The guidelines for standardizing approaches to providing adequate nutrition for pregnant women, nursing mothers, and young children were developed in accordance with the President’s List of Instructions following a State Council meeting on social support for families in the Russian Federation. The guidelines aim to improve the regulatory framework and enhance the effectiveness of organization of adequate nutrition for the above-mentioned categories of citizens, consistent with the priority areas of state policy in the field of maternal and child health. The document provides a systematic overview of the organizational, managerial, regulatory, and medical aspects of providing adequate nutrition to target population groups. Particular attention is given to unifying the legal frameworks, including the development of a multi-level system of regulatory acts, as well as allocation of powers among the executive bodies of constituent entities of the Russian Federation. The recommendations address financial and economic support, proposing a methodology for calculating the standard financial support per recipient. This enables the constituent entities of the Russian Federation to plan budget allocations taking into account regional specificities. Since the stated social support standard is implemented based on a physician’s opinion, is regionally specific, and is implemented in accordance with the legislation of the constituent entities of the Russian Federation, the document is recommended for use by the executive authorities of the constituent entities when developing and improving regulatory acts and programs for organizing the provision of adequate nutrition for pregnant women, nursing mothers, and young children.
relevance: Patients with morbid obesity undergoing general anesthesia for laparoscopic surgery are highly sensitive to complications, including transient hypoxemia, hemodynamic instability, delayed awakening, opioid hypersensitivity, postoperative pulmonary complications, and postoperative nausea and vomiting. Optimization of anesthesia management without opioids remains an important clinical challenge. CASE DESCRIPTION: A 35-year-old female patient (height 164 cm, weight 180 kg, body mass index 66.9 kg/m2) underwent robot-assisted hysterectomy for recurrent endometrial hyperplasia under combined anesthesia (general anesthesia with epidural analgesia). The mean qCON (consciousness index) during surgery was 50.2. The analgesic component of anesthesia was achieved through epidural administration of 0.1% ropivacaine hydrochloride solution, 10 mL every 30 minutes, at an infusion rate of 250 mL/hour during bolus delivery. The mean qNOX (nociception index) was 29.8. The mean total duration of qNOX peaks was 98.2 seconds over the 2 hours 35 minutes of surgery. Intraoperative hemodynamics were stable: blood pressure ranged from 120/70 to 140/80 mm Hg, heart rate 70–80 bpm, and SpO2 98–100%. Muscle relaxation was not maintained by additional administration of rocuronium bromide due to adequate relaxation of the abdominal wall and absence of inspiratory triggering from the patient. The TOF neuromuscular transmission ratio ranged from 40% to 50%, and electromyography (EMG) values ranged from 10 to 25, indicating adequate relaxation of the anterior abdominal wall muscles. The postoperative period was uneventful. The patient was discharged on postoperative day 6 in satisfactory condition with no active complaints. CONCLUSION: In this clinical case, the chosen anesthesia management tactic provided effective analgesia and enabled early mobilization of the patient.
The absence of maternal immune rejection of a haploidentical fetus remains unexplained. We hypothesize that the presence of different HLA antigens on trophoblasts and maternal cells via killer cell immunoglobulin-like receptors (KIRs) provides two-way tuning (education) of decidual natural killer cells (dNK) with the appearance of allo- (HvG) and autoreactive (HvH) dNK. Disturbances in dNKHvG and dNKHvH representation may lead to abnormalities in placental development and pregnancy pathology. Our data show that recurrent pregnancy loss is not associated with specific HLA and KIR genotypes in mother and fetus, although the peculiarities of tuning involving KIR3DL2 may affect pregnancy outcome. Mathematical modeling shows the dependence of dNKHvG and dNKHvH representation on the probability of random KIR gene expression. The new description of NK cell involvement in the immune response in the placenta via two-way tuning is applicable to all cases where there are target cells with normal and different “guest” HLA expression (viral infections, tumors, etc.) ![Figure][1] Graphic abstract (Cover work) Image of fetus in utero in graphic abstract adapted from Servier Medical Art (), licensed under CC BY 4.0 () Highlights A hypothesis has been proposed according to which random expression of NK cell receptor genes in combination with two-way tuning (education) of NK cells by different affinity pairs of inhibitory killer cell immunoglobulin-like receptors (KIRs) and their ligands on decidual cells and trophoblasts leads to the presence of populations of maternal decidual NK cells with allo- and autoreactivity in the placenta. It has been shown that the features of the HLA and KIR genotypes of the mother and fetus are not the underlying cause of habitual miscarriage, although genetic features can affect the course of pregnancy. Model calculations of the representation of auto- and alloreactive maternal decidual NK cells show that the effectiveness of their participation in the structural and functional reorganization of the placenta should depend on the probability of KIR gene expression. The hypothesis of two-way tuning of NK cells in the presence of different target cells with normal and different “guest” HLA expressions is applicable to describe the involvement of the innate immune system in the response to pregnancy, viral infection, inflammation, wounds, tumors, and transplantation. ### Competing Interest Statement The authors have declared no competing interest. [1]: pending:yes
Background. Rheumatic diseases are a large group of heterogeneous inflammatory and degenerative-metabolic diseases, characterized by systemic damage, covering all structures of connective tissue (joints, cartilage, bones, periarticular tissues), and also involve blood vessels, internal organs, skin and mucous membranes, mainly with a systemic, not local, nature of damage. Most chronic rheumatic diseases occur in women, and the onset coincides with the peak of childbearing age (18-45 years). The number of women with rheumatic diseases planning to have children increases annually everywhere.Results. The study of pregnancy outcomes, children's health in the neonatal period and during follow-up observation was conducted in women with rheumatic diseases. Women with rheumatic diseases are more likely to have premature births or require operative delivery. Newborns have an increased frequency of pathologies, including prematurity, low gestational weight, intrauterine pneumonia, necrotizing enterocolitis, respiratory distress syndrome and cardiac arrhythmias such as bradycardia and atrioventricular blocks. Children born to women with rheumatic diseases have lower weight-for-height indicators and Apgar scores, as well as a high frequency of complications in the early neonatal period. The health of children at 1 year of life was characterized by the presence of predominantly functional disorders. The decision on breastfeeding should be made individually for each woman with rheumatic diseases.Conclusion. Women with rheumatic diseases planning pregnancy require comprehensive dynamic observation. It is critical to adapt the therapeutic strategy to control rheumatic diseases and minimize the impact of autoantibodies on the fetus.
OBJECTIVE:To study the features of protein expression of gene NDRG1 in primary breast cancer (BC) and to identify its relationship with regional metastasis. MATERIAL AND METHODS:The study included 358 cases of primary BC stages I-III without neoadjuvant chemotherapy with an assessment of a number of clinical, morphological and immunohistochemical parameters of the tumor, including NDRG1 protein expression status and its expression level. RESULTS:In two study groups with and without metastatic lymph node involvement, a statistically significant relationship was found between NDRG1 expression and histological type of BC, tumor grade, estrogen receptors expression, progesterone receptors expression, HER2 status and index Ki-67 (tumor cell proliferative activity). No statistically significant relationship was found between NDRG1 expression and patient age, tumor node size, and multifocality in two study groups with and without metastatic lymph node involvement. CONCLUSION:NDRG1 protein expression is statistically significantly associated with regional metastasis of breast cancer (p=0.015). The differences were due to a higher frequency of cases with NDRG1 positive versus negative status in the group of breast cancer with lymph node metastases.
