[Changes in court practice in cases of poor quality of dental care]. / Izmeneniya sudebnoi praktiki po delam, kasayushchimsya nekachestvennogo okazaniya stomatologicheskoi pomoshchi.

The study objective is to analyze changes in court practice over a 10-year period (from 2013 to 2022) including the quantitative and qualitative composition of complaints for conducted dental treatment, considering legislative changes in the procedure for the provision of dental service and formalization of the relationship between patient and medical organization. An investigation of 1800 legal cases containing complaints, forensic reports and court decisions allowed to identify tendencies in increasing the number of cases in which patients' demands were fully or partially satisfied, from 54% in 2013-2017 up to 61% in 2018-2022. At the same time, the amounts of payments determined by the courts increased by 14 times. In addition, the percentage of claims against medical organizations providing care under the CHI program increased significantly (from 5% in 2013-2017 to 15% in 2018-2022). A significant impact of changes in normative legal documents regulating the provision of dental care on the qualitative composition of complaints and the issues formed for medical experts by court has been noted.

[Effect of a new low-cholesterol meat and vegetal product on correction of simulated lipid metabolism disorders in rats].

The paper presents the biomedical evaluation of meat and cereal spread from low-cholesterol raw material with vegetable ingredients, recommended as a functional food. The experimental model with myocardial infarction like changes in hearts of the animals, accompanied by vascular changes similar to atherosclerotic changes in humans, as well as the modeling of the metabolic imbalance of lipids have been carried out by intramuscular injection of epinephrine and unbalanced feeding the animals with food rich in cholesterol, with a high content of carbohydrates and fats. Wistar rats were divided into 4 groups of 12 animals each. The rats in groups 1-3 were induced the cardio distress with intramuscular injection of epinephrine; group IV consisted of intact (healthy) animals. Dramatic changes in biochemical blood status that indicated heart disease have been observed within 2 days after the injection of epinephrine (0.2 ml per 1 kg of animal body weight) to the tested animals. During the experiment a sharp increase in activity of indicator enzymes of alanine aminotransferase (ALT) and aspartate aminotransferases (AST), with a predominance of AST over ALT, along with an increase in LDH activity have been observed. The 1.4-1.6 fold increase in blood serum creatinine has also been found. Later the animals in groups 1, 2, 3 with simulated cardio pathology were fed a ration with intervention of food rich in cholesterol, with a high content of carbohydrates and fats (50% of the diet) for a month for induction of lipid metabolism disorders. An increase in the concentration of cholesterol and triglycerides by 3 fold or more has been observed. In addition, an accumulation of sulfhydryl groups has been noted, as evidenced by increased rates of thymol. For further normalization of lipid metabolism, the animals in tested group I were fed the diet with intervention of spread, developed in accordance with GOST 12318-91 "Canned meat "Meat spread"; the rats of group 2 were fed with spread with vegetable supplements (pumpkin by-products and alginates), and group 3 received a standard diet within the next month. The results of biochemical blood serum studies have shown that the level of cholesterol, triglycerides, creatinine and sulphydryl groups in the experimental groups 1 and 2 decreased, indicating a positive influence on lipid metabolism and prevention of peroxides formation in the organism. These changes were more pronounced when meat product with plant additives and alginate was used in the diet. Only under the application of the meat-vegetable pate cholesterol level ceased to differ from that of the control group of animals. Based on the significant reduction of blood malondialdehyde level, antioxidant properties of vegetable supplements have been proven. The experimental data showed that the spread, developed on the basis of low-cholesterol raw meat with vegetable ingredients (pumpkin by-products and alginates) can be used to correct metabolic disorders of lipids, reducing the risk of cardio pathology in the body.

[Additional chromosomal abnormalities in dynamic of target therapy for chronic myeloid leukemia in children and adolescents].

Chromosomal abnormalities of bone marrow cells in dynamic chronic myeloid leukemia (CML) with bcr-abl-tyrosinkinase inhibitor (400 mg/m2) in 34 children and adolescent were estimated. Appearence of additional chromosomal abnormalities such as del(16)(q22), del(11)(q23), del(6) (q23), del(21)(q12), trisomy chromosome 8, additional neartetraploid clones were evidence about tumor cells resistence to therapy in children and adolescent.

[Cytogenetic peculiarity of chromosomal abnormalities in myelodisplastic syndromes in childhood].

Cytogenetic investigation results in bone marrow cells of 70 children and teenagers from 1 to 18 years with myelodysplastic syndromes (MDS) were presented. Between them were 29 girls and 41 boys. According MDS categories were registrated refractory anemia (RA), refractory cytopenia with multilineage dysplasia (RCMD) and refractory anemia with excess blasts (RAEB) (30, 29 and 11 patients, respectively). High spectrum of mosaic clones in bone marrow cells were found: 1) normal and near-tetraploidy 2) abnormal and normal, 3) abnormal, near-tetraploidy and normal, 4) evolution of clonal chromosomal abnormalities and 5) unrelated clones. Normal clone was estimated in 18.6% cases. Karyotype of bone marrow cells in MDS were characterized high frequency of unbalanced (85.7%) and near-tetraploidy clones (45.7%). Between type of structural rearrangements in all categories was dominated deletion - 48.6%. Accordingly categories RA, RCMD, RAEB -50, 41.4 and 45.4%, respectively. More often in structural rearrangements in MDS were involved chromosomes (Chr) 9, 3 and 11, in RA - Chr 9 and 11, in RCMD - Chr 3, 11, 17 and 10, in RAEB - Chr 3 and 9.

[Phenomenon of the evolution of clonal chromosomal abnormalities in childhood acute myeloid leukemia].

Analysis of chromosomal abnormalities in bone marrow cells in 116 children with diagnosis of acute myeloid leukemia (AML) was performed. Frequency of evolution of clonal chromosome abnormalities in AML constituted 42,3%. The most abundant among them were numerical abnormalities of chromosomes 8, 9, and 21 as well as secondary structural abnormalities in region 12p12, 9p22, 9q22, 9q34, 11q14-23, and 16q22. Numerical abnormalities were registered in 26,7% cases. The basic mechanism of leukemic clone evolution was trisomy, deletion and monosomy. The frequency of evolution was 7 times higher in the age group up to 2 years and twice higher in the age group up to 5 years. The high frequency of evolution was established at t(15;17)(q22;q22) and the absence at inv(16)(p13q22). The patients with clonal evolution died earlier, before reaching remission, that can be connected with heavy initial state and high frequency of relapse. Conception of abnormality clone evolution was proposed at some stages: I--appearance of balanced rearrangement; II--trisomy; III--lose of chromosomal material. Appearance of unbalanced genome in evolution possess an advantage in proliferate activity and can be connected with the answer on chemotherapy. Identity of abnormal chromosome structure at diagnosis and relapse of disease can be an evidence of the influence of chemical agent on establishment of some types of evolution of chromosome abnormalities in leukemic cells in AML in children.

[Rearrangements of chromosome 9 in different hematological neoplasia].

The frequencies of chromosome 9 abnormalities in children with hematological neoplasia have constituted: 25/112 in acute lymphoblastic leukemia (ALL), 10/83--in acute myeloid leukemia (AML), 3/20--in refractory anemia (RA). The frequency of deletions was higher than of translocations in ALL. Deletions were found as sole abnormalities as in complexity karyotypes. More often the rearrangements affected bands 9q34 and 9q22. Translocation t (9;22)(q34; q11) occured in 7.1% cases ALL. In AML the translocations were detected with greater frequency than deletions. The long arm bands 9q22 and 9q34 were more often involved in structural rearrangements. Deletions, translocations and duplications were registered in MDS. Comparison with clinical features showed no correlation with age and the main hematological indexes including the amount of blast cells in initial period. Multidrug resistance and disease progression during chemotherapy were noted in t (9;22).

[Chromosome 11 rearrangements in the different haematological neoplasias].

The cases of chromosome 11 abnormalities in leukemic bone marrow cells have constituted 14.0% in acute lymphoblastic leukemia (ALL), 18.7% in acute myeloid leukemia (AML), and 16.7% in refractory anemia (RA). The bands of the short arms 11p13, 11p14, llp15 and the long arms 11q14, 11q21, 11q23 were involved in chromosome rearrangements. The rearrangements of the band 11q23 were detected more often. Reciprocal translocations were found with the highest frequency, while para- and pericentic invertions, terminal and intestitial deletions occured with the lower incidence. Deletions were found in RA cases only. Comparison with the clinical features showed no correlation with the age and the main haematological indexes including the amount of blast cells in the initial period. The results have showed the poor prognosis of the abnormalities not only of 11q21, 11q23 in acute leukemia (AL), but of 11p13, 11p15 in AML as well, while not enough data on this subject is availalbe in the literature.

[Outpatient follow-up and management of pregnant women with hypertension].

AIM: To study variants of the course of chronic hypertension in pregnant women and determination of factors predisposing to a persistent rise of arterial pressure (AP) in pregnancy. MATERIAL AND METHODS: A total of 50 pregnant women were examined (heart rhythm variability and psychological testing) who had AP 140/90 mm Hg and higher as shown by measurements at three outpatient check-ups. After delivery the patients were retrospectively devided into two groups. Twenty-seven group 1 women had frequent rises of AP to 140/90 and higher throughout pregnancy; twenty-three women of group 2 had high AP only at early terms of pregnancy, later they became normotensive without use of hypotensive drugs. 24-h AP monitoring was made in 29 patients. By its results, two subgroups were identified: 11 patients with essential hypertension and 18 women with neurocirculatory dystonia by hypertensive type. RESULTS: In group 1 there was an early fall of cardiac performance, higher values of SMIP test according to scales 2 (pessimism), 3 (emotional lability), 4 (impetuosity) and 7 (anxiety). CONCLUSION: The analysis of 24-h AP profiles revealed more persistent and significant rise of AP in patients with essential hypertension than in those with neurocirculatory dystonia. They also demonstrated high AP variability correlating with a risk of cardiovascular diseases.

[The use of the nucleolar apparatus indices of the leukemic cells in patients with acute myeloblastic leukemia for the early detection of resistant clones]. / Ispol'zovanie nekotorykh pokazatelei iadryshkovogo apparata leikoznykh kletok bol'nykh ostrym mieloblastnym leikozom dlia rannego vyiavleniia rezistentnykh klonov.

Changes were studied in the value for the nucleolar coefficient as were the percentage of large and compact nucleoli and numbers of Ag-NOR in the peripheral blood of patients with acute myeloblastic leukemia in order that resistant clones might be identified as early as possible. It has been ascertained that within 24 hours of the start of polychemotherapy "7 + 3" leukotic cells respond in different ways to the chemotherapeuticals employed depending on the outcome of the illness.