A MEDICAL SERVICE OF IMPROPER QUALITY: SOME ASPECTS OF THE INVESTIGATION METHODOLOGY

В статье рассматриваются преступления против здоровья населения и в сфере охраны жизни и здоровья человека, совершаемые медицинскими работниками. Обосновывается необходимость объединения этих преступлений в качестве единого объекта криминалистического исследования. Приводятся примеры фактов привлечения работников системы здравоохранения к уголовной ответственности за оказание услуг, не отвечающих требованиям безопасности. Определяются законодательные пробелы, связанные с отсутствием уголовно-правовой охраны человеческого плода в процессе родового акта, а также с невозможностью применения квалифицирующих признаков указанных преступлений в случае виновного причинения гибели плоду. The article considers crimes against public health and in the sphere of protection of life and health committed by medical workers. The necessity of combining these crimes as a single object of forensic investigation is substantiated. Examples of bringing of health care workers to criminal liability for the provision of services that do not meet the safety requirements are given. The legislative gaps associated with the lack of criminal law protection of human fetus in the process of delivery, as well as the inability to apply the qualifying signs of these crimes in the case of culpable causing the death of a human fetus are identified.

Morphometric analysis of duodenum in human fetus

Objective The mucosa of the duodenum is lined by finger-like villi. In adults, the villus height to width ratio is about 4–5:1. The aim of this study is to evaluate the villus height to width ratio in the human fetus. Methods Eighty-one human fetal autopsies were included in the study. Three random villi were measured with the X and Y-axes. The statistical analysis was performed by Pearson correlation, Kolmogorov-Smirnov, chi-square, linear regression tests, and Student’s t-test. Results There were 29 female and 52 male fetuses. The age range was between 12 and 40 weeks of gestation. Of 81 fetuses, 2 were in the first trimester, 73 in the second trimester, and 6 in the third trimester. The mean villus height to width ratios in the first, second, and third trimesters were 2.75±0.37, 3.21±0.17, and 3.76±0.6, respectively. There was no correlation between the week of gestation and duodenum villus height to width ratio (p=0.080). The mean villus height to width ratios among females and males were 3.62±1.28 and 3.02±0.84, respectively (p=0.014). Conclusion In our study, villi were blunter and shorter in fetuses than in adults but not in children regardless of weeks of gestation compared to the literature. The gradual elongation of villi after birth may be attributed to environmental factors.

Morphological variability of the plantaris tendon in the human fetus

Muscular anatomy often differs between species and individuals. In particular, the plantaris muscle (PM) demonstrates great morphological variability in its course and its proximal and distal attachments. The aim of this study was to investigate the morphological variation of the PM tendon in human fetuses. Forty-six spontaneously aborted human fetuses (23 male, 23 female) aged 18–38 weeks of gestation were studied. Morphology of the attachment of the PM was assessed in both lower extremities (n = 92). The PM was present in 72 lower limbs (78.26%) and absent in 20 (21.74%). Eight types of PM distal attachment were identified. We propose an eight-fold classification of PM insertion in fetuses. Leg length, length of tendon, extension point (ExP) from the calcaneus, and ExP thickness differed significantly among types of PM insertion.

Fetoscopy-assisted enables valvuloplasty in a human fetus with disadvantageous intrauterine position — A case report

Background Some fetuses scheduled for balloon valvuloplasty present with unfavorable lies that render a successful procedure unlikely or impossible. In these situations, Foetal posturing previously has been achieved by maternal laparotomy. As a less invasive means, we demonstrate the feasibility of a minimally-invasive fetoscopic approach. Case Percutaneous ultrasound-guided Foetal balloon valvuloplasty for severe aortic valve stenosis was attempted in a human fetus at 29 + 4 weeks of gestation under general maternofetal anesthesia. Unfortunately, prior to the procedure, the fetus had been observed on several occasions remaining in a dorso-anterior cephalic position. Therefore, the left ventricle could not be accessed by the conventional percutaneous ultrasound-guided approach. In order to achieve the desired Foetal lie, fetoscopic assistance was employed: using a standardized fetoscopic setup, a fetoscope and two graspers, the fetus was rotated in dorsoposterior position. After this maneuver, successful balloon valvuloplasty was achieved. Mother and fetus tolerated the procedure well and complications were not observed. Discussion Fetoscopy-assisted Foetal posturing offers itself as an alternative to maternal laparotomy in fetuses presenting with a persisting disadvantageous position at the time of ballon valvuloplasty. Due to the increased risks of preterm rupture of membranes and earlier delivery posed by the fetoscopic approach, this technique may preferably be used in more mature fetuses when Foetal posturing cannot be achieved by other means.

Dynamic Spatiotemporal Expression Changes in Connexins of the Developing Primate’s Cochlea

Connexins are gap junction components that are essential for acquiring normal hearing ability. Up to 50% of congenital, autosomal-recessive, non-syndromic deafness can be attributed to variants in GJB2, the gene that encodes connexin 26. Gene therapies modifying the expression of connexins are a feasible treatment option for some patients with genetic hearing losses. However, the expression patterns of these proteins in the human fetus are not fully understood due to ethical concerns. Recently, the common marmoset was used as a primate animal model for the human fetus. In this study, we examined the expression patterns of connexin 26 and connexin 30 in the developing cochlea of this primate. Primate-specific spatiotemporal expression changes were revealed, which suggest the existence of primate-specific control of connexin expression patterns and specific functions of these gap junction proteins. Moreover, our results indicate that treatments for connexin-related hearing loss established in rodent models may not be appropriate for human patients, underscoring the importance of testing these treatments in primate models before applying them in human clinical trials.