Shock-Associated Systemic Inflammation in Amniotic Fluid Embolism, Complicated by Clinical Death.

BACKGROUND: Amniotic fluid embolism (AFE) is one of the main causes of maternal mortality in developed countries. The most critical AFE variants may be considered from the perspective of systemic inflammation (SI), a general pathological process that includes high levels of systemic inflammatory response, neuroendocrine system distress, microthrombosis, and multiple organ dysfunction syndrome (MODS). This research work aimed to characterize the dynamics of super-acute SI using four clinical case studies of patients with critical AFE. METHODS: In all the cases, we examined blood coagulation parameters, plasma levels of cortisol, troponin I, myoglobin, C-reactive protein, IL-6, IL-8, IL-10, and TNF-α, and calculated the integral scores. RESULTS: All four patients revealed the characteristic signs of SI, including increased cytokine, myoglobin, and troponin I levels, changes in blood cortisol, and clinical manifestations of coagulopathy and MODS. At the same time, the cytokine plasma levels can be characterized not only as hypercytokinemia, and not even as a "cytokine storm", but rather as a "cytokine catastrophe" (an increase of thousands and tens of thousands of times in proinflammatory cytokine levels). AFE pathogenesis involves rapid transition from the hyperergic shock phase, with its high levels of a systemic inflammatory response over to the hypoergic shock phase, characterized by the mismatch between low systemic inflammatory response values and the patient's critical condition. In contrast to septic shock, in AFE there is a much more rapid succession of SI phases. CONCLUSION: AFE is one of the most compelling examples for studying the dynamics of super-acute SI.

Acute and Chronic Systemic Inflammation: Features and Differences in the Pathogenesis, and Integral Criteria for Verification and Differentiation.

Currently, there is rationale for separating the systemic manifestations of classical inflammation from systemic inflammation (SI) itself as an independent form of the general pathological process underlying the pathogenesis of the most severe acute and chronic diseases. With this aim in view, we used integral scales of acute and chronic SI (ChSI), including the following blood plasma parameters: interleukins 6, 8, 10; tumor necrosis factor alpha; C-reactive protein; D-dimer; cortisol; troponin I; myoglobin. The presence of multiple organ dysfunction according to the SOFA score was also taken into account. The effectiveness of the scales was tested in groups of intensive care patients during different periods of acute trauma, sepsis, and septic shock. The ChSI scale was applicable under systemic autoimmune diseases, chronic purulent infections, chronic limb threatening ischemia, and end-stage renal disease of various genesis. The number of examined patients was 764 in total. The scales allowed us to verify specific phases of acute SI and identify pathogenetic risk factors of lethal outcomes, as well as the most severe variants of the chronic pathologies course. These scales are open adaptable systems (in terms of the nomenclature and choice of indicators). They are primarily intended for scientific research. However, the SI verification methodology presented in this paper may be useful for developing advanced criteria for assessing both the typical links in the pathogenesis of many diseases and the severity of the overall condition of patients for clinical practice.

Migrant Women's Economic Success in Russia: Objective Reality and Subjective Assessment.

This study contributes to the growing body of literature on the outcomes of labor migration by focusing on the effects of migrant legal status on the economic and perceptual measures of migration success. To study the effects of legal status, we use a sample of Central Asian migrant women who work in Russia and of their native counterparts who occupy the same positions on the labor market. Similar to the studies in the developed settings, we find that a temporary legal status is associated with an earnings penalty and that permanent legal status corrects this earning disparity. We also find that both temporary and permanent migrant status is positively associated with perceptions of pay inequality but that, irrespective of these perceptions, both types of migrants are more likely to be satisfied with their jobs than natives. We interpret these findings within the legal and social context of migrant economic incorporation in Russia and relate them to the findings from other migrant-receiving settings.

Legality, Racialization, and Immigrants' Experience of Ethnoracial Harassment in Russia.

Using data from a structured survey and in-depth interviews in three Russian cities, our study engages the scholarship on immigration legal regimes and racialization practices to examine the experiences of ethnoracially motivated harassment among working migrant women from Kyrgyzstan, Tajikistan, and Uzbekistan in Russia. The results of statistical analyses show that regularized legal status is associated with a significantly lower likelihood of experiencing harassment at the hands of law enforcement agents and other actors alike. Regardless of legal status, however, the analyses reveal significant variations across the three migrant groups, with members of the group that is seen as racially most distinct from the host population having the highest odds of reporting harassment. The analysis of in-depth interviews confirms and expands on these patterns, providing additional insights into the complex expressions and interplay of legality and race in migrants' everyday experiences. The study findings are situated within the cross-national literature on migrants' legal and ethnoracial exclusion in receiving contexts.