[PATIENT SATISFACTION AS AN INDICATOR OF PATIENT ORIENTATION IN ORGANIZATION OF PAID MEDICAL SERVICES].

Nowadays, the idea of the patient as the main subject of medical care is being established in the public consciousness. It is around the patient that all types of professional medical activities and all forms of relationships with other subjects of modern health care are organized.In the professional sphere, this idea is seen as a principle of patient focus. In the provision of paid care, this factor acquires special relevance and is largely determined by the compliance of the process and results of the provision of medical care with the expectations of consumers of medical services. In this regard, the study of the expectations of the contingent of people applying for paid medical services to state medical organizations, and the degree of their satisfaction with receiving paid medical care was the purpose of this study.

[The effect of the new coronavirus infection on the structure of children traumatism].

The traumatism, including children traumatism, is one of priority problem of health care in the Russian Federation. The indices of children traumatism and disability because of injuries are the most important indices of children health. They characterize quality of child care in family, depend on common norms of public behavior, reflect cases of aggression and violence in relationship of adults and children and in children communities. The available comparative data permitted to analyze impact of the pandemic on structure and level of children traumatism as exemplified by the Kursk Oblast.

[Models of community-based psychiatric care in Italy and England]. / Modeli vnebol'nichnoi psikhiatricheskoi pomoshchi v Anglii i Italii.

THE AIM OF THE STUDY: Is to study and compare models of out-of-hospital psychiatric care in different countries-Italy and England.In the Italian model of community-based psychiatric care, institutions have been created - homes for permanent residence with a security regime (REMS), the most common of which are intensive (or assertive) treatment in the community and mandatory outpatient treatment. The form of intensive treatment is an active and long-term maintenance and treatment of patients. The essence of the methodology is to provide assistance at home, which is carried out by specially trained multidisciplinary teams, including psychiatrists, nurses, psychologists, social workers. However, in the long term, there is a tendency to increase relapses and acute conditions. The English model of community psychiatric care is based on the practice of the method of «individual case management¼. After the acute attack is stopped, the main work program includes work with a psychologist and/or a psychotherapist in the form of a number of multidimensional group and family therapy activities, training of social skills and ways of independent living, development of communication, self-esteem and confident behavior, which is achieved through psychocorrective work, as well as drug therapy and didactic training on appropriate simulators.Special attention is paid to social recovery, work with the family, social and labor recovery and instrumental support.

[The ways of developing management of organization and caring of women with diagnosis of habitual non-carrying of pregnancy].

In Russia, in conditions of reproductive crisis of modern family, miscarriage IS one of the important problems, in particular habitual miscarriage as significant risk factor of development of maternal and perinatal pathology. The timely identification and medical care support of pregnant women suffering from habitual miscarriage is essential in ensuring and maintaining their reproductive health. To obtain reliable and objective information by control boards on effectiveness of organization and provision of obstetric care to women with diagnosis of habitual miscarriage is an actual task. The purpose of the study is to develop information support of management of organization and provision of medical care of women with habitual miscarriage, based on identification and use of specific risk factors of development and prevention of this pathology.

[Cysteine cathepsins: structure, physiological functions and their role in carcinogenesis]. / Tsisteinovye katepsiny: stroenie, fiziologicheskie funktsii i rol' v kantserogeneze.

Cysteine cathepsins (Cts) also known as thiol proteinases belong to the superfamily of cysteine proteinases (EC 3.4.22). Cts are known as lysosomal proteases responsible for the intracellular proteins degradation. All Cts are synthesized as zymogens, activation of which occurs autocatalytically. Their activity is regulated by endogenous inhibitors. Cts can be secreted into the extracellular environment, which is of particular importance in tumor progression. Extracellular Cts not only hydrolyze extracellular matrix (ECM) proteins, but also contribute to ECM remodeling, processing and/or release of cell adhesion molecules, growth factors, cytokines and chemokines. In cancer, the expression and activity of Cts sharply increase both in cell lysosomes and in the intercellular space, which correlates with neoplastic transformation, invasion, metastasis and leads to further tumor progression. It has been shown that Cts expression depends on the cells type, therefore, their role in the tumor development differs depending on their cellular origin. The mechanism of Cts action in cancer is not limited only by their proteolytic action. The Cts influence on signal transduction pathways associated with cancer development, including the pathway involving growth factors, which is mediated through receptors tyrosine kinases (RTK) and various signaling mitogen-activated protein kinases (MAPK), has been proven. In addition, Cts are able to promote the epithelial-mesenchymal transition (EMT) by activating signal transduction pathways such as Wnt, Notch, and the pathway involving TGF-ß. So, Ctc perform specific both destructive and regulatory functions, carrying out proteolysis, both inside and outside the cell.

[The development of management of medical organizations providing specialized primary medical sanitary care to mental patients].

Actually, in Russian health care, the organization of community-based medical care of patients with mental disorders is considered as one of requested problems to be resolved. The in-patient substituting forms of specialized primary medical and social care for mental patients create optimal conditions for treatment and rehabilitation of this group of patients without separation from familiar social environment, that in many ways reduces "personality stigmatization" and promotes returning of individual to full-fledged social life, decreasing the load on the most expensive hospital care. One of such organizational forms implemented in Moscow under the new model of provision of mental care is out-patient mental module that provides specialized primary medical and social care and is tested in conditions of basic medical organization. Hence, the purpose of the study is to develop system of indices for continuous information support of management of implemented innovations.

[The role of saturated fatty acids in impaired lipid metabolism in patients with alcohol dependence syndrome]. / Rol' nasyshchennykh zhirnykh kislot v narushenii lipidnogo obmena u patsientov s sindromom zavisimosti ot alkogolya.

OBJECTIVE: To determine the content and role of saturated fatty acids (SFA) in lipid metabolism disorder in patients with alcohol dependence syndrome (ADS). MATERIAL AND METHODS: A total of 123 men were examined: 44 patients with ADS and 79 healthy people. The patients were examined on the 5-6 day after admission to the hospital. The content of saturated fatty acids (SFA) (caproic, caprylic, capric, undecyl, lauric, tridecane, myristic, pentadecanoic, palmitic, margarine, stearic, arachin, eicosanoic, behenic) was determined by gas-liquid chromatography. Quantitative calculation of SFA levels was carried out by the AgilentChemStationB.03.01 program (USA). The ratio of stearic to palmitic acid (C18:0/C16:0) was calculated. The study of the enzymatic activity of aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyltransferase (GGT) was carried out by generally accepted standardized methods on a Cobas Mirra automated analyzer. RESULTS: In ADS patients, changes in the composition of SFA were found with an increase in the number of short-chain fatty acids (caproic acid by 52.2%, caprylic acid by 75.5%); medium-chain acids (capric acid by 47.9%, undecyl acid by 74.7%, lauric acid), but with a decrease in the concentration of long-chain acids (pentadecanoic by 5.1%, margarine by 34.7%, arachinic by 19.58%, eicosanoic by 26.6%, behenic by 5.1%). Less correlations between the fatty acid content and the parameters of the lipid transport system of blood serum were established in ADS patients compared to the controls. This indicates deep disorders of lipid metabolism. CONCLUSION: The results expand the understanding of the complex mechanisms of lipid metabolism disorders in ASD, which is important for secondary prevention. They also substantiate the need for a purposeful study of lipid metabolism disorders in patients with ADS at an earlier stage of the disease.

QUANTUM CHEMICAL MODELING OF ANTIOXIDANT ACTIVITY OF GLUTATHIONE INTERACTING WITH HYDROXYL- AND SUPEROXIDE ANION RADICALS.

Following the analysis of the results of quantum chemical simulation of interaction between a GSH molecule and oxygen radicals ∙OH and ∙OO-, it was found that it takes place through the acid-base mechanism, where GSH acts as a base towards ∙OH, and as an acid towards ∙OO-. The results of quantum chemical calculations (electron density redistribution, energy characteristics) were correlated at the time of interaction of a GSH molecule with ∙OH and ∙OO- with a change of macroscopic parameters ofthe process of free oxygen, radical electroreduction in the presence of GSH (potential and maximum current of reduction waves), which is a direct experimental macroscale, evidence of results ofthe conducted nanoscale theoretical simulation.

Changes in disease activity, cytokine production, and proliferation of peripheral blood mononuclear cells in patients with rheumatoid arthritis after simvastatin treatment.

OBJECTIVES: The aim of this study was to investigate changes in disease activity, cytokine profiles, and proliferation of peripheral blood mononuclear cells (PBMCs) in active rheumatoid arthritis (RA) patients treated with simvastatin. METHODS: Thirty-three patients with active RA were prescribed simvastatin (40 mg/day) for 3 months. Most of the patients received background traditional disease-modifying anti-rheumatic drugs (DMARDs) in stable doses. At the end of treatment there was a reduction in the 28-joint Disease Activity Score (DAS28) and in the Health Assessment Questionnaire (HAQ) score. RESULTS: Eleven patients (33%) achieved a moderate European League Against Rheumatism (EULAR) response. There was a decrease in circulating interleukin (IL)-17 concentrations and spontaneous PBMC proliferation. Anti-CD3-stimulated IL-10 and tumour necrosis factor (TNF)alpha production by PBMCs was upregulated after simvastatin therapy. A reduction in serum IL-6 was detected only in the responder group. Baseline circulating IL-10 concentrations were higher in responders than in non-responders. CONCLUSION: Simvastatin treatment is associated with moderate clinical improvement in patients with active RA. Immunological changes produced by simvastatin in peripheral blood are complex and may reflect both its anti- and pro-inflammatory properties.

Primary biliary cirrhosis and coronary atherosclerosis: protective antioxidant effect of bilirubin.

Increased concentration of lipid peroxidation products in patients with primary biliary cirrhosis is related to elevation of serum lipid content, but not to activation of lipid peroxidation. Hyperbilirubinemia in patients with primary biliary cirrhosis is accompanied by a decrease in the concentration of lipid peroxidation products and increase in antioxidant activity of blood serum. Antioxidants play a major role in the prevention of atherosclerosis. We hypothesized that the absence of increased risk of atherosclerosis in patients with primary biliary cirrhosis is due to inhibition of lipid peroxidation in blood serum by antioxidant compound bilirubin.

Xestospongin C empties the ER calcium store but does not inhibit InsP3-induced Ca2+ release in cultured dorsal root ganglia neurones.

The action of Xestospongin C (XeC) on calcium concentration in the cytosol ([Ca2+]i) and within the lumen of endoplasmic reticulum (ER) ([Ca2+]L) was studied using cultured dorsal root ganglia (DRG) neurones. Application of 2.5 microM of XeC triggered a slow [Ca2+]i transient as measured by Fura-2 video-imaging. The kinetics and amplitude of XeC-induced [Ca2+]i response was similar to that triggered by 1 microM thapsigargin (TG). The [Ca2+]L was monitored in cells loaded with low-affinity Ca2+ indicator Mag-Fura-2. The cytosolic portion of Mag-Fura-2 was removed by permeabilisation of the plasmalemma with saponin. Application of XeC to these permeabilised neurones resulted in a slow depletion of the ER Ca2+ store. XeC, however, failed to inhibit inositol 1,4,5-trisphosphate (InsP3)-induced [Ca2+]L responses. We conclude that XeC is a potent inhibitor of sarco(endo)plasmic reticulum calcium ATPase, and it cannot be regarded as a specific inhibitor of InsP3 receptors in cultured DRG neurones.

Ca(2+) dynamics in the lumen of the endoplasmic reticulum in sensory neurons: direct visualization of Ca(2+)-induced Ca(2+) release triggered by physiological Ca(2+) entry.

In cultured rat dorsal root ganglia neurons, we measured membrane currents, using the patch-clamp whole-cell technique, and the concentrations of free Ca(2+) in the cytosol ([Ca(2+)](i)) and in the lumen of the endoplasmic reticulum (ER) ([Ca(2+)](L)), using high- (Fluo-3) and low- (Mag-Fura-2) affinity Ca(2+)-sensitive fluorescent probes and video imaging. Resting [Ca(2+)](L) concentration varied between 60 and 270 microM. Activation of ryanodine receptors by caffeine triggered a rapid fall in [Ca(2+)](L) levels, which amounted to only 40--50% of the resting [Ca(2+)](L) value. Using electrophysiological depolarization, we directly demonstrate the process of Ca(2+)-induced Ca(2+) release triggered by Ca(2+) entry through voltage-gated Ca(2+) channels. The amplitude of Ca(2+) release from the ER lumen was linearly dependent on I(Ca).

Impairment of respiratory functions in mitochondria of rats with an inherited hyperproduction of free radicals.

The functional characteristics of liver mitochondria and physical-chemical properties of mitochondrial membranes were studied in S rats with congenitally enhanced capacity to free radical generation in comparison to those in Wistar rats. It was shown previously that intense lipid peroxidation, numerous DNA rearrangements, protein oxidation, morbid states resembling human degenerative diseases and short life-span are characteristic of S rats. In present study we have demonstrated that in S rats at the age of 2-3 months the respiratory rate of the mitochondria in active metabolic state is lower than in Wistar rats, and so are the values for the respiratory control ratio, oxidative phosphorylation and membrane potential. By 10-12 months of age the decrease of the respiration rate and oxidative phosphorylation in S rat mitochondria become even more dramatic. These changes are associated with a decrease in the extent of dip of proteins into the membrane lipid layer or with the increase in the amount of protein aggregates. The results add to the understanding of the nature of morbid conditions developed under the effect of intensive free radical generation and to the comprehension of their role in aging.

Inherited enhancement of hydroxyl radical generation and lipid peroxidation in the S strain rats results in DNA rearrangements, degenerative diseases, and premature aging.

Previously by selection and inbreeding of Wistar rats susceptible or resistant to the cataractogenic effect of galactose the S and R rat strains differing in the intensity of hexose transport into the animal cells were developed. High level of OH-radical generation and enhanced lipid peroxidation are revealed in the liver and myocardium of the S rats in contrast to the R rats. Data are obtained supporting the view that enhanced generation of OH-radicals within the S rat tissues is due to oxidation and autooxidation of the abundant amounts of monosacharides intensely accumulating in the rat cells. In spite of continuous inbreeding for more than 40 generations and a high rate of homozygosity, numerous DNA rearrangements are revealed in the S rat genomes. Fragility of the S rat cell membranes is detected. Cataracts and other lens lesions, emphysema, tumors, cardiomyopathy-like changes in the myocardium, scoliosis, brain disfunctions are characteristic of the S rats, as well as low fertility and short life-span indicative of premature aging.