neoplasia and large bowel carcinoma. CONCLUSIONS: We suggest the following protective factors for CRC: vegetarian food, plant oil, rural life, aspirin intake, legumes, fish, fruit and vegetable consumption. We observe a similarity between the risk factors for colorectal polyps and cancer formation. They act simultaneously and depend on genetic predisposition. A combination of endoscopic treatment and correction of the alimentary factors could be used as a means of cancer prevention.