Morphological characteristic of premature infants’s kidneys with opened Ductus Arteriosis (by the autopsy).

Background. Kidney has protracted nephrogenesis and depend on hemodynamic changes on the highest level in support of natural transition to extrauterine circulation. Fetal communications like Ductus Arteriosus take part in the shunting from the aorta to the pulmonary artery. Increase of this shunting of the blood leads to hyperperfusion with hypoxic changes of some development systems of organs with protracted morphogenesis so like kidneys. Objective. To determine the features of postnatal morphogenesis of the kidneys in premature infants with a gestational age of 25 to 35 weeks on the background of an open ductus arteriosus. Methods. 21 autopsy material premature infant’s kidney which were fixed by 10%-formalin and then were subjected to the standard histological procedures. Slides were stained by hematoxylin and eosin. We used the complex of histological and morphometric methods. There were created 3-demenshional models of kidney’s fragments. We carried out biometrical and statistical analysis. Results. During our research it was determines that the changes of the volume of the functional parenchyma of the kidney and the diameter of the Ductus Arteriosus became in inverse relationship. The wider the duct the smaller the volume of the functional parenchyma because of atrophic and necrotic changes during the late stages of glomerulo- and tubulogenesis. These changes could be distinguished by the quantitative density of development on three germinate layers of the cortex of kidney. Сonclusion. Summing up, it determined the retardation of glomerulogenesis particularly superficial area of the cortex because of the opened Ductus Arteriosus.

The pathomorphology of the renal cortex depending of arterial hypertension duration course

The kidneys autopsy material of persons with arterial hypertension in different duration was examined. Morphometry of the renal corpuscle area and cortical and juxtamedullary nephrons vascular glomeruli was performed. There were 4 groups - a control group (with a normal blood pressure level), and groups with arterial hypertension - the initial stage (group 2), arterial hypertension for 5-10 years (group 3), long-term arterial hypertension - more than 10 years (group 4). It was found that cortical nephrons are distinguished by earlier and more pronounced hyperplasia of the vascular glomerulus, they are more rapidly exposed to sclerosis, which appears in the 5-10th year of the course of the disease. The hyperplasia of the vascular glomerulus components is progressively increasing in juxtaglomerular nephrons, they are less susceptible to sclerosis processes. Key words: arterial hypertension, juxtaglomerular apparatus, juxtamedullary nephrons, vascular glomerulus.

Level of neurotransmitters in neuroamine-containing lung structures in different forms of tuberculosis

The aim of the study was to identify the features of variations in the localization of monoamines (catecholamines, serotonin)in the cell structures of autopsy material of lungs affected by tuberculosis. Material and methods. 165 cases of secondary pulmonary tuberculosis were studied. We studied 2500 histological preparations of patients aged 30 to 55 years, divided into 5 groups, corresponding to the forms of secondary tuberculosis (group 1-acute focal tuberculosis, group 2-fibro-focal tuberculosis, group 3-infiltrative tuberculosis, group 4-acute cavernous tuberculosis, group 5 - fibro-cavernous tuberculosis. To selectively detect neuroamine-containing structures of the lungs and adrenergic nerve fibers, the Falk-Hillarp luminescence-histochemical method was used in the modification of E. M. Krokhina, based on the reaction of neuroamine condensation with formaldehyde. Results. When using the Falk-Hillarp luminescence-histochemical method, mycobacteria of tuberculosis containing catecholamines and serotonin were detected in autopsy material of lungs affected by a specific inflammatory process, as well as neuroamine-containing granular luminescent cells and mast cells. Affected and unaffected areas of the lungs contain different amounts of the studied monoamines. The results of the study revealed the dependence of the number of cells and the content of the studied bioamines in them on the form of secondary tuberculosis. It was found that in small forms of secondary tuberculosis (acute focal, fibrotic-focal), the number of cells and quantitative parameters of the studied neurotransmitters (catecholamines, serotonin) in granular luminescent cells and mast cells change in the direction of increase. In destructive processes in the lungs (acute cavernous and fibrous-cavernous tuberculosis), the content of catecholamines in the studied structures in the affected area prevails over the control. The concentration of serotonin in the studied cells of the area of lung tissue affected by the tuberculosis process is reduced. The number of neuroamine-containing cells is significantly reduced. The maximum luminescence of catecholamines and serotonin in granular luminescent cells was determined in the infiltrative form of tuberculosis. In mast cells, the highest content of catecholamines was found in the group of acute cavernous tuberculosis, and serotonin in the group of the infiltrative form of the disease. In stained sections of the lungs in this form of tuberculosis, a luminescent pathway of lymphocytes was found. The nerve fibers detected at the sites of mycobacteria were also changed. They did not have a clear luminescence, looked "swollen", in places they did not have varicose veins. Conclusion. Comparing the results of the study with the literature data, it was found that pulmonary tuberculosis occurs as a delayed reaction, and Mycobacterium tuberculosis manifests itself as a corpuscular antigen.

Morphometric and genetic studies of the mechanisms of damage to the cardiovascular system in Kuzbass miners with dust lung pathology

Introduction. The combined impact of unfavorable factors of the production environment in miners leads to the development of associated pathology of the bronchopulmonary and cardiovascular systems, the predisposition to which depends on the individual susceptibility of the body. In this regard, it is important to comprehensively study the pathogenetic mechanisms underlying the formation and course of occupational and work-related diseases for a personalized approach to the diagnosis, prevention and therapy of this pathology. The purpose of this study was to study the mechanisms of damage to the cardiovascular system in miners with dust lung pathology on the basis of morphological and genetic studies. Materials and methods. For genetic studies, venous blood drawing was conducted in 190 Kuzbass miners. The main group included 126 miners of the main professions with the previously proven diagnosis "dust lung pathology", the comparison group consisted of 64 workers without a proven diagnosis working in similar sanitary and hygienic conditions. Morphometric studies were carried out using autopsy material obtained during 80 forensic medical examinations of miners in the Kemerovo region. All the miners were divided into 4 groups depending on their underground work experience. The control group was formed from 20 cases of forensic medical examinations of men who died in road accidents and did not have organ pathology according to the results of autopsies. Results. The study of the autopsy material revealed the presence of morphostructural changes in the vascular walls of the miners’ hearts in the form of hypertrophy of the smooth muscle cells of the medial layers, thickening of the endothelial lining, and the development of fibroplastic changes in the perivascular zones. These changes began to form from the first years of work in the underground conditions and progressed with increasing work experience contributing to the "recalibration" of the heart vessels with the formation of the lumen "obstruction". One of the mechanisms of endothelial damage in miners was a change in the expression of the EDN1 gene, which regulates the synthesis of endothelin-1. The risk and resistance genotypes of the development of dust lung pathology for the rs5370 polymorphism of the EDN1 gene were identified. Morphostructural rearrangement of the endothelium in the combination with its pathological activation contributed to the occurrence of endothelial dysfunction in miners. Conclusions. The conducted studies of the parameters of the vascular endothelium indicate its key role in the pathogenesis of bronchopulmonary and cardiovascular pathology in miners of the main professions. Getting into the body of workers, particles of coal-rock dust lead to morphostructural rearrangement of the cells of the endothelial layer and its pathological activation. The contribution of molecular and genetic mechanisms to the development of occupational lung pathology and associated diseases of the circulatory system in miners is revealed. Ethics. The studies were carried out in compliance with the ethical standards of the Bioethical Committee of the Research Institute for Complex Problems of Hygiene and Occupational Diseases, elaborated on the basis of the Helsinki Declaration of the World Medical Association "Ethical Principles for Conducting Human Scientific Medical Research" as amended in 2013 and the "Rules of Clinical Practice in the Russian Federation" approved by the Order of the Ministry of Health of the Russian Federation No. 266 dated 19.06.2003. All workers were informed about their participation in the molecular-genetic study and gave written consent to carry it out. The research of the dead miners was based on the secondary examination of blocks and ready-made histological micro-preparations of the material of the Bureau for Forensic Medical Expert Examination of the cities of Novokuznetsk, Osinniki, and Prokopyevsk. The study of pathomorphological material was carried out in accordance with the Federal Law of 21.11.2011, No. 323-FZ "On the Fundamentals of Health Protection of Citizens in the Russian Federation", in particular, with Article 67 "Carrying out pathological and anatomical autopsies", Federal Law of 12.01.1996, No. 8-FZ "On burial and funeral business" (Article 5, paragraphs 1, 2), as well as on the basis of the Order of the Ministry of Health of April 29, 1994, No. 82 "On the procedure for conducting pathological and anatomical autopsy" (Annex to the Order of the Ministry of Health and Medical Industry of 29.04.1994 No. 82), the Order of the Ministry of Health of Russia of 24.03.2016. No. 179n "On the rules for conducting pathological and anatomical examinations".

Morphological changes in the ampula of the uterine tubes in different periods of life of giving women

The aim of the study is to determine the dynamics of morphological changes in the ampullae of the fallopian tubes at different age periods of life using autopsy material from women giving birth. Materials and research methods. The analysis of the results of a complex morphological study of the ampullae of the fallopian tubes of 150 corpses of giving birth women of adolescence, the first and second periods of adulthood, elderly and old age was carried out. Results. The histological picture revealed regular atrophic changes in all layers of the wall of the ampulla of the fallopian tube. When comparing the mean values in five age groups according to the Kruskell-Wallis test, statistically significant differences in the length of the epithelial lining in the transverse section of the ampulla of the right and left fallopian tubes (p < 0,001), as well as the wall thickness of the ampulla of the right and left fallopian tubes (p < 0,001) have been identified. Conclusion. The results of the study supplement the literature data on morphological changes in the fallopian tube and can be used as a standard reference.

A relationship between causative agents of infectious diarrhea and fatal outcomes in pre-school children

Infectious diarrhea is one of the leading causes of fatal outcomes in young children. Differential diagnostics of such infections within the first hours of illness poses significant objective obstacles. Data from laboratory studies of autopsy material and pathological studies provide valuable information for understanding the spectrum of differential diagnostics and etiological structure of infectious diarrhea with fatal outcomes in young children. Materials and methods. There were analyzed 100 cases of fatal outcomes in children under the age of six years registered in Russia from November 2011 to December 2019, who was diagnosed with infectious diarrhea at different levels of the healthcare system. The data were assessed based on available medical case reports and the laboratory testing of autopsy samples performed by using nucleic acid amplification methods. Results. The diagnosis of infectious diarrhea was revised in 24 patients, based on the data of a set of intravital and post-mortem studies. In patients with unconfirmed diagnosis of acute intestinal infections, pneumonia was the most often detected — in 45.8% (11/24), sepsis — in 29.2% (7/24), meningitis/meningoencephalitis, acute surgical pathology and asphyxiation associated with vomit aspiration — in 16.7 % (4/24) cases. The causative agents of infectious diarrhea were identified in 71 of 76 patients with confirmed diagnosis of acute intestinal infections. Most prevalent were group A rotaviruses — 52.6% (40/76), group F adenoviruses — 17.1% (13/76), and noroviruses — 13.2% (10/76). Combination of pathogens was detected in 29 cases (38.2%). Prehospital lethal outcomes in patients with infectious diarrhea were observed in 17 cases (22.4%). In total, rate of neonatal deaths due to acute intestinal infections accounted for 62.2% and 2-year-old toddlers — 20.3%. 64 of 76 (84%) children had no unfavorable premorbid background. The most common pathologies associated with infectious diarrhea with developing fatal outcomes were pneumonia (including aspiration pneumonia) in 22.4% (17/76) and aspiration asphyxia in 6.6% (5/76). Hemolytic-uremic syndrome associated with diarrhea was diagnosed in 7.9% (6/76) of children. Conclusions. Within the first years of life children comprise a risk group for developing fatal outcomes during infectious diarrhea. Lack of unfavorable premorbid background should not be considered as a reliable positive prognostic criterion. Diagnostics of pneumonia should be included in the mandatory examination plan for children with severe infectious diar rhea. Based on study of clinical and autopsy material, group A rotaviruses were the lead causative agents among those resulting in infectious diarrhea with fatal outcomes in young children. Special attention should be paid to preventing vomit aspiration within the first days after disease onset.

Morphological and Molecular-Biological Changes in the Coronary Arteries after Stenting

This review addresses morphological changes in coronary arteries following stenting, which result from damage to the vascular wall. These changes include 1) formation of a thrombus in the site of intimal injury; 2) inflammation; 3) proliferation and migration of smooth muscle cells; 4) formation of extracellular matrix. Each of these pathological processes has specific morpho-biological features. The review shows the role of von Willebrand factor in development of early thrombosis after intimal injury, which provokes activation of the inflammatory response followed by proliferation of smooth muscle cell that synthetize the extracellular matrix. These cellular and intercellular changes are based on overexpression of TGF-β1 protein, which facilitates modulation of various types of smooth muscle cells, including contractile and secretory ones. Issues of fine regulation of cellular and intercellular interactions by apoptosis, activation of mTOR signaling molecules, and microRNA are still understudied. Dynamic changes in drug-coated stents during development of neoatherosclerosis and late thrombosis remain not elucidated. Current reports show that initial mechanisms triggering pathological regenerative and hyperplastic processes that result in coronary restenosis in the area of implanted stents may form early (first hours or days) after stenting. Most studies were performed on experimental rather than on autopsy material, which does not allow fully unbiased interpretation of obtained data. Studying dynamics of morphological and molecular changes in coronary arteries after stenting, including on autopsy material, will allow one to express an opinion on the risk of postoperative thrombosis and restenosis.

Microflora of autopsy material from HIV-infected patients

According to literature, lungs are affected in 25 – 60% of HIV-infected individuals. The most common opportunistic disease in this group of patients is pneumonia of various etiology. HIV-positive patients show a wide microbiological landscape of pneumonia pathogens.The aim of the study was to determine the structure of the microflora of autopsy material obtained from the lungs of HIV-infected patients.Methods. 83 samples of autopsy material from patients with HIV infection and 27 samples from HIV-negative patients were analyzed. The deceased were treated in the pulmonary departments of Samara with a diagnosis of community-acquired pneumonia. Due to the large variety of microorganisms recovered from the autopsy material, the microorganisms were divided into several groups: Enterobacteria, non-fermentative gram-negative bacteria, Enterococci, Staphylococci, Sterptococci, and Corynebacteria. The fungi were divided into two subgroups. The first included Candida spp., the second included other types of fungi. The tests for pneumocystis infection, Mycobacterium tuberculosis, and non-tuberculosis mycobacteria were not performed.Results. Enterobacteria were found in 39.2%, non-fermentative gram-negative bacteria – in 27.3% and Enterococci – in 19.6% of the HIV-infected patients. Staphylococcus spp. were found in 4.2%, and Corynebacteria and Streptococci in 0.7% of those patients. Candida spp. accounted for 6.3%, other fungi were found in 2.0% of cases. Enterobacteria and non-fermentative gram-negative bacteria were found in 26.2% of HIV-negative patients. Enterococcus spp. – 21.4%, Staphylococci – 7.1%, Streptococci – 2.4% of those patients. Candida spp. 16.7% were found in 16.7% of HIV-negative patients. Enterobacteria were found significantly more often in the autopsy material from HIV-infected patients. The study shows the high importance of gram-negative flora as a causative agent of infectious lesions of the lung tissue. At the same time, we statistically confirmed an increase in prevalence of Enterobacteria in HIV-positive patients. Although these pathogens are not always detected in the sputum from HIV-infected patients with bronchopulmonary disorders, they are detected only by autopsy examination of the lung tissue.Conclusion. Diagnosis and treatment of pneumonia in HIV-infected patients with severe immunodeficiency have a few specific features, such as increasing the frequency of sputum culture, reducing the number of errors at the preanalytical stage of collecting the biomaterial, ensuring proper conditions for its transportation to a bacteriological laboratory, improving the quality of analysis. The physicians should be aware of the possible detection of gram-negative flora as a causative agent of lung infections and the possible change of the causative agent.

Abstract P-32: Lung Structural Changes in Covid-19 Patients

Background: The main causes of death from Covid-19 are lung lesions with the development of respiratory failure. However, structural changes in the lung tissue in this pathology are poorly studied. We examined autopsy material from patients with Covid-19. The severe condition of patients, the manifestation of pulmonary symptoms of damage (cough, dyspnea) and the high probability of viral pneumonia at COVID-19 led to the widespread use of CT diagnostics in this group of patients, which allowed to identify of the primary signs of the disease, their subsequent transformation as well as the most adverse radiation symptoms corresponding to the severe course of the process (Speranskaya, 2020; Pan et al., 2019). In the cases studied by us, the detection of typical symptoms revealed by radiation diagnostics of COVID-19 was subsequently confirmed by PCR data, which may indicate a high information content and specificity of detecting CT symptoms of a lesion as a method of primary diagnostics. The aim of our study is to confirm at the microscopic level the correspondence of MSCT changes. Methods: The material was taken at autopsy of deceased patients, fixed in 10% formalin solution in phosphate buffer, paraffin sections were stained with hematoxylin and eosin. The autopsy material was examined using a Carl Zeiss light microscope, Axioskop 40. Results: Studies have shown that most of the alveoli of the lung tissue kept their airiness. However, their lumens were significantly reduced due to a significant thickening of the interalveolar septa caused by pronounced inflammatory infiltration mainly by lymphocytes. The most significant changes were revealed from the side of the microvasculature. There are numerous blood clots of various sizes in the lumen of most micro-vessels. The walls of microvessels have been significantly thickened with pronounced inflammatory infiltration and significant edema. The lumens of microvessels have been characterized by significant polymorphism. Intraluminal clots have been also characterized by pronounced polymorphism. The parietal pleura has been thickened. This has been reflected in the MSCT images and corresponds to the processes of perivascular infiltration. Conclusion: The primary CT pattern of COVID-19 is a picture of infiltration of individual secondary pulmonary lobules of the "ground glass" type, followed by a decrease in the lesion volume at a favorable course of the disease, or their increase, the addition of a CT picture of a "cobblestone pavement" and the appearance of alveolar infiltration in the area of "ground glass" at the unfavorable course of the disease.

CLINICAL AND HISTOPATHOLOGICAL FEATURES OFLUNG INJURY IN COVID-19 INFECT

The aim of the study was to evaluate the histopathological changes in the lungs of patients who died of a new coronavirus infection (COVID-19) in relation to the length of hospital stay. We evaluated lung autopsy material, autopsy reports, and death summaries of 39 patients who died of COVID-19. The length of hospital stay ranged from a few hours to 25 days. At all stages of the disease, lung alterations (desquamation of bronchial and alveolar epithelium), circulatory disorders (alveolar edema and hemorrhages, congestion in small blood vessels, thrombosis), compensatory response (fibrosis) were identified. The patients who died during the first week of hospitalization demonstrated predominant signs of circulatory disorders (alveolar edema, hyaline membranes, alveolar hemorrhages, congestion in small blood vessels). Fibrosis, usually not typical for the first week of acute respiratory distress syndrome, was detected in 46% of the deceased during the first week of hospitalization, which may be due to late hospitalization or patterns of fibrosis development in COVID-19. For those who died in the 2nd and 3rd weeks of hospitalization, the compensatory response and progression of fibrosis were noted. By the 3rd week, pulmonary fibrosis was detected in 91% of patients. Thrombotic complications (thrombosis, pulmonary artery thromboembolism) were observed in almost half of fatalities occurring during weeks 2–3. Hemorrhagic infarction was found in 43% (6 patients) who died during week 2 of hospitalization, three of them were diagnosed with pulmonary embolism, indicating progression of pulmonary vascular damage.