Methodological approaches to the organization of internal control of the quality and safety of medical activity in a medical organization

The modern stage of functioning of domestic health care is characterized by the formation of regulatory and legal requirements for the system of internal control of quality and safety of medical activity.One of the tasks of internal control of quality and safety of medical activity is to ensure and assess the compliance of medical care provided by medical workers to the criteria for assessing the quality of medical care, as well as to consider the reasons for non-compliance of medical care provided to these criteria. Requirements to quality criteria, procedures for assessing the quality of medical care, compliance with the established procedure of medical records maintenance and development of measures to eliminate and prevent violations are established by various regulatory documents. At the same time, of great importance for a medical organization is not only the fulfillment of requirements in the field of quality control and safety of medical activity, but also the introduction of an effective system of internal control of quality and safety of medical activity, based on regulatory and legal requirements and giving real results.It determines the necessity of creating in a medical organization the system of collection and analysis of quality data and development of internal documents, establishing the processes of quality control and assessment of medical care, the methodology of selecting medical documentation for control and assessment of the quality of medical care, as well as the requirements to the results of analysis and documenting of decisions made.The article presents the experience of Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivian on the creation of a system for collecting and analyzing data on the quality of medical care and making management decisions to eliminate and prevent nonconformities, which operates within the framework of the quality management system of medical care of the institute

Immunosenescence as a reason of individualizing immunosuppressive therapy in kidney transplantation

Transplantation in elderly patients is obviously more challenging due to existing underlying diseases, changes in pharmacokinetics of immunosuppressive drugs, polypragmasy, and transformation of immunoreactivity (immunosenescence). Our review presents data on modification of adaptive and innate immunity during aging. It also considers the possibility of both reduced and adapted immunosuppressive therapy in elderly renal transplant recipients in achieving an optimal balance between efficacy and complications

Operative treatment of orthopedic complications in upper limb in children and adults with cerebral palsy

Introduction The benefits of surgical treatment of orthopaedic complications in the upper limb caused by cerebral palsy have been debated by some researchers. Secondary complications developed due to muscle spasticity and retraction are a serious obstacle to a significant improvement in healthrelated quality of life of CP patients. Objective To explore outcomes of CP patients who underwent surgical treatment at the Russian Ilizarov Scientific Centre “Restorative Traumatology and Orthopaedics” between 2014 and 2016. Material and methods Total 23 operative interventions were produced for 21 patients aged from 11 to 36 years (mean age of 16.6 years) using an authors’ technique. We used integral scales of the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS). Classification systems intended for differential evaluation of upper extremity motor and functional impairment included Van Heest’s deformity assessment test, the House upper extremity assessment test and Gshwind and Tonkin classification. Results Spastic diplegia was diagnosed in 6 cases including 4 GMFCS III and 2 GMFCS IV. Manual ability was assessed as MACS IV in 3 cases and MACS V in 3. Fifteen patients with hemiparethic spastic CP underwent surgical treatment of upper limbs. Manual ability was assessed as MACS III in 4 cases, MACS IV in 8 and MACS V in 3. The use of the limb by the House’s scale showed level 1 in 2, level 2 in 5, level 3 in 10 and level 4 in 6 cases. The Gschwind and Tonkin classification for pronated forearm revealed level 1 in1, level 2 in 8, level 3 in 10 and level 4 in 4 cases. There was correlation between an extent of pronation contracture and impaired function of the thumb. Improved functional abilities of the upper limb, the cosmetic appearance and comfort with the use were recorded in all the cases. Conclusion Results of multilevel interventions on upper limbs in CP patients allow us to conclude that differential approach to the choice of technique and extent of surgery to ensure efficacious surgical treatment

Case of acute drug-induced hepatitis after halothane anesthesia

The aim of publication. To present the case of severe acute drug-induced hepatitis after halothane anesthesia in relation to significance of allergies history preoperative inquiry and assessment of medical management of patients, using modern prognostic scales.Key points. Biotransformation of volatile anesthetics can result in production of toxic metabolites and metabolic by-products, resulting in damage of the liver and kidneys. Disorders of liver function can be of two types: early – transient elevation of transaminase activity and late – liver necrosis. Mortality rate at the latter reaches 50–80%. In presented clinical case both variants developed in the same patient in different terms are described. Despite of acute drug-induced hepatitis with severe liver failure, complex treatment resulted in favorable outcome, including the remote-terms result.Conclusion. The most important factors determining favorable prognosis at drug-induced liver disease, include adequate doses of glucocorticosteroids, application of MARS-therapy and absence of background liver disease. Application of differential diagnostics algorithms and prognostic scales at drug-induced liver disease helps clinician to choose proper treatment approach at specific stage

Highly Luminescent Salts Containing Well-Shielded Lanthanide-Centered Complex Anions and Bulky Imidazolium Countercations

In this paper, we report on the syntheses, structures, and characterization of four molten salts containing imidazolium cations and europium(III)- or terbium(III)-centered complex anions. In the complex anions, the lanthanide centers are wrapped by four pseudodiketonate anionic ligands, which prevent them from contacting with high-frequency oscillators and allow them to show intense characteristic europium(III) or terbium(III) emission, small line widths, high color purity, high quantum yields (30−49%), and long decay times (\u3e2 ms)

7,8-Dihydro-8-oxo-1,N6-ethenoadenine: an exclusively Hoogsteen-paired thymine mimic in DNA that induces A→T transversions in Escherichia coli

14 pags., 9 figs.This work investigated the structural and biological properties of DNA containing 7,8-dihydro-8-oxo-1,N6-ethenoadenine (oxo-ϵA), a non-natural synthetic base that combines structural features of two naturally occurring DNA lesions (7,8-dihydro-8-oxoadenine and 1,N6-ethenoadenine). UV-, CD-, NMR spectroscopies and molecular modeling of DNA duplexes revealed that oxo-ϵA adopts the non-canonical syn conformation (χ = 65º) and fits very well among surrounding residues without inducing major distortions in local helical architecture. The adduct remarkably mimics the natural base thymine. When considered as an adenine-derived DNA lesion, oxo-ϵA was >99% mutagenic in living cells, causing predominantly A→T transversion mutations in Escherichia coli. The adduct in a single-stranded vector was not repaired by base excision repair enzymes (MutM and MutY glycosylases) or the AlkB dioxygenase and did not detectably affect the efficacy of DNA replication in vivo. When the biological and structural data are viewed together, it is likely that the nearly exclusive syn conformation and thymine mimicry of oxo-ϵA defines the selectivity of base pairing in vitro and in vivo, resulting in lesion pairing with A during replication. The base pairing properties of oxo-ϵA, its strong fluorescence and its invisibility to enzymatic repair systems in vivo are features that are sought in novel DNA-based probes and modulators of gene expression.MIT Skoltech Next Generation Program Pilot Grant (to J.M.E.); National Institutes of Health (NIH) [R01-CA080024 to J.M.E.]; NIEHS Center Grant [P30-ES002109 (to Center for Environmental Health Sciences, which provided access to NGS facilities)]; Skoltech (to T.S.Z.); MICINN [PID2020-116620GB-I00 to C.G.]; Ministry of Science and Higher Education Russian Federation [07515-2021-1049 to A.V.A. – synthesis and UV/CD studies]. Funding for open access charge: Skoltech.Peer reviewe

Beringian Standstill and Spread of Native American Founders

Native Americans derive from a small number of Asian founders who likely arrived to the Americas via Beringia. However, additional details about the intial colonization of the Americas remain unclear. To investigate the pioneering phase in the Americas we analyzed a total of 623 complete mtDNAs from the Americas and Asia, including 20 new complete mtDNAs from the Americas and seven from Asia. This sequence data was used to direct high-resolution genotyping from 20 American and 26 Asian populations. Here we describe more genetic diversity within the founder population than was previously reported. The newly resolved phylogenetic structure suggests that ancestors of Native Americans paused when they reached Beringia, during which time New World founder lineages differentiated from their Asian sister-clades. This pause in movement was followed by a swift migration southward that distributed the founder types all the way to South America. The data also suggest more recent bi-directional gene flow between Siberia and the North American Arctic

Noninvasive assessment of the fractional reserve of coronary blood flow with a one-dimensional mathematical model. Preliminary results of the pilot study

Aim. To evaluate the diagnostic accuracy of a noninvasive method of fractional flow reserve (FFR) assessment based on a one-dimensional hemodynamic model build on data obtained from the coronary computed tomography angiography (CCTA).Material and methods. The study enrolled 57 patients: 16 of them underwent 64-slice computed tomography — included retrospectively, 34 — prospectively, with a 640-slice CT scan. Specialists from the Laboratory of Mathematical Modeling processed CT images and evaluated noninvasive FFR. Ischemia was confirmed if FFR <0,80 and disproved if FFR ≥0,80. After that the prospective group of patients was hospitalized for invasive FFR assessment as a reference standard; if ischemia was proved, patients underwent stent implantation. In the retrospective group, patients already had invasive FFR values estimated. Statistical analysis was performed using R programming language packages (cran-r.project.com). Continuous variables are presented as mean values ± standard deviations, order variables are presented as medians with interquartile ranges in parentheses. We used the D’Agostino-Pearson omnibus test for the assessment of normality of distribution; a Q-Q Plot was also constructed. We performed the Bland-Altman analysis and ROC-analysis for comparison of these two methods, and the Pearson’s chi-squared to assess the degree of correlation.Results. During data processing, 3 patients of the retrospective and 34 patients of the prospective group were excluded from the study. The sensitivity of our method was 90,91% (95% CI; 58,72-99,77), specificity — 86,67% (95% CI; 59,54-98,34), P<0,05, accuracy — 88,46 (95% CI; 69,85-97,55) — in per-vessel analysis. In perpatient analysis, the sensitivity was 91,67% (95% CI; 61,52-99,79), specificity — 80% (95% CI; 28,36-99,49), (P<0,05); accuracy 88,24 (95% CI; 63,56-98,54).Conclusion. Our method has quite a high accuracy and can be successfully used in clinical practice in order to enhance the diagnostic efficiency of the CCTA

Многоуровневые инъекции ботулинического токсина типа А (Абоботулотоксина) при лечении спастических форм детского церебрального паралича: ретроспективное исследование опыта 8 российских центров

Background: The contemporary application of Botulinum toxin A (BTA) in cerebral palsy (CP) implies multilevel injections both in on-label and off-label muscles. However, there is no single international opinion on the effective and safe dosages, target muscles, and intervals between the injections.Objective: Our aim was to analyze the Russian multicenter independent experience of single and repeated multilevel injections of Abobotulinum toxin А in patients with spastic forms of CP.Methods: 8 independent referral CP-centers (10 hospitals) in different regions of Russia. Authors evaluated intervals between the injections, dosages of the BTA for the whole procedure, for the body mass, for the each muscle, and functional segment of the extremities.Results: 1872 protocols of effective BTA injections (1–14 repeated injections) for 724 patients with spastic CP were included. The age of the patients was between 8 months to 17 years 4 months at the beginning of the treatment (with a mean of 3 years 10 months). Multilevel BTA injections were indicated for the majority (n = 634, 87.6%) of the patients in all the centers. The medians of the dosages for the first BTA injection were between 30–31 U/kg (500 U), the repeated injections doses up to 45 U/kg (1000 U) (in most centers). The median intervals between the repeated injections were 180–200 days in 484 (66.9%) patients and 140–180 days in 157 (24.7%) patients. In 2 centers, children with GMFCS IV–V were injected more often than others.Conclusion: Multilevel BTA injections were indicated for the most patients. The initial dose of Abobotulinum toxin A was 30–31 U/kg. The repeated injections dose could increase up to 40 U/kg. The repeated injections were done in 140–200 days after the previous injection.Современная концепция ботулинотерапии при детском церебральном параличе (ДЦП) предлагает использование многоуровневых инъекций в расширенное число мышц. Однако по-прежнему отсутствует консенсус относительно выбора оптимальных доз, мышц и интервалов между инъекциями.Цель исследования: изучить российский опыт применения однократных и повторных многоуровневых инъекций абоботулотоксина при лечении спастичности у пациентов с ДЦП.Методы: в ретроспективном исследовании проанализирован опыт ботулинотерапии при ДЦПв 8 специализированных центрах России. Изучали протоколы клинически эффективных инъекций. Оценивали общие дозы препарата БТА, дозы на единицу массы тела пациентов, на всю инъекционную сессию и отдельные мышцы, а также интервалы между инъекциями.Результаты: изучено 1872 протокола клинически эффективных инъекций, всего от 1 до 14 повторных инъекций, сделанных 724 пациентам в возрасте от 8 мес до 17 лет 4 мес (медиана возраста на момент первой инъекции БТА — 3 года 10 мес) на момент начала ботулинотерапии. Большинство пациентов (n = 634; 87,6% инъекций) получили многоуровневую ботулинотерапию. Во всех центрах при первичных инъекциях БТА медиана доз находилась в пределах 30–31 Ед/кг массы тела (общая — 500 Ед). При повторных инъекциях в большинстве учреждений максимальные дозы превышали 45 Ед/кг (1000 Ед). Средние интервалы между повторными инъекциями колебались в пределах 140–180 сут для 157 (24,7%) и 180–200 сут для 484 (66,9%) пациентов. В 2 из 8 центров пациенты с наиболее выраженными двигательными нарушениями (GMFCS IV–V) требовали более частых повторных инъекций БТА.Заключение: в специализированных центрах большинству пациентов с ДЦП ботулинотерапию проводили по многоуровневой схеме. Общая доза абоботулотоксина при первичных инъекциях составляла 30–31 Ед/кг; при повторных инъекциях она могла быть увеличена до 40 Ед/кг и более. Вопрос о повторном проведении инъекции БТА рассматривался в интервале 140–200 сут после предшествующей инъекции