Acquired Immunodeficiency Syndrome

案情简介患儿小彤，9年前（3岁）以“无明显诱因下出现全身散在点状皮疹，为鲜红色，压之不褪色，间断发热，间断头疼并伴有口腔粘膜出血”为主诉入住省医院，经诊断为“重度再生障碍性贫血”，完善相关检查及输血风险告知后，给予输血及免疫抑制剂等对症治疗。半年内，小彤先后6次在省医院住院输血治疗，先后输血70余次，在此期间HIV抗体检测均为阴性。第6次出院后仅隔13天，小彤第7次入院治疗，住院1个月后经临床检验中心及省疾控中心检测确认其感染艾滋病病毒。小彤遂因此起诉省医院及血液中心要求赔偿。最终二审法院认定小彤护理依赖年限为5年，若5年后仍需护理依赖，可另行再主张。判决血液中心赔偿各项损失合计73万余元（含护理依赖费24万余元），省医院承担连带责任。7年后小彤再次起诉，认为其感染艾滋病病毒属于免疫系统疾病，且患有重度再生障碍性贫血，需要长期护理依赖，要求省医院及血液中心再赔偿5年护理费共计44万余元。法院审理一审法院认为，患儿小彤在省医院住院治疗期间输入由血液中心提供的血液感染艾滋病毒。血液中心因未按照要求及时、有效的开展血液核酸检测工作，不能按要求提供血液安全保障，应承担主要赔偿责任。省医院作为具备相应医学专业技术及技能的机构，对短时期内反复多次输血可能带来的风险应当具备预见性，对由此造成患者因输血导致的感染后果亦存在过错，应当承担连带赔偿。患儿感染艾滋病属于免疫系统疾病，且其患有重度再生障碍性贫血，需长期依赖他人护理，对其主张今后的护理依赖费应予支持，判决血液中心赔偿患儿护理费44万余元，省医院承担连带赔偿责任。血液中心不服，认为患儿是艾滋病病毒感染者，不是艾滋病病人。是否需要护理依赖，应该由鉴定部门出具专业意见。省医院应与血液中心平均承担责任，而不是连带责任，提起上诉。二审法院认为，省医院承担连带责任及护理依赖问题，原生效判决书已经确认，对于生效判决书确认的事实及裁判的结果，非经再审程序撤销，其具有司法公信力。护理依赖费应参照当地私营单位就业人员平均工资标准计算，一审对护理费的计算标准有误，改判血液中心赔偿患儿护理费26万余元，省医院承担连带赔偿责任。法律简析本案系患者住院治疗期间输血感染艾滋病病毒引发的医疗纠纷。对于因输入不合格的血液的侵权责任，我国《民法典》明确规定“药品、消毒产品、医疗器械的缺陷，或者输入不合格的血液造成患者损害的，患者可以向药品上市许可持有人、生产者、血液提供机构请求赔偿，也可以向医疗机构请求赔偿。患者向医疗机构请求赔偿的，医疗机构赔偿后，有权向负有责任的药品上市许可持有人、生产者、血液提供机构追偿”。患者输入的血液绝大多数都是在医院进行的，对于血液和血液制品，医疗机构都应负有最终的把关责任，这种责任关系着患者的生死存亡。医务人员与普通人群存在的最大不同在于其接受过医学教育，具备专业知识与专业技能，经过专门考核，具有一般人不具备的行医资格。作为专业机构和专业人员，医院和医生有能力与责任对血液和血液制品进行鉴别。对输入不合格的血液，医疗机构因过错致使患者受到输血损害的，应当承担侵权责任；无过错输血造成患者损害的，也应当承担赔偿责任。医疗机构赔偿后，有权向负有责任的血液提供机构追偿。血站是采集、提供临床用血的机构，是不以营利为目的的公益性组织。血站应当根据国务院卫生行政部门制定的标准，保证血液质量，对采集的血液必须进行检测；未经检测或者检测不合格的血液，不得向医疗机构提供。无偿献血的血液必须用于临床，不得买卖，血站、医疗机构不得将无偿献血的血液出售给单采血浆站或者血液制品生产单位。本案中血液中心因未按照要求及时、有效的开展血液核酸检测工作，不能按要求提供血液安全保障，被法院判决承担赔偿责任。另外，当事人对自己提出的诉讼请求所依据的事实或者反驳对方诉讼请求所依据的事实，应当提供证据加以证明，在作出判决前，当事人未能提供证据或者证据不足以证明其事实主张的，由负有举证证明责任的当事人承担不利的后果，但是对于已为人民法院发生法律效力的裁判所确认的事实，当事人无须举证证明。故此，本案中血液中心的上诉理由得到二审法院的支持。血液是重要的临床医疗资源，与人民群众的健康密切相关。近年来，国家陆续修订《血站管理办法》《临床用血管理办法》等规章，对献血工作提出更高、更细致的要求，对保证医疗临床用血需要和安全，保障献血者和用血者身体健康等方面发挥了积极重要的作用。血液提供机构应当严格执行《中华人民共和国献血法》及上述相关管理规范，以保障临床用血需要和输血安全、保障献血者和用血者身体健康。撰文 | 医法汇编辑 | Swagpp● 柳叶刀最新：全球生育率持续下降，逼近临界值！25年后，近50%国家的自然增长率为负，中国人口将持续减少● 怪不得他总是get不到你！Neuron最新：两性基因的神经环路不同，导致共情行为存在性别差异● 热议！专科生应聘影像技师，主任无奈拒绝：你很优秀，但我们只招本科！医生：初中生都能胜任，赶快取消这个专业吧，本科生恨它恨得牙痒痒版权说明：梅斯医学（MedSci）是国内领先的医学科研与学术服务平台，致力于医疗质量的改进，为临床实践提供智慧、精准的决策支持，让医生与患者受益。欢迎个人转发至朋友圈，谢绝媒体或机构未经授权以任何形式转载至其他平台。点击下方「阅读原文」 立刻下载梅斯医学APP！

NEWARK, Del., March 27, 2024 /PRNewswire/ -- Look out for a growing market in Parenteral Formulas (delivered intravenously for nutrition) FMI predicts a surge due to rising malnutrition and preterm births worldwide (2024-2034). The report offers a comprehensive analysis to help you capitalize on this trend, including market drivers, potential challenges, and exciting opportunities. It even provides investment insights and strategic decision-making tools. According to a recent Future Market Insights (FMI) report, sales of parenteral formula are expected to reach a value of US$ 12.5 billion by 2034. The market is anticipated to rise at a CAGR of around 5.7% from 2024 to 2034. It is estimated to attain a value of US$ 6.8 billion by 2024. Download the Sample PDF report to explore key market insights and trends: The high prevalence of chronic diseases worldwide is a key factor propelling the parenteral formulation industry. Parenteral formulation consumption has increased recently due to the rising prevalence of short bowel syndrome, cancer, AIDS, diabetes, Crohn's disease, and other digestive problems. The International Agency for Research on Cancer (IARC), for instance, estimates that 18.1 million new cases and 9.6 million deaths occurred in 2018. Furthermore, according to the National Renal Foundation, 10% of people worldwide suffer from chronic renal disease every year. Based on several forms of patient feeding, the study provides a thorough segmentation of the global parenteral formula industry. The global market is divided into categories based on the kind of nutrition: carbohydrates, trace elements, electrolytes & minerals, single-dose amino acid solutions, parenteral lipid emulsions, and vitamins. Lipid emulsion infusion provides a significant energy source, helps avoid high glucose infusion rates, and is required for the delivery of vital fatty acids. The potential advantages of using parenteral lipid emulsions as a drug delivery system have contributed to the segment's expansion. Patients with impaired gastrointestinal tracts or those who are unable to consume enough food orally or enterally are shifting toward parenteral nourishment. Products for parenteral nutrition contain a variety of micronutrients like vitamins, minerals, and trace elements. These also contain macronutrients like carbohydrates, amino acids, and lipid emulsions. The parenteral formula market is mainly pushed by rising chronic illnesses like HIV, Crohn's disease, and cancer. The market is also augmented by extensive research & development efforts of leading firms to create new parenteral nutrition products. Scope of the Parenteral Formula Market Report Key Takeaways from the Parenteral Formula Market Study: Global parenteral formula sales grew at a CAGR of 4.7% from 2019 to 2023. The United States parenteral formula industry is poised to exhibit a CAGR of 3.8% during the assessment period. The parenteral formula market in Germany is anticipated to rise at a steady CAGR of 4.4% during the forecast period from 2024 to 2034. Japan's parenteral formula market is poised to exhibit a CAGR of 5.1% during the assessment period. By type of nutrient, the electrolytes segment is expected to register a CAGR of 7.7% from 2024 to 2034. The online pharmacies segment is anticipated to thrive at 8.3% CAGR during the projection period. "Critical care settings, surgical units, and long-term care facilities are adopting parenteral formulas to help patients suffering from chronic conditions. Key companies are hence striving to come up with novel formulas to enhance safety and efficacy," says Nandini Roy Choudhury (Client Partner for Food & Beverages at Future Market Insights, Inc.). Who is Winning Baxter International Inc., B. Braun Melsungen AG, Fresenius Kabi AG, Otsuka Pharmaceutical Co., Ltd., Aculife Healthcare Private Limited, and Nutricia (a subsidiary of Danone) are some of the key players in the global market. These companies are expanding product portfolios, employing strategies like advertising to propel growth in the market. The parenteral formula industry has a diverse and dynamic competitive landscape. Leading companies are focusing on research & development, sustainable sourcing, and new formulations. For instance, Otsuka Pharmaceutical received marketing approval for ENEFLUIDⓇ Injection in 2020. The injection contains water-soluble vitamins, lipids, amino acids, glucose, and electrolytes. Purchase now and gain full access to the Parenteral Formula Industry report, featuring comprehensive Market Forecast, Company Share Analysis, Competition Intelligence, DROT Analysis, Market Dynamics and Challenges, and Strategic Growth Initiatives. Get More Valuable Insights into the Parenteral Formula Market Future Market Insights (FMI), in its new offering, provides an unbiased analysis of the global parenteral formula market, presenting historical demand data (2019 to 2023) and forecast statistics for the period from 2024 to 2034. The study incorporates compelling insights on the parenteral formula market based on the type of nutrient (carbohydrates, amino acids, lipids, electrolytes, vitamins and minerals, and specialty formulas), indications (neurological diseases, GI disorders, malnutrition, Alzheimer's, cancer care, chronic kidney diseases, dysphagia, others), and sales channels (store-based and online pharmacies) across various regions. About the Food & Beverage Division at Future Market Insights (FMI) Future Market Insights (FMI) Food & Beverage team offers comprehensive business intelligence services, with a vast array of reports and data points analyzed across 50+ countries over a decade. The team provides consulting services and end-to-end research, offering expert analysis, actionable insights, and strategic recommendations to clients worldwide. Contact them to explore how they can assist with your unique business intelligence needs. About the Author: Nandini Roy Choudhury (Client Partner for Food & Beverages at Future Market Insights, Inc.) has 7+ years of management consulting experience. She advises industry leaders and explores off-the-eye opportunities and challenges. She puts processes and operating models in place to support their business objectives. She has exceptional analytical skills and often brings thought leadership to the table. Nandini has vast functional expertise in key niches, including but not limited to food ingredients, nutrition & health solutions, animal nutrition, and marine nutrients. She is also well-versed in the pharmaceuticals, biotechnology, retail, and chemical sectors, where she advises market participants to develop methodologies and strategies that deliver results. Another feather to her cap manifests in the form of process automation. She is vocal about bringing automation to the fore to bring a 360-degrees-round revolution in manufacturing sector Her core expertise lies in corporate growth strategy, sales and marketing effectiveness, acquisitions and post-merger integration and cost reduction. Nandini has an MBA in Finance from MIT School of Business. She also holds a Bachelor's Degree in Electrical Engineering from Nagpur University, India. Nandini has authored several publications, and quoted in journals including Beverage Industry, Bloomberg, and Wine Industry Advisor. Explore FMI's Extensive Coverage in the Food and Beverage Domain: Infant Formula Market Analysis based on Powder, Liquid, and Ready-to-feed Forms from 2024 to 2034. – Review and Request to Access the Sample Report. Cellular Nutrition Market Analysis by Antioxidants and Vitamins and Minerals Types, 2023 to 2033. - Review and Request to Access the Sample Report. Digestive Health Supplements Market by Probiotics, Enzymes, and Others, Forecast, 2023-2033 . - Review and Request to Access the Sample Report. Probiotic Supplement Market Analysis based on Tablets, Capsules, Liquid, Powder, and Gummies from 2024 to 2034. - Review and Request to Access the Sample Report. Hydration Supplement Market by Electrolyte Tablets and Sports Drinks from 2024 to 2034. - Review and Request to Access the Sample Report. About Future Market Insights (FMI) Future Market Insights (FMI) is a leading market intelligence and consulting service provider, serving clients in over 150 countries. FMI is headquartered in Dubai and has delivery centers in the UK, the U.S., and India. FMI's latest market research reports and industry analysis help businesses navigate challenges and make critical decisions with confidence and clarity amidst breakneck competition. Our customized and syndicated market research reports deliver actionable insights that drive sustainable growth. A team of expert-led analysts at FMI continuously tracks emerging trends and events in a broad range of industries to ensure that our clients prepare for the evolving needs of their consumers. Contact Us Nandini Singh Sawlani Future Market Insights Inc. Christiana Corporate, 200 Continental Drive, Suite 401, Newark, Delaware - 19713, USA T: +1-845-579-5705 For Sales Enquiries: [email protected] Website: LinkedIn| Twitter| Blogs | YouTube Logo: SOURCE Future Market Insights

BRONX, N.Y., March 27, 2024 /PRNewswire/ -- Just as you can't make an omelet without breaking eggs, scientists at Albert Einstein College of Medicine have found that you can't make long-term memories without DNA damage and brain inflammation. Their surprising findings were published online today in the journal Nature. Continue Reading This image shows fragments released from the nuclei of neurons undergoing DNA damage during learning: DNA (large white dot at center right), histones (purple), and transcription factors (red and green). "Inflammation of brain neurons is usually considered to be a bad thing, since it can lead to neurological problems such as Alzheimer's and Parkinson's disease," said study leader Jelena Radulovic, M.D., Ph.D., professor in the Dominick P. Purpura Department of Neuroscience, professor of psychiatry and behavioral sciences, and the Sylvia and Robert S. Olnick Chair in Neuroscience at Einstein. "But our findings suggest that inflammation in certain neurons in the brain's hippocampal region is essential for making long-lasting memories." The hippocampus has long been known as the brain's memory center. Dr. Radulovic and her colleagues found that a stimulus sets off a cycle of DNA damage and repair within certain hippocampal neurons that leads to stable memory assemblies—clusters of brain cells that represent our past experiences. Elizabeth Wood, a Ph.D. student, and Ana Cicvaric, a postdoc in the Radulovic lab, were the study's first authors at Einstein. From Shocks to Stable Memories The researchers discovered this memory-forming mechanism by giving mice brief, mild shocks sufficient to form a memory of the shock event (episodic memory). They then analyzed neurons in the hippocampal region and found that genes participating in an important inflammatory signaling pathway had been activated. "We observed strong activation of genes involved in the Toll-Like Receptor 9 (TLR9) pathway," said Dr. Radulovic, who is also director of the Psychiatry Research Institute at Montefiore Einstein (PRIME). "This inflammatory pathway is best known for triggering immune responses by detecting small fragments of pathogen DNA. So at first we assumed the TLR9 pathway was activated because the mice had an infection. But looking more closely, we found, to our surprise, that TLR9 was activated only in clusters of hippocampal cells that showed DNA damage." Brain activity routinely induces small breaks in DNA that are repaired within minutes. But in this population of hippocampal neurons, the DNA damage appeared to be more substantial and sustained. Triggering Inflammation to Make Memories Further analysis showed that DNA fragments, along with other molecules resulting from the DNA damage, were released from the nucleus, after which the neurons' TLR9 inflammatory pathway was activated; this pathway in turn stimulated DNA repair complexes to form at an unusual location: the centrosomes. These organelles are present in the cytoplasm of most animal cells and are essential for coordinating cell division. But in neurons—which don't divide—the stimulated centrosomes participated in cycles of DNA repair that appeared to organize individual neurons into memory assemblies. "Cell division and the immune response have been highly conserved in animal life over millions of years, enabling life to continue while providing protection from foreign pathogens," Dr. Radulovic said. "It seems likely that over the course of evolution, hippocampal neurons have adopted this immune-based memory mechanism by combining the immune response's DNA-sensing TLR9 pathway with a DNA repair centrosome function to form memories without progressing to cell division." Resisting Inputs of Extraneous Information During the week required to complete the inflammatory process, the mouse memory-encoding neurons were found to have changed in various ways, including becoming more resistant to new or similar environmental stimuli. "This is noteworthy," said Dr. Radulovic, "because we're constantly flooded by information, and the neurons that encode memories need to preserve the information they've already acquired and not be 'distracted' by new inputs." Importantly, the researchers found that blocking the TLR9 inflammatory pathway in hippocampal neurons not only prevented mice from forming long-term memories but also caused profound genomic instability, i.e, a high frequency of DNA damage in these neurons. "Genomic instability is considered a hallmark of accelerated aging as well as cancer and psychiatric and neurodegenerative disorders such as Alzheimer's," Dr. Radulovic said. "Drugs that inhibit the TLR9 pathway have been proposed for relieving the symptoms of long COVID. But caution needs to be shown because fully inhibiting the TLR9 pathway may pose significant health risks." The study is titled "Formation of memory assemblies through the DNA-sensing TLR9 pathway." Other Einstein authors are: Hui Zhang, Ph.D., Zorica Petrovic, B.A., Anna Carboncino, Ph.D., Kendra K. Parker, B.A., Thomas E. Bassett, Ph.D., Xusheng Zhang, M.S. The other contributors are: co-first author Vladimir Jovasevic, Ph.D., at Northwestern University, Chicago, IL; Maria Moltesen, Ph.D., Naoki Yamawaki, Ph.D., Hande Login, Ph.D., Joanna Kalucka, Ph.D., all at Aarhus University, Aarhus, Denmark; Farahnaz Sananbenesi, and Andre Fischer, Ph.D., at University Medical Center, Göttingen, Germany. About Albert Einstein College of Medicine Albert Einstein College of Medicine is one of the nation's premier centers for research, medical education and clinical investigation. During the 2023-24 academic year, Einstein is home to 737 M.D. students, 209 Ph.D. students, 124 students in the combined M.D./Ph.D. program, and approximately 239 postdoctoral research fellows. The College of Medicine has more than 2,000 full-time faculty members located on the main campus and at its clinical affiliates. In 2023, Einstein received more than $192 million in awards from the National Institutes of Health. This includes the funding of major research centers at Einstein in cancer, aging, intellectual development disorders, diabetes, clinical and translational research, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore, the University Hospital and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. For more information, please visit einsteinmed.edu, follow us on Twitter, Facebook, Instagram, LinkedIn, and view us on YouTube. SOURCE Albert Einstein College of Medicine