[PUBLIC CONTROL AS A MEAN OF ENSURING THE REALIZATION OF THE RIGHT TO HEALTH CARE].

The purpose of the article is to reveal the essence and specific features of public control as a mean of ensuring the realization of the right to health care, taking into account the existing scientific points of view and reasoning. The research materials were scientific works of Ukrainian scholars, analytical materials, political and legal opinion-based journalism, Internet resources and Ukrainian legislation regulating the activities of public control (supervision) in the health care sector. Generally scientific (systemic, structural and functional, comparative, etc.) and specially legal methods of scientific cognition (formal and legal, comparative and legal, method of studying legal practice, etc.) were used in the course of the study. The author has provided characteristics of public control in the health care sector and has formulated own definition of such a control. The author has studied the powers of the subjects of public control in the health care sector, where control over the observance of legislation in the activities of a certain authority or health institution is the main one. It has been noted that the activities of subjects, exercising public control, have the organizational nature and do not lead to legally significant consequences, although they contribute to the implementation of legal forms of ensuring relations in the health care sector. It has been emphasized that the subjects, exercising public control, do not have authoritative powers, but contribute to the realization of civil right to participate in the healthcare management.

[MEDICAL INSURANCE AS A METHOD OF SOCIAL PROTECTION OF CITIZENS IN UKRAINE].

The article is focused on studying social and economic conditions affecting the choice of the type of health insurance. The objective of the article is to justify the type of medical insurance as the method of social protection of citizens in Ukraine, where the access of the population to medical care is the key condition. The methodology of this study includes traditional and special methods of scientific cognition: synthesis, analysis, induction, deduction, generalization, proving, structural and functional, formal and legal, comparative, theoretical and prognostic. Analysis of the competitive environment at the market of medical services in the countries with developed market economies and in Ukraine demonstrates that business competition at this market, in general, has its own characteristics, which can negatively affect the quality of medical care. Assessing medical services by price and non-price criteria within a competitive environment, the authors of the article make actual the issue of fair access to medical care. The level of socio-economic development and constitutional restrictions on the transformation of medicine in Ukraine induce the feasibility of implementing health insurance in the form of compulsory state social medical insurance.

Relative Human Telomere Length Quantification by Real-Time PCR.

Telomere measurement by quantitative PCR amplification is a well-known simple method to detect telomere length that involves large numbers of samples. The method has been developed by Cawthon in 2002 (Cawthon, Nucleic Acids Res 30:47e-47, 2002) and remains the most frequently used technique either in original or modified version. Telomere length is estimated by comparing the amount of telomere repeat amplification product (T) to a single copy gene (S) product. The T/S ratio correlates with the average telomere length. Cawthon suggested and recommended the use of 36B4 (RPLP0) as a single copy gene. However, Cawthon's suggestion was no longer considered a single copy gene and the gene was not suitable and appropriate for normalization.We thereby introduced a simple method for relative measurement of average human telomere length using quantitative real-time PCR. Our protocol was based on Cawthon's initial technique (Cawthon, Nucleic Acids Res 30:47e-47, 2002), modified by single-copy gene (SCG) primers and optimized.This technique is rapid, low cost, not demanding on DNA amount (or live cells), and can be used for a high-throughput screening and time monitoring.

[Eosinophilic granuloma of the parietal bone of an adult patient with BRAF mutation]. / Éozinofil'naia granulema temennoi kosti s mutatsiei gena BRAF u vzroslogo patsienta.

The paper describes a case of eosinophilic granuloma of the parietal bone in a 32-year-old man. Histological examination revealed a large number of bean-shaped Langerhans cell histiocytes with lobed nuclei and nuclear grooves. The histiocytes alternated with the foci of obvious eosinophilic infiltration and with eosinophilic microabscesses. There were osteoclast-like multinucleated giant cells, bone resorption, and numerous bone rods covered with osteoblast chains. The histiocytes expressed CD1α, langerin, CD68, S100, and p53 (in 90.0% of the tumor cells). The Ki-67 proliferation index was 18.0%. A molecular genetic study identified BRAFV600E mutation (nucleotide substitution s.1799 T>A (p.V600E) in the heterozygous state). Clinical and morphological data and the results of molecular genetic studies led to the conclusion that there was eosinophilic granuloma of the right parietal bone (the unifocal form of Langerhans cell histiocytosis (LCH), type I, group A1, with the monoossal nature of lesion and with BRAFV600E mutation). In adults, this disease is extremely rare (2-5 cases of LCH per million people, bone loss in the fourth decade of life in 2.5% of the patients).

[Analysis of the association of polymorphic variants of SYP1A2, GSTT1,GSTM1, GSTP1, XRCC1, XRCC3, AR and VDR genes with predisposition to the development of prostate cancer].

One of the risk factors for the development of malignant tumors, including prostate cancer, is an individual genetic predisposition due to the various unfavorable polymorphic variants of normal genes. The aim of the study was to com- pare the frequency of different genotypes of polymorphic vari- ants of genes CYPJA2, GSTT, GSTM, GSTP1 (xenobiotics detoxification), XRCC1, XRCC3,(DNA repair) and VDR, AR (transcription factors) in patients with prostate cancer and in control group to determine their association with genetic pre- disposition to this disease. According to the results obtained the rs1544410 AA genotype (VDR gene) and the presence of less than 20 CAG repeats in the 1st exon (AR gene) are the risk factors for the development of prostate cancer. The het- erozygous genotype 722 CT (XRCC3 gene) demonstrated the protective effect.

[Telomere length, telomerase activity, stress and aging].

The review is dedicated to analysis of data available at present time concerning possible influence of stress upon telomere lengths and telomerase activity, as well as various ways of counteracting it. Present-day telomerase theory of aging gains a new impetus, shedding light upon the influence of psychological state of humans and their ability to counteract stress, upon the process of aging. It also tends to regard telomere shortening and the decrease in the activity of telomerase as a marker of level of the ability to adapt to both inner and outer influences. Both aging and age-dependent diseases are proved to be substantially retarded not only by the administration of drugs, but also by psychological means, which forms a good way towards healthy longevity. With complete understanding of the impossibility to prevent or even to slow down natural senescence itself, these methods allow to remove causes, which accelerate senescence, and to increase the average human longevity.

[Mosaic forms of ataxia-telangiectasia].

Ataxia-telangiectasia (AT) is a severe hereditary autosomal recessive neurodegenerative disease associated with accelerated aging and caused by mutation in both alleles of atm gene. This gene encodes a key protein of cell response to DNA damage--an ATM protein kinase. Normally, upon formation of DNA double strand breaks ATM is autophosphorylated and its active form phospho-ATM (P-ATM) appears. Here we describe a mosaic form of AT in which cells of the same patient with normal atm gene demonstrated the accumulation of P-ATM in response to DNA double-strand breaks-inducing factors whereas in cells bearing a mutant form of atm P-ATM was not detected. The epigenetic markers such as histone deacetylases SIRT1 and SIRT6, and trimethylated forms of histone H3 - H3K9me3 and H3K27me3--were studied in the nuclei of primary fibroblasts derived from patients with different forms of AT and the increase of SIRT6 level was revealed.

Family presence in the adult burn intensive care unit during dressing changes.

OBJECTIVES: To improve communication, discharge readiness, and satisfaction of burn patients and their families. METHODS: In March 2009, the burn intensive care unit at University of Louisville Hospital, Louisville, Kentucky, incorporated family presence during dressing changes. Adverse family events during observation, measures of patient- and family-centered care according to a standardized patient satisfaction survey, infection rates, and staff members' response to the intervention were tracked. RESULTS: Through December 2011, no adverse family events occurred, patients' satisfaction scores increased, and infection rates did not increase. Staff members responded positively to the project. CONCLUSIONS: Allowing family presence during dressing changes provides an opportunity to educate and include patients' family members in care delivery.

[Male circumcision is not associated with an increased prevalence of erectile dysfunction: results of the Cottbus 10,000-men survey]. / Die männliche Zirkumzision ist nicht mit einer höheren Prävalenz der erektilen Dysfunktion assoziiert: Ergebnisse der "Cottbuser 10.000-Männer-Fragebogenstudie"

BACKGROUND: There are conflicting data regarding the significance of the presence of the male prepuce or circumcision on erectile function and sexual satisfaction in men. MATERIALS AND METHODS: A total of 10,000 men selected according to the age distribution of the city of Cottbus (Brandenburg, Germany) were provided with a questionnaire comprised of 35 items integrating the International Index of Erectile Function (IIEF-6) and further questions on sexual quality of life, comorbidities and previous surgical treatment. Of the men who completed the questionnaire 2,499 were living in a partnership and formed the study group for this survey. Based on the IIEF-6, two study endpoints (SEP) were defined (point values ≤ 25/SEP1 and ≤ 21/SEP2). By multivariable logistic regression analysis the independent influence of previous circumcision on both endpoints was assessed. Furthermore, a correlation between sexual satisfaction of men and circumcision was also analyzed. RESULTS: Of the study group167 men had undergone circumcision (6.7 %). Erectile dysfunction (ED) was present in 40.1 % of men based on SEP1 (minor to severe ED) and in 27.8 % based on SEP2 (moderate to severe ED). Based on SEP1 as well as SEP2 age, history of smoking, hypertension, diabetes, chronic ischemic heart disease, peripheral arterial obstructive disease, cirrhosis of the liver and history of pelvic surgery were found to have an independent influence on the presence of ED. A status after circumcision did not show an independent influence on either study endpoints (SEP1: OR 1.36, p=0.174; SEP2: OR 1.42, p=0.175). Furthermore, there was no significant correlation between sexual satisfaction of men and a history of circumcision. CONCLUSIONS: Based on the present study which represents the largest survey worldwide on male ED using the IIEF as a validated instrument, it could not be confirmed that the prevalence of ED is increased in men following circumcision. Sexual satisfaction of men in this study was independent of the presence of the prepuce.

[Diagnostics of ataxia-telangiectasia by the express-test found on the method of indirect immunofluorescence].

Ataxia-telangiectasia (AT) is a hereditary severe neurodegenerative disease developing, when mutations take place in both alleles of the atm gene, which encodes the key protein of the cellular response to DNA damage (DDR)--ATM proteinkinase. In response to the occurrence of double-strand DNA breaks, the ATM proteinkinase pass the autophosphorylation, and its active form--the phospho-ATM (P-ATM) appears in cells. In the nuclei of cells having the atm gene, P-ATM is revealed, being absent in cells with mutated forms of this gene, by means of the application of the modified method of indirect immunofluorescence. This peculiarity may be applied in the clinic, in order to confirm the diagnosis of AT.

[Violation of the homologous chromosomes approchement as the answer to the small doses of roentgen irradiation].

Any violation of the homologous chromosome DNA repair leads to the genome instability, characteristic for hereditary syndromes and for aging cells. Using low doses of ionizing radiation (3-10 cGy) we have found any transference of the homologous centromere loci of the chromosome 1 (1q12) from the periphery to the cen- tre of the nucleus in the lymphocytes of young healthy donors. The same effect was found after any influence of RNA-polymerase inhibitor a-amanitine. Some changes in the chromatin structure during aging (70-80 years old patients) result in the difficulties in chromosome displacement, accompanied with any trouble in the appro- achement of the homologous chromosome loci as an answer to low doses of radiation.

[The factor analysis results of the relationship of socio-demographic, clinical and functional indicators with the likelihood of identifying age-related disorders in the population in North-Western Russia].

By using the method of factor analysis (principal component method) the determinants of disease in elderly and senile patients were searched with an estimate of their influence degree in the population of the North-West Russia. The data from medical records of 712 patients of both sexes aged 59 to 98 years were analyzed. The factor 1 proved to be associated with: marital status, living conditions, family relationships, bad habits, appearance, cough, diet, hearing and vision, laxatives, joint health, ability to move and sleep disturbances. Factor 2 combined diseases of older: cerebral stroke, myocardial infarction, cardiac arrhythmia, diabetes, kidney disease, obesity, thyroid disease, Parkinson's disease, lung disease, anemia, arthritis, osteoporosis, the number of surgeries and joint diseases. The factor 3 was found to self-association ability before and after admission to the assessment of the patients' mental state for MMSE test after admission. It is concluded that the development of age-related (especially the musculoskeletal system pathology) is associated with social characteristics and living conditions of patients, and treatment of the most age-related diseases requires consideration of comorbidity.

[The influence of age of donors on the ability of cells to homologous recombination DNA repair].

Old and young donors cells show different ability to homologous recombination (shown on the first stage--the chromosome transference) in vitro, that we suppose could be the reasons of the genome instability in aging. Homologous recombination, induced by X-radiation, is limited in cells taken from donors older than 70 years. Alpha-amanitin, the RNA-polymerize II repressor, in toxic doze, could induce the chromosome transference in the cells from all studied groups: from old and young donors and donors with repair process defect (with BRCA 1, 2 mutations). Summarized effect of X-radiation and alpha-amanitin does not increase the induction of the chromosome transference.

[Telomere length in the population of long-lived persons of North-West region of Russia].

Interdisciplinary study of telomere length, polymorphism of genes of renin-angiotensin (ACE) and serotonin (5HTR2A and 5HTTPR) systems in population of aged and old inhabitants of the North-West of Russia was conducted, in their relations to data from clinical and geriatric anamnesis, and psychological functioning. Regular link between telomere length and respondent's age was demonstrated in subgroups of old respondents and long-livers, by method of factor analysis.

[Distribution of serotonin transporter 5-HTTLPR gene polymorphism in population of the North-West of Russia].

Genetic polymorphism of the promotor zone of the gene of serotonin transporter (5HTT) is related to adaptive ability of humans, along with ability of conducting emotional control. Consequently, 5HTT polymorhisms form a constructive model of enhanced resistance to psychoemotional strain in aged humans. The paper is dedicated to tracing back relations between 5HTT polymorphic variants, and psychological characteristics of the long-livers of the North-Western Russia, as well as the geriatric ones.

Ocular neuroprotection by siRNA targeting caspase-2.

Retinal ganglion cell (RGC) loss after optic nerve damage is a hallmark of certain human ophthalmic diseases including ischemic optic neuropathy (ION) and glaucoma. In a rat model of optic nerve transection, in which 80% of RGCs are eliminated within 14 days, caspase-2 was found to be expressed and cleaved (activated) predominantly in RGC. Inhibition of caspase-2 expression by a chemically modified synthetic short interfering ribonucleic acid (siRNA) delivered by intravitreal administration significantly enhanced RGC survival over a period of at least 30 days. This exogenously delivered siRNA could be found in RGC and other types of retinal cells, persisted inside the retina for at least 1 month and mediated sequence-specific RNA interference without inducing an interferon response. Our results indicate that RGC apoptosis induced by optic nerve injury involves activation of caspase-2, and that synthetic siRNAs designed to inhibit expression of caspase-2 represent potential neuroprotective agents for intervention in human diseases involving RGC loss.

[Metformin slows down ageing processes at the cellular level in SHR mice].

It has been shown recently that metformin, the indirect mTOR-kinase inhibitor, significantly increases medium (by 37.8%) and maximum (by 10.3%) life span of SHR mice (Anisimov et al., 2008). We obtained fibroblasts from skin of 11-, 16-, 19- and 23-months-old SHR mice treated with metformin since the third and ninth day of life. We studied markers of cellular senescence in these fibroblasts. Significant differences were observed between the average number of senescence-associated heterochromatic foci (SAHF), the average of area nuclei and fluorescence intensity of nucleus after staining for gamma-H2AX in control and experimental animals. Also, we showed that metformin prevented the accumulation of fibroblasts with large area of nuclei; high activity of senescence-associated beta-galactosidase (SA-beta-gal), and high fluorescence intensity after staining for gamma-H2AX. It appears that accumulation of large quantity of senescence markers within a cell triggers it to enter the aging process. It appears that the increase of "old" cell population above the threshold disrupts the normal function of certain tissues, organs, and finally, the whole organism. It appears that metformin delays the "old" cells accumulation and prolongs the organism youth.

[Distribution of structural polymorphisms of angiotensin-converting enzyme and serotonin receptor 5-HT2A genes among long-livers of North-Western Russia].

In the group of long-livers of the North-West of Russia, I/D polymorphism of angiotensin-converting enzyme (ACE) gene and C102T polymorphism of serotonin receptor (5-HT2A) gene were studied. No reliable differences in allele frequency of these genes between long-livers and young people were detected. Nevertheless, highly pronounced difference in the A1/A2 allele frequency of 5-HT2A gene between populations of the North-West of Russia, on the one hand, and of the USA, on the other hand, was discovered (i.e. 0.397(A1), 0.603(A2), and 0.615(A1), 0.385(A2), respectively). Differences of this kind between the two populations deserve special consideration, conditioning the necessity of further detailed analysis of other genes of the serotonin system in the populations of other regions of Russia.