[Features of methodology for the formation of standard operational procedure in the practice of bureau of forensic medical expertise]. / Osobennosti metodologii formirovaniya standartnykh operatsionnykh protsedur v prakticheskoi deyatel'nosti byuro sudebno-meditsinskoi ekspertizy.

OBJECTIVE: To analyze and summarize data on formation and implementation in practice of standard operational procedures for developing algorithm to improve the quality management system of bureau of forensic medical expertise. MATERIAL AND METHODS: Normative legal documents regulating principles of standardization in healthcare were studied. Literature was analyzed in PubMed, Google Scholar, eLIBRARY search engines in English and Russian languages on the issues of development and implementation of standard operational procedures in practice. RESULTS: Data on using standard operational procedures as a standardization element in medical practice have been analyzed and generalized. Specific proposals for developing system of standard operational procedures, based on general principles for the creation of such documents, in forensic medical expert institutions have been proposed. CONCLUSION: Suggested recommendations can be used in practice to develop new common standard operational procedures.

Efficacy of an aerosol-resistant pepsin powder used in artificial digestion for the detection of Trichinella larvae in meat.

Trichinellosis is an important worldwide foodborne zoonosis. The gold standard test to detect Trichinella spp. larvae in muscle samples of animals intended for human consumption is the artificial digestion method. Handling and dispensing of conventional pepsin powder present significant safety risks for analysts. The use of pepsin powder that is resistant to aerosolization should alleviate these safety concerns. The aim of this study was to compare the efficacy of an aerosol-resistant pepsin powder to conventional pepsin powder in the artificial digestion method. Proficiency samples of pork diaphragm containing specific numbers of viable Trichinella spiralis larvae were tested in two laboratories. The results revealed that aerosol-resistant pepsin was simple, effective and convenient to use, and showed good solubility and larval recovery that met the requirements of the European Union regulation EU 2015/1375. Overall, the efficacy of the aerosol-resistant pepsin was comparable to the conventional pepsin and safer for analysts.

Prenatal Hypoxia Impairs Olfactory Function in Postnatal Ontogeny in Rats.

Analysis of the age-related dynamics of olfactory behavior in the odor preference and food search testsshowed that all male Wistar rats, regardless of age, preferred valerian essential oil, whose components have the properties of pheromones in rodents, when given a selection of eight essential oils; young rats displayed better food-seeking results than adult and old animals. Acute prenatal hypoxia (PH) on E14 (7% O2 for 3 h) led to impairment of the valerian odor preference at all ages studied and to decreased productivity of food searches. Neurodegenerative processes were seen in the piriform cortex after PH, with reductions in the number of neurons and increases in glial elements. We have previously observed these changes in the entorhinal cortex and hippocampus, but not in the olfactory bulbs. This suggests that PH-induced decreases in olfactory function in rats may result from impairments to the formation of the central elements of the analyzer during the first months of postnatal ontogeny.

[Assessment of nutritive status and its correction in oncological patients after operations in the hepatopancreatoduodenal zone].

Surgical interventions in the hepatopancreatoduodenal zone in cancer patients are associated with high risk of nutritional deficiency in the postoperative period. This feature is due to both the volume of the operation itself (pancreatoduodenectomy), and the predominance of catabolic processes in the early postoperative period. In this regard, the monitoring of the main indicators of carbohydrate, protein and fat metabolism in the early postoperative period becomes fundamental for choosing the correct tactics of nutritional support for this patients. Aim. Improvement of the nutritional status of cancer patients after operations carried out in the hepatopancreatoduodenal zone in connection with malignant neoplasms by means of a comprehensive comparative analysis of the effectiveness of isolated enteral, isolated parenteral and mixed types of nutritional support in the early postoperative period. Material and methods. The examination included 40 patients with an average age of 44.5±6.8 years (15 men, 25 women). All patients for analysis were divided into two groups: the first, the main - patients receiving strictly enteral and/or probe nutrition (n=21), the second, control - isolated parenteral nutrition (n=19). The dynamic of the main predictors of nutritional status in the early postoperative period was assessed: the level of total blood protein, including albumin, lymphocyte count, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activity, their ratio - the de Ritis coefficient (as indirect criterion of cytolytic syndrome), total bilirubin. The analysis included the time interval of the enteral and parenteral nutrition in the early postoperative period, together with the number of bed-days required to correct the nutritional status in these patients in an intensive care unit. To objectify and clarify the dynamics of the nutritional status of patients in the pre- and postoperative period, we used the generally accepted scales for assessing nutritional status - Subjective Global Assessment (SGA) Nutritional Risk Index (NRI). Results. According to the SGA and NRI rating scales, the overwhelming majority of patients in the main and control groups (85.7% and 94.7%, respectively) had a normal nutritional status before the operation. In the postoperative period, 4 (21%) patients in the control group showed signs of moderate malnutrition by day 12, which regressed after the enteral nutritional support was connected. There were no statistically significant changes in nutritional status in patients of the main group. The basal metabolic rate in patients of both groups had no statistical differences before surgery (2296±279 kcal/day). On the 15th day of the postoperative period, its increase by 394 kcal/day was recorded in the main group, in the control group an increase in the basal metabolic rate was observed only with the addition of the enteral component of nutritional support, on average, by 321 kcal/day. There was no statistically significant decrease in the level of blood lymphocytes in patients of the main group (p=0.289) in comparison with the traced tendency to lymphopenia (p=0.019) in patients of the control group. The patients of the main group showed a slower regression of the ALT activity, and, accordingly, less increase in the de Ritis coefficient. Conclusion. In patients operated in the hepatopancreatoduodenal zone due to malignant neoplasms, in the early postoperative period, the enteral administration of nutritional mixtures may be preferable, both as an isolated method of nutritional support and as a supplement to parenteral nutrition, given its positive effect on the gastrointestinal tract passage, the level of basal metabolism, the state of the protein-synthetic function of the liver and, indirectly, the degree of cytolytic syndrome.

Maternal Hyperhomocysteinemia Induces Neuroinflammation and Neuronal Death in the Rat Offspring Cortex.

Maternal hyperhomocysteinemia is one of the common complications of pregnancy that causes offspring cognitive deficits during postnatal development. In the present work, we evaluated the effect of prenatal hyperhomocysteinemia on structural and ultrastructural organization, neuronal and glial cell number, apoptosis (caspase-3 content and activity), inflammatory markers (tumor necrosis factor-α, interleukin-6, and interleukin-1ß), and p38 mitogen-activated protein kinase (p38 MAPK) phosphorylation in the offspring brain cortex in early ontogenesis. Wistar female rats received methionine (0.6 g/kg body weight) by oral administration during pregnancy. Histological and biochemical analyses of 5- and 20-day-old pups' cortical tissue were performed. Lysosome accumulation and other neurodegenerative changes in neurons of animals with impaired embryonic development were investigated by electron microscopy. Neuronal staining (anti-NeuN) revealed a reduction in neuronal number, accompanied by increasing of caspase-3 active form protein level and activity. Maternal hyperhomocysteinemia also elevated the number of astroglial and microglial cells and increased expression of interleukin-1ß and p38 MAPK phosphorylation, which indicates the development of neuroinflammatory processes.

Regulation of Neprilysin Activity and Cognitive Functions in Rats After Prenatal Hypoxia.

The amyloid-degrading enzyme neprilysin (NEP) is one of the therapeutic targets in prevention and treatment of Alzheimer's disease (AD). As we have shown previously NEP expression in rat parietal cortex (Cx) and hippocampus (Hip) decreases with age and is also significantly reduced after prenatal hypoxia. Following the paradigms for enhancement of NEP expression and activity developed in cell culture, we analysed the efficacy of various compounds able to upregulate NEP using our model of prenatal hypoxia in rats. In addition to the previous data demonstrating that valproic acid can upregulate NEP expression both in neuroblastoma cells and in rat Cx and Hip we have further confirmed that caspase inhibitors can also restore NEP expression in rat Cx reduced after prenatal hypoxia. Here we also report that administration of a green tea catechin epigallocatechin-3-gallate (EGCG) to adult rats subjected to prenatal hypoxia increased NEP activity in blood plasma, Cx and Hip as well as improved memory performance in the 8-arm maze and novel object recognition tests. Moreover, EGCG administration led to an increased number of dendritic spines in the hippocampal CA1 area which correlated with memory enhancement. The data obtained allowed us to conclude that the decrease in the activity of the amyloid-degrading enzyme NEP, as well as a reduction in the number of labile interneuronal contacts in the hippocampus, contribute to early cognitive deficits caused by prenatal hypoxia and that there are therapeutic avenues to restore these deficits via NEP activation which could also be used for designing preventive strategies in AD.

Aliphatic-aromatic stacking interactions in cyclohexane-benzene are stronger than aromatic-aromatic interaction in the benzene dimer.

Stacking interactions between cyclohexane and benzene were studied in crystal structures from the Cambridge Structural Database and by ab initio calculations. Calculated at the very accurate CCSD(T)/CBS level of theory, the cyclohexane-benzene interaction energy is -3.27 kcal mol-1, which is significantly stronger than the interaction in the benzene dimer (-2.84 kcal mol-1) indicating the importance of aliphatic-aromatic interactions.

Eight years of quality control in Bulgaria: impact on mammography practice.

The requirements for quality control (QC) in diagnostic radiology were introduced in Bulgarian legislation in 2005. Hospital medical physicists and several private medical physics groups provide QC services to radiology departments. The aim of this study was to analyse data from QC tests in mammography and to investigate the impact of QC introduction on mammography practice in the country. The study was coordinated by the National Centre of Radiobiology and Radiation Protection. All medical physics services were requested to fill in standardised forms with information about most important parameters routinely measured during QC. All QC service providers responded. Results demonstrated significant improvement of practice since the introduction of QC, with reduction of established deviations from 65 % during the first year to 7 % in the last year. The systems that do not meet the acceptability criteria were suspended from use. Performance of automatic exposure control and digital detectors are not regularly tested because of the absence of requirements in the legislation. The need of updated guidance and training of medical physicists to reflect the change in technology was demonstrated.

Molecular properties of lysine dendrimers and their interactions with Aß-peptides and neuronal cells.

Prevention of amyloidosis by chemical compounds is a potential therapeutic strategy in Alzheimer's, prion and other neurodegenerative diseases. Regularly branched dendrimers and less regular hyperbranched polymers have been suggested as promising inhibitors of amyloid aggregation. As demonstrated in our previous studies, some widely used dendrimers (PAMAM, PPI) could not only inhibit amyloid aggregation in solution but also dissolve mature fibrils. In this study we have performed computer simulation of polylysine dendrimers of 3rd and 5th generations (D3 and D5) and analysed the effect of these dendrimers and some hyperbranched polymers on a lysine base (HpbK) on aggregation of amyloid peptide in solution. The effects of dendrimers on cell viability and their protective action against Aß-induced cytotoxicity and alteration of K+channels was also analysed using human neuroblastoma SH-SY5Y cells. In addition, using fluorescence microscopy, we analysed uptake of FITC-conjugated D3 by SH-SY5Y cells and its distribution in the brain after intraventricular injections to rats. Our results demonstrated that dendrimers D3 and D5 inhibited amyloid aggregation in solution while HpbK enhanced amyloid aggregation. Cell viability and patch-clamp studies have shown that D3 can protect cells against Aß-induced cytotoxicity and K+channel modulation. In contrast, HpbK had no protective effect against Aß. Fluorescence microscopy studies demonstrated that FITC-D3 accumulates in the vacuolar compartments of the cells and can be detected in various brain structures and populations of cells after injections to the brain. As such, polylysine dendrimers D3 and D5 can be proposed as compounds for developing antiamyloidogenic drugs.

[A case of invasive cervical carcinoma associated with pregnancy]. / Sluchai na invaziven kartsinom na matochnata shiika i bremennost.

The cervical cancer is the most usual neoplastic disease, which takes place during the pregnancy. The prognosis for the women depends mostly of the clinical stage and the presence of nodal metastasis. The principes of the treatment do not differ from the standard oncologic therapy in nonpregnant women. Differencies exist in the way and the time of the terminanation of the pregnancy. The authors present y case of pregnancy and invasive cervical adenocarcinoma diagnosticated in m. 1.X. immeadiately after cesarean section an extended hysterectomy y modo Piver 111 with pelvic nodal dissection is done.

[The use of Diprivan as an anticonvulsant in the early postoperative period of an otogenic brain abscess]. / Prilozhenie na Diprivan kato antikonvulsant v ranniia sledoperativen period na otogenen mozuchen abstses.

This is a report on a female patient with otogenic cerebellar abscess and symptomatic generalized convulsions, irresponsive to conventional diazepam and phenobarbital therapy. Fractionated propofol administration yields good effect without noteworthy changes in respiration and circulation.

[The use of ketamine in an experimental model of generalized cerebral ischemia]. / Prilozhenie na ketamin pri eksperimentalen model na generalizirana mozuchna iskhemiia.

Thus far, a sufficiently effective cerebroprotective substances has not been discovered. Glutamate overproduction plays a key role in ischemic brain lesion. Ketamine is assigned to the group of commonly used clinical anesthetics, being also familiar as NMDA antagonist. Sodium fluoride-induced cerebral ischemia in mice is used as a model of circulatory ischemic lesion. As shown by the experimental data, simultaneous administration of NaF + ketamine has no effect whatsoever on the survivorship of animals, as compared to that in the control group treated with NaF alone. Beforehand treatment of mice with 150 mg/kg ketamine brings about considerable prolongation of the survival term (15 per cent of the animals survive for more than 2 hours). The inference is reached that ketamine is endowed with cerebroprotective activity largely attributable to glutamate antagonism at the level of ischemia involved neurons.

[Hemodynamic changes and nitric oxide production in an experimental model of sepsis]. / Khemodinamichni promeni i produktsiia na azoten okis v eksperimentalen model na sepsis.

Nitric [correction of Nitrous] oxide is most likely a queer "end mediator" giving rise to vasoplegia in septic shock patients. The study is aimed at comparative assessment of kinetic changes in the synthesis of nitric [correction of nitrous] oxide in experimentally induced sepsis model with the corresponding hemodynamic parameters. The laboratory animals--pigs--are divided up in two groups, and exposed to general narcosis induction, orotracheal intubation and mechanical ventilation under controlled regimen. The hemodynamic parameters studied include: MAP, CO and SVR. Additional endotoxin (1 mg/50 ml) in the form of infusion is given to the animals in the sepsis group. Nitrate production mirrors NO synthesis, insofar as there are no other relevant mechanisms of nitrate synthesis. The kinetic parameters of nitrate production are estimated using stable nitrate isotopes--N15. The theory of compartment models and appropriate computerized simulation are used to calculate the respective constants. In the endotoxin treated group (n = 5) a significantly higher level of synthesis of induced NO production is documented--26 +/- 9 mumol/h, as compared to production in the control group--6 +/- 7 mumol/h, as well as a significant increase in cardiac output and systemic vascular resistance reduction. The good correlation between enhanced NO production and hemodynamic response (increase in cardiac output and decrease in systemic vascular resistance) corroborates the validity of the method.

[The pathophysiological and intensive care-resuscitation aspects of septic shock]. / Patofiziologichni i intenzivnoreanimatsionni aspekti na septichniia shok.

Sepsis and septic shock continue to be the most common causes of death and multiple organ failure among patients in intensive care units. The standard therapeutic regimens include surgical removal of the source of sepsis, antimicrobial therapy, optimizing oxygenation, volume resuscitation, and treatment with catecholamines. The ever extending knowledge of the pathophysiological role played by cytokines and nitrous oxide in septic shock promote the efforts to control their synthesis and pharmacologic action in clinical situations. New therapeutic approaches have become available, including the administration of high doses immunoglobulins, monoclonal antibodies against endotoxin, pentoxilfyline and nitrous oxide inhibitors. Based on the encouraging findings, controlled clinical studies are undertaken to assay with precision their clinical efficacy.

[Nitric oxide--a basic mediator of vasodilation and septic shock]. / Azotniiat okis--osnoven mediator na vazodilatatsiiata i septichniia shok.

Nitric oxide is synthesized from the amino acid I-arginine by a family of enzymes, the nitric oxide synthases. The synthesis of nitric oxide by vascular endothelium is responsible for the vasodilatator tone that is essential for the regulation of blood pressure. NO also contributes to the control of platelet aggregation and the regulation of cardiac contractility. These actions are all mediated by the activation of soluble guanylate cyclase and the consequent increase in the concentration of cGMP in target cells. Several studies suggests that some diseases are related to defects in the generation or action of nitric oxide. Some of the features of septic shock, including hypotension, vascular hyporeactivity, myocardial depression and tissue damage appears to result from excess production of NO. Controlled clinical trials to assess the effects of nitric oxide synthase inhibitors on mortality and morbidity in septic shock seem justified and are already planned.

[Glutamate antagonists--a new stage in the development of cerebral protection?]. / Glutamatnite antagonisti--nov etap v razvitieto na tserebralnata protektsiia?

This is a survey of 35 papers, published in medical journals worldwide over the past 5 years, in an attempt to disclose the current level of understanding the fine biochemical mechanism underlying neuronal lesions, as well as to outline the possible trends of cerebroprotective therapy evolution, as put forward by the authors of the cited works. A number of researches demonstrate the role of glutamate and other excitatory amino acids in neuronal lesions' development during hypoxia, hypoglycemia, cranio-cerebral trauma and the like. It is logical to presume that the antagonists of glutamate receptors and their relationship to ionic canals may be considered as having an essential bearing on the build-up of a complex cerebroprotective strategy, corroborated in turn by a number of studies on cell cultures in vitro, and in numerous animal models as well. The already known and clinically used phencyclidine compounds, and first and foremost, the general anesthetic ketamine, spark a great surge of interest along these lines.

[The potentials of computed axial tomography (CAT) in the diagnosis of carcinoma of the cervix uteri]. / Vuzmozhnosti na kompiuturnata aksialna tomografiia (KAT) pri diagnoza na kartsinom na matochnata shiika.

14 women with diagnosis Ca colli uteri Ib stage were investigated. CAT (computer axial tomography) was carried out before and after surgery (Wertheim). CAT gave a picture of the tumor lesion as well as of the regional lymph nodes. This method proved fast, efficient and non invasive for the correct diagnosis of Ca colli uteri and surgery effect.