[The combination of moral and law norms in regulation of medical activity].

The article considers proposals developed according results of the study and targeted on improving social regulation of medical activities on basis of complex institutional approach. The complexity of approach lies in the fact that in regulation of public relations in health care opposition between norms of law and norms of morality is not allowed because in medicine they inter-condition and inter-complement each other. The institutional aspect of approach is reflected in tight interaction of moral and legal foundations, as well as in mechanisms of implementation of social standardization of specific sphere of medical activity. The formalized model of integrated institutional approach is presented. The importance of bioethics, in which principle of inter-complementarity of morality and law is realized to its maximum extent is emphasized. The significance of structural principles of bioethics that characterize totality of stable relationships of subjects of medical intervention is highlighted. The emphasis is made on interrelation between principles of bioethics and medical ethics, on norms of medical ethics, that largely determine content of professional duty of physician. The norms of medical ethics are grouped into three systems: "doctor-patient", "doctor-colleague" and "doctor-society" that are contained in international ethical documents and "The Code of Professional Ethics for Physicians" of the Russian Federation. The importance of internal and external mechanisms of implementation of complex social regulation of medical activity is marked.

[The mechanisms of regulation of disputes concerning inappropriate medical services support].

The article presents the results of comparative study of dispute resolution mechanisms related to the improper provision of medical services. On the basis of consumer model of physician-patient relationship basic options of pretrial and alternative mechanisms of settlements of disputes related to inadequate rendering of paid medical services are considered. On the basis of legal design for consumers and medical personnel the simple and evident statement of possible alternatives of mechanisms of settlement of disputes is presented. Te preferable design is consecutive application of all pretrial and alternative mechanisms of settlement of disputes. In case when there is no desirable result is the final decision is taken by court. It is concluded that the settlement of most disputes (90%) using pretrial and alternative dispute resolution mechanisms will significantly reduce time to resolve conflicts, as well as minimize unfavorable moral and economic consequences for consumers and providers of medical services.

[Pathomorphology of shock-related changes as a criterion for age dating of injury].

The necessity of integrated approach to age dating of injuries implies the search for new diagnostic criteria. Shock may be one of them. Analysis of shock-related morphological changes in the affected and intact tissues along with concomitant inflammatory reactions permits to more accurately determine the length of the post-trauma period.

[Influence of nicotinamide adenine dinucleotide and hemin concentrations on the growth of Haemophilus influanzae type b and the synthesis of capsular polysaccharide].

In the process the cultivation of H. influenzae, type b, in semisynthetic nutrient medium with aminopeptide base the growth of the bacteria and the synthesis of capsular polysaccharide were shown to depend on the concentrations of aminopeptide, nicotinamide adenine nucleotide (NAD) and hemin. An increase in the concentrations of NAD and hemin stimulated the growth of H. influenzae and inhibited the synthesis of capsular polysaccharide. Similar effect was observed in the simultaneous increase of NAD and hemin concentrations. At elevated concentrations of NAD and hemin and the content of aminopeptide equal to 350 mI/l the maximum weight of biomass was achieved. The increase of hemin concentration had no influence on the growth of H. influenzae, type b, and the synthesis of capsular polysaccharide.

[Influence of the aminopeptide concentration on the growth of Haemophilus influenzae, type b, and the synthesis of its capsular polysaccharide].

The influence of the aminopeptide concentration on the growth of H. influenzae b culture and the synthesis of H. influenzae b capsular polysaccharide was determined. The maximum amount of capsular polysaccharide was accumulated at the concentration of aminopeptide in the culture fluid reaching 50 ml/l. An increase in the aminopeptide concentration led to a decreased amount of synthesized polysaccharide and an increased amount of biomass. The decrease of the aminopeptide concentration to 10 ml/l resulted in decreased amounts of both biomass and synthesized polysaccharide.

[Changes in hemostasis and vagal tonus in healthy individuals and patients with facial neuropathy by micro-dose heparin stimulation of nasal receptors]. / Izmenenie gemostaza i vagotonii u zdorovykh i bol'nykh nevropatieí litsevogo nerva, putem stimuliatsii retseptorov nosa mikrodozami geparina.

The effects of heparin microdoses on vagal tone (the Bayevsky heart rate variability index) and blood coagulation time were examined in 15 healthy men and women and in 14 patients with acute facial neuropathy. Nasal inhalation of heparin solution vapour (thrice every 30 sec, interrupted by a 60-80 sec interval) without changes in olfactory sensation or nasal secretion prolongs the onset and completion of blood clotting and decreased heart rate (vagal activation) in normotony volunteers. The similar procedure of distilled water nasal inhalation appears to be ineffective.

[Mechanism of action of N-acetylglucosaminyl-N-acetylmuramylalanyl-D-isoglutamine on the nonspecific anti-infection resistance of mice]. / K mekhanizmu deistviia N-atsetilgliukozaminil-N-atsetilmuramilalanil-D-izoglutamina na nespetsificheskuiu protivoinfektsionnuiu rezistentnost' myshei.

The stimulating influence of glucose-containing muramyldipeptide (GMDP) on the nonspecific resistance of mice was shown to depend on the features of the pathogenesis of the infection. Thus, the intraperitoneal injection of GMDP increased the survival rate of mice infected with Escherichia coli, but had no stimulating effect on the resistance of the animals to Salmonella typhimurium natural infection in whose pathogenesis macrophages played an essential role. Experiments demonstrated that GMDP was capable of enhancing the ingestive function of macrophages, but did not increase their bactericidal activity with respect to this infection.

[Effect of immunization with an enterobacterial vaccine on the rate of plating out of Shigella from the intestinal mucosa of mice orally infected]. / Vliianie immunizatsii énterobakterial'noi vaktsinoi na vysevaemost' shigell iz slizistoi kishechnika myshei pri peroral'nom zarazhenii.

The oral and subcutaneous immunization of mice with the vaccine prepared from S. minnesota strain R595, chemotype Re, known as enterobacterial vaccine, was found to significantly decrease the number of shigellae in cultures obtained by the inoculation of homogenized mucosal samples taken from the large intestine of mice, the vaccine prepared from S. minnesota isogeneous strain SF 1111 with the intact structure of lipopolysaccharide had no such activity. Antisera, obtained by the immunization of rabbits with enterobacterial vaccine, contained high titers of antibodies to Re-glycolipid and were capable of decreasing the isolation rate of shigellae from homogenized mucosal samples taken from the large intestine of mice; at the same time S. flexneri were found capable of binding with antibodies to glycolipid of Re-chemotype.

[The protective properties of myelopeptides in the development of infectious processes caused by bacteria of the genus Salmonella]. / Protektivnye svoistva mielopeptidov pri razvitii infektsionnykh protsessov, vyzvannykh bakteriiami roda Salmonella.

The protective properties of myelopeptides in the development of bacterial infection in mice and young pigs, caused by S. typhimurium 415, S. cholerae-suis 1422 and 370, have been studied. Myelopeptides have been found to possess protective properties when injected into animals infected with S. typhimurium and S. cholerae-suis in lethal doses. The best protective effect (survival rate of 100%) has been achieved by the injection of myelopeptides 24 hours before challenge. Myelopeptides have also been found to promote the weight gain of young pigs infected with S. cholerae-suis.

[The adjuvant effect of synthetic glycopeptides on humoral immune response to thymus-dependent antigen]. / Ad"iuvantnoe deistvie sinteticheskikh glikopeptidov na gumoral'nyi immunnyi otvet na timuszavisimyi antigen.

The comparative study of 5 analogs of muramyldipeptide (MDP) on primary and secondary immune response to bovine serum albumin has been studied. The adjuvant activity of the MDP analogs has been shown to be closely connected with their structure. Thus, the replacement of glutamine by aspartic acid leads to the loss of adjuvant properties, and the replacement of L-alanine by its stereoisomer causes a perceptible decrease in these properties. The most active analog of MDP is GlcNAc-MurNAc-Ala-D-Glu-NH2 which produces a stimulating effect when introduced parenterally (subcutaneously and intraperitoneally) in a dose of 1 microgram, and orally in a dose of 100 micrograms.

[Antigenic makeup of the protective fractions of S. typhimurium]. / Antigennyi sostav protektivnykh fraktsii S. typhimurium.

The authors present the results of chemical and immunochemical study of 4 protective fractions (Grasset's antigens, hydroxylamine vaccines, surface antigens, and Boivin's antigens) isolated from the virulent S. typhimurium strain, and of suppressor revertant obtained from streptomycin-dependent mutant of the initial strain. Despite some differences in their chemical and antigenic composition, Grasset's antigens, surface antigens fraction, and hydroxylamine vaccine contained the main cell protective substances and could be used (after further study) as vaccines for enteral immunization. On the basis of the results of chemical analysis and the study of Boivin's antigens antigenic structure it is supposed that O-antigen was changed in the revertant strain.

[Humoral and cellular immunity factors in peroral vaccination with an S. typhimurium antigenic complex]. / Gumoral'nye i kletochnye faktory immuniteta pri peroral'noi vaktsinatsii antigennym kompleksom S. typhimurium.

The role of individual immunity factors in protection from S. typhimurium infection was studied on mice immunized orally in a single administration with an antigenic complex obtained by the treatment of bacterial cells with hydroxylamine. The oral administration of this preparation induced the systemic and local transformation of the organism, which was manifested by the accumulation of antibody-producing cells in the immunocompetent organs (spleen, mesenteric lymph nodes) and the increase of the phagocytic activity of macrophages in peritoneal fluid. Cellular immunity factors were found to be important for the development of resistance to salmonellosis caused by S. typhimurium after oral immunization with the antigenic complex.

[Effectiveness of oral immunization of white mice with a complex S. typhimurium antigen]. / Effektivnost' peroral'noi immunizatsii belykh myshei kompleksnym antigenom S. typhimurium.

The protective properties of hydroxylamine preparation obtained from a virulent strain of S. typhimurium were studied in experiments with natural infection after a single oral immunization. The new data obtained in these experiments suggest that the treatment of bacteria with hydroxylamine allows to produce the preparation which, when administered orally, has the immunizing dose only 20 times as great as its immunizing dose for subcutaneous administration. The action of gastric juice on hydroxylamine preparation, as well as the duration and specificity of immunity induced by the oral administration of this preparation were studied. The oral administration of some adjuvants was found to make it possible to considerably decrease the effective dose of the vaccine.

[Immunological efficacy of live streptomycin-dependent salmonellae vaccines used orally in experiment on monkeys]. / Immunologicheskaia éffektivnost' zhivnykh streptomitsinzavisimykh sal'monelleznykh vaktsin pri peroral'nom primenenii v éksperimente na obez'ianakh

Experiments were conducted on 99 monkeys; a study was made of the reactogenic properties and the immunological efficacy of the streptomycin-dependent S. enteritidis and S. typhimurium mutants in oral application. The results of clinical, bacteriological, pathomorphological and fluorescent-serological studies demonstrated that the vaccines in the doses under study were areactogenic for monkeys in 5-fold oral administration and promoted development of marked immunity. The greatest immunizing effect was obtained in 5-fold oral vaccination with the subsequent three-fold (in 2 months) revaccination of the monkeys. Associated streptomyqin-dependent S. enteritidis and S. typhimurium vaccine could be used for prophylaxis of salmonellosis in monkeys.

[Capacity of triterpene glycosides from holothurians to stimulate antibacterial resistance in a model of experimental murine salmonellosis]. / Sposobnost' triterpenovykh glikozidov iz goloturii stimulirovat' antibakterial'nuiu ustoichivost' na modeli éksperimental'nogo sal'monelleza myshei.

When injected intraperitoneally into mice in doses of 40.0-0.4 microgram, Cucumarioside, the preparation of triterpene glycosides obtained from sea cucumbers (Cusumaria japonica), enhanced the resistance of the animals to the subsequent challenge with Salmonella typhimurium. The study of the duration of the persistence of salmonellae in mice receiving the preparation in a dose of 0.001 microgram revealed a decrease in the contamination of their organs. The same dose of the preparation stimulated the phagocytic activity of peritoneal exudate cells with salmonellae showing decreased cytopathogenic action. This suggests that Cucumarioside enhances nonspecific protective factors, activates the macrophagal system and facilitates the development of complete phagocytosis.

[Effect of cucumarioside (a triterpene glycoside from the holothurian Cucumaria japonica) on the development of an immune response in mice to corpuscular pertussis vaccine]. / Vliianie kukumariozida (triterpenovogo glikozida iz goloturii Cucumaria japonica) na razvitie immunnogo otveta myshei na korpuskuliarnuiu kokliushnuiu vaktsinu.

The influence of cucumarioside, triterpene glycoside obtained from Cucumaria japonica (Echinodermata, Holoturioidea), or sea cucumbers, on the resistance of mice to Bordetella pertussis infection (with the use experimental pertussis meningoencephalitis as a model) and on the development of immune response to corpuscular pertussis vaccine was studied. The preparation under test was shown to have greatly pronounced immunomodulating properties depending on both the concentration of cucumarioside and the route of its administration, as well as on the dose of pertussis vaccine. When administered orally in a dose of 4 micrograms per mouse and intraperitoneally in doses of 0.04 and 0.0004 micrograms, cucumarioside enhanced the protective effect of corpuscular pertussis vaccine. The use of cucumarioside in a dose of 0.001 micrograms per mouse abolished the suppressive action of large doses of pertussis vaccine in the background rosette-formation test at an early period after immunization and increased number of immune rosettes formed by lymphocytes in the spleen of mice immunized with different doses of the corpuscular vaccine.

[Sensitivity of different mouse strains to Streptococcus pneumomiae serotype 3]. / Chuvstvitel'nost' razlichnykh linii myshei k Streptococcus pneumoniae serotipa 3.

The sensitivity of different mouse strains to Str. pneumoniae, serotype 3, after the intraperitoneal injection of the infective agent was studied. These experiments revealed that the animals under study, so far as their susceptibility and sensitivity were concerned, formed a single group, highly sensitive to this serotype. The sublethal dose of the pneumococcus was determined. The distribution of pneumococci in the organs during a definite time interval was shown and the fact of the prolonged carriership of the capsular forms of the pneumococci was established.

[Results of treatment of dysentery patients with streptomycin-dependent vaccine in comparison with other methods of treatment]. / Rezul'taty lecheniia bol'nykh dizenteriei streptomitsinzavisimoi vaktsinoi v sopostavlenii a drugimi metodami terapii.

Comparative study of various methods of treatment was carried out on 777 patients suffering from acute dysentery with a bacteriologically confirmed diagnosis. To assess the therapeutic efficacy, along with consideration of clinical signs of the disease, immunoglobulin level was examined in the blood and coprofiltrates; also the state of reparative processes in the mucosa was appreciated by the histological examination of the biopsy material. Results of the work carried out indicated the inexpediency of the treatment of this disease with a combination of levomycetin and phthalazol. The use of live streptomycin-dependent dysentery vaccine was indicated in protracted torpid dysentery and was of no avail in acute form of the disease. A good therapeutic effect was observed with the application of pathogenetic therapy alone.

[Antigenic activity of Bordetella pertussis during cultivation in liquid nutrient media]. / Antigennaia aktivnost' kokliushnykh bakterii v protsesse kul'tivirovaniia v zhidkoi pitatel'noi srede.

The authors studied the antigenic activity of Bordetella pertussis during stab cultivation. For the first time there were revealed changes (oscillations) of antigenic activity: formation of 3 peaks of which the middle was the highest. A possibility of improving the quality of pertussis vaccine by using biomass at the height of the peak was experimentally founded.

[Effect of inducers and inhibitors of mixed function oxidases on body resistance to endotoxins of gram-negative bacteria]. / Vliianie induktorov i ingibitorov oksidaz smeshannoi funktsii na rezistentnost' organizma k éndotoksinam gramotritsatel'nykh bakterii.

Experimental typhoid intoxication in white mice leads to the inhibition of microsomal oxidation in the liver, which is manifested by the prolongation of hexenal-induced sleep and a decrease in the toxic action of parathion. Phenobarbital, capable of inducing oxidases with mixed function (OMF), enhances the process of the detoxification of endotoxin injected into the animals, which is manifested by the increase of its LD50. Soluble levomycetin succinate, widely used for the treatment of typhoid-paratyphoid infections, is a powerful inhibitor of OMF (as shown by the hexenal test). Benzonal, the analog of phenobarbital, removes the inhibitory effect of the antibiotic. Experimental studies carried out in the course of this investigation make it possible to substantiate the clinical trial of these preparations (OMF inducers) used in the complex therapy of typhoid-paratyphoid infections for the stimulation of natural detoxification mechanisms of the body. Benzonal is the preparation of choice for use in clinical practice.