[Preventability of perinatal losses by the example of the large industrial cities Chelyabinsk and Novosibirsk]. / Predotvratimost' perinatal'nykh poter' v Cheliabinske i Novosibirske.

Perinatal mortality rate is an indicator that characterizes the quality of medical care, as well as the social and economic situation in the region. OBJECTIVE: to audit perinatal losses in large regional centers of the Russian Federation with a population of over 1 million inhabitants, such as Chelyabinsk and Novosibirsk. MATERIAL AND METHODS: A comprehensive postmortem examination of 309 cases of perinatal losses in 2016 was made, which was supplemented with an assessment of preventability according to the Scandinavian-Baltic classification. RESULTS: The rate of preventable deaths in Chelyabinsk and Novosibirsk amounted to 91 and 81.5% of cases, respectively; the deaths were due to stillbirths at more than 28 weeks' gestation and to dead newborns in almost half of cases. The proportion of intranatal deaths was shown to increase in Chelyabinsk; the number of neonatal deaths at more than 33 weeks' gestation rose in Novosibirsk. CONCLUSION: Supplementing the traditional clinical and postmortem analysis with an assessment of the preventability of perinatal loss makes it possible to ensure a unified approach to evaluating these conditions and the comparability of autopsy results in different subjects of the Russian Federation and to determine regional reserves for reducing perinatal mortality rates.

[Some aspects of examining the images of tracer hyperfixation foci in osteoscintigrams by computer-assisted automated analysis].

OBJECTIVE: to analyze the numerical characteristics of bone metastases according to scintigraphic data. MATERIAL AND METHODS: Computer-assisted automated analysis was used to examine planar skeletal osteoscintigrams in patients with breast cancer who had both complete remission and disease progression with skeletal metastases. Brightness in the image was used as an analyzed indicator. RESULTS: Examination of physiological tracer accumulation in patients without skeletal metastases suggests that there is a wide variability of brightness values in the scintigrams of individual skeletal areas. At the same time, the skeletal anatomic areas show significant differences in the average image brightness values (p < 0.01). In virtually all skeletal areas, the average brightness values in the pathological tracer hyperfixation foci (HFFs) in the scintigrams are dominant over the similar values of physiological HFFs. CONCLUSION: There is a direct relationship between the tracer accumulation levels in the skeletal areas without metastatic involvement and the bone metastases occurring in the same areas.

[Development of targeted indicators of quality in postmortem examination].

The indicators of quality for impartial quantitative assessment of postmortem examination have been suggested. These indicators were based on ratio of achievement and target indexes of pathologicoanatomic activity. The indicators are necessary for decision making for enhancement of pathologicoanatomic service quality in the health-care agencies.

[Diagnosis and causes of death in diabetes mellitus].

In the pandemic of diabetes mellitus (DM), there is no unified approach to making the final clinical and postmortem diagnoses of deaths caused by coronary heart disease (CHD), cerebrovascular diseases (CVD), and some other vascular catastrophes. The acute and chronic forms of CHD and CVD and acute and chronic ischemic lesions in other vascular basins, which result in death in DM, should be regard as its complications. Moreover, DM is a peripheral vascular disease.

[Thyroid morphology in a children population living in the environmentally polluted area].

Comprehensive study of the "normal" thyroid gland in fetuses and children of different age groups in the Chelyabinsk region revealed a number of changes characteristic of the so-called dysregulation pathology. The role of ecological factors and outcome of resuscitation and intensive therapy in these changes is discussed. It is shown that the development and manifestation of tumoral and non-tumoral diseases of thyroid gland prone to a combination of various diseases are delayed till the school age.

[Uterine mucosal morphofunctional characteristics in women with early miscarriages of infectious genesis].

Eighty-two reproductive-aged patients who had early miscarriages of infectious genesis were examined. Group I comprised 56 women who had a history of one spontaneous miscarriage; Group 2 included 26 patients with a history of 2 spontaneous miscarriages or more. The examination used a set of diagnostic tools for the identification of genital infections and histological, histochemical, and statistical studies. Group 2 patients were ascertained to have more frequently infectious inflammatory genital diseases. In the women of both groups, chronic endometritis of mainly Ureaplasma, Mycoplasma, and viral etiologies was recorded in 100% of cases while that of mixed etiology was observed in 57%. Moreover, the signs of endometrial stromal fibrosis and atrophy, receptor apparatus lesion, and suppressed tissue protective immune reactions were significantly more evident in Group 2 patients.

[The characteristics of the epithelium and endometrial extracellular matrix in miscarriage during early pregnancy associated with chronic endometritis].

In miscarriage associated with chronic endometritis, the uterine mucosa was found to have a lower expression of TGFR-beta, gelatinases and a higher exposure of TIMP-1 and EGFR, which confirms a pathogenetic association between the imbalance of growth factors, endoproteases and their inhibitors and points to the active involvement of these cytokines and endopeptidases in the inflammatory, reparative processes and remodeling of tissues. The imbalance of growth factors, proteases, and antiproteases is likely to be a cause of uterine mucosal remodeling with progressive collagenogenesis and atrophy of the glandular apparatus along with pathogen persistence, which may be one of the factors predisposing to miscarriage. This makes it necessary to eliminate the causative agent of the endometrial infectious-inflammatory process in the earliest periods of the onset of disease and permits the drawing up of approaches to targeted drug therapy for some pathogenetic links of disease.

[Pathology service of the public health system of Russia: conceptual directions of creation].

The principles of effective pathology service in the public health system are presented and discussed, by taking into account its state-social administration on the basis of an industrial management model. To set up official pathology committees as pathology service-controlling centers monitoring the situation in the pathology institutions (respective subdivisions of health care facilities and other organizations) developing and implementing proposals to improve the system is the most important condition for the qualitative performance of work and services in the specialty of anatomical pathology.

[Evaluation of malignancy of squamous cell lung cancer by clinico-morphological, immunohistochemical and prognostic study of tumor markers].

An immunological study was carried out in 127 cases of surgical treatment of squamous cell lung cancer. Cryostat sections were used to identify markers of proliferation (Ki-67 and topoisomerase IIalpha), apoptosis (p53 and CAS) and intercellular adhesion (E-cadcherin). It was shown that Ki-67 and topoisomerase IIalpha proliferation rates and CAS expression may be interpreted as additional factors of squamous cell cancer aggressiveness while E-cadcherin expression--as a favorable prognosticator. In cases of Ki-67 in excess of 36%, 5-year survival dropped to 38% as compared with 70% when that index was below 36%.

[Significance of some growth factors in the pathogenesis of chronic gastritis in children].

Gastric biopsy specimens taken from 44 children aged 7 to 15 years who had a clinical diagnosis of chronic gastritis (CG) were studied. In Helicobacter pylori (Hp)-associated CG (n = 24), there were accelerated cell regeneration processes in the antral and fundal mucosae as compared with the rate of proliferation and apoptosis in Hp-unassociated CG (n = 20). The increased proliferation of gastric mucosal (GM) elements has been shown to be associated with the high density of EGFR, in Hp-associated CG in particular, which is generally observed in the insufficient level of TGFR-beta. The authors have ascertained the important role and heterodirectional functional load of EGFR and NGFR-beta in the pathogenesis of CG. This disease is characterized by the maximum EGRF expression that is directly correlated with the rate of cell regeneration processes and the activity of an inflammatory process. Moreover, the rate of proliferation and apoptosis are associated with the increased expression of EGRF on the other hand and with the inadequate reperesenation of TGFR-beta on the GM cell membranes, which is particularly prominent in children with Hp-associated CG.

[Endometrial pathomorphology in bacterial vaginosis associated with chronic endometritis].

A complex morphological and morphometric study was used to examine endometrial biopsy specimens from 133 patients with bacterial vaginosis (BV). Chronic endometritis (CE) was detected in 100% of them. The morphological components of CE in BV were significant dystrophic changes in integumentary endotheliocytes and glandular cells, differently pronounced polymorphocellular infiltration of the uterine mucosa with signs of tissue lymphopenia, as well as stromal and vascular fibroblastic changes with the decreased volume density of the endometrial integumentary endothelium, lower relative volumes of glands, and increased relative volume of connective tissue. The characteristic structural changes for CE and BV are intensive processes of apoptosis of the uterine mucosal epithelium in the presence of its slight proliferative activity, which determines progressive endometrial atrophy and may contribute to non-developing pregnancy. As this takes place, discrinism occurs in the uterine mucosa, mainly as inadequate progesterone reception of endometrial target cells, which leads to uterine gland dysfunction and may also cause fetal depletion syndrome.

[Independent postmortem examination: contents of its concept, organizational aspects of its performance].

The paper discloses the contents of the concept of independent postmortem examination and describes the organizational aspects of postmortem examination according to the materials of primary postmortem studies of autopsy and biopsy of surgically removed organs.

[Frequency of divergence of final clinical and anatomical diagnoses as an indicator of medical care quality].

The authors show it necessary to modify the frequency of divergence between final clinical and anatomical diagnoses as an indicator of health care. This parameter should be integral and based on the analysis of the leading principles of analysis of a revealed faulty of health care, by taking into account both controllability of the underlying disease at the moment of a patient's first visit to a doctor for its manifestations and at the stage of health care delivery when misdiagnosis and maltreatment are made.

[Choice of optimal respiratory support in acute parenchymatous respiratory failure].

The principal goals of respiratory therapy for acute respiratory failure are to correct gas exchange and to lower respiratory performance. In acute lung lesion syndrome (ALLS) and acute respiratory distress syndrome (ARDS), the oxygenation index (PaO2/FiO2) reflects the degree of alveolar-capillary membrane damage. The changes in PaO2/FiO2 between 400 to 300 at adequate ventilation can be interpreted as occult alveolar-capillary insufficiency. The principle of power saving in ALLS/ARDS is to choose a respiratory support regimen that may ensure oxygenation safety by eliminating the excess work of respiration. The ratio of PaO2/FiO2/VO2 is proposed to consider to be a criterion for the effectiveness of respiratory support in ALLS/ARDS and a marker of energy deficiency. It has been established that the function of the alveolar-capillary membrane is not impaired with the PaO2/FiO2 ratio of more than 1.5 and the ratio of less than 1.0 is typical of the severe course of the severe course of ARDS and suggests both alveolar-capillary membrane damage and energy deficiency.

[Correlation of proliferation, apoptosis, angiogenesis and metastasizing in various histogenetic types of pulmonary cancer (an immunohistochemical investigation)]. / Sootnoshenie protsessov proliferatsii, apoptoza, angiogeneza i metastazirovaniia v razlichnykh gistologicheskikh tipakh raka legkogo (immunogistokhimicheskoe issledovanie).

Surgical material from 157 patients with lung carcinoma was studied. Immunohistochemical detection of the following oncomarkers was performed: Ki67, p53, CD34, CAS, Topoisomerase II alfa, nm23 protein, E-cadherin. The existence of association between proliferation, tumour cell apoptosis and formation of vessels in the tumour stroma is established. Angiogenesis correlated with proliferative activity of tumour cells this resulting from the effect of growth factors secreted by cells of both tumours and stroma. Angiogenesis in lung carcinoma may also be stimulated by mitogenetic factors accumulating in tumour tissue due to the "uncompleted" apoptosis. Low nm23 and E-cadherin expression is found in lung carcinoma with regional lymphogenic metastases indicating probably cancer metastases.

[The analysis of cases of delayed diagnosis of tuberculosis among the population of the Cheliabisk district]. / Analiz sluchaev zapozdaloi diagnostiki tuberkuleza u naseleniia Cheliabinskoi oblasti.

There was a steady-state rise in tuberculosis morbidity in the Chelyabinsk Region in the 1990s. At the same time, the number of patients whose disease is untimely detected was on the increase and in some cases the disease is found just at autopsy. These facts result from the lower efficiency of tuberculosis controlling measures, from low training of general physicians in detecting and diagnosing tuberculosis, and from failure to meet the standards for examining all those who have fallen ill.

[Autopsy: problems and approaches to their solving]. / Patologo-anatomicheskaia ékspertiza: problemy i puti ikh razresheniia.

Further upgrading of pathology expertise should be based on scientific legitimate grounds with creation of national and regional consulting and controlling centres, cost-effect standards of pathology diagnosis and expertise.

[Morpho-ecological characteristics of thyroid diseases in various regions of Russia and Belorussia from surgical data]. / Morfoékologicheskaia kharakteristika zabolevanii shchitovidnoi zhelezy v razlichnykh regionakh Rossii i Belorussii po dannym operatsionnogo materiala.

Thyroid lesions were histologically studied on surgical material obtained in 1992-1996 in 12 regions of Russian Federation and Republic of Belarus. Various forms of thyroid pathology were considered with reference to local ecological situation. An increase of thyroid carcinoma incidence and particularly that of papillary carcinoma was observed in regions with radiation pollution (Chelyabinsk and Bryansk regions). A high degree of correlation exists between the incidence of various forms of thyroid pathology and radiation situation. This is also true for pollution of sewage and the presence of ferrous metallurgy factories. No correlation was found with the pollution of atmosphere.

[A rare complication after surgical correction of the rupture of Valsalva's sinus aneurysm into the right heart ventricle]. / Redkoe oslozhnenie khirurgicheskoi korrektsii proryva anevrizmy sinusaVal'sal'vy v pravyi zheludochek serdtsa]

Postsurgical myocardial infarction in a 68-year-old female was observed after occasional compression of the coronary artery by a teflon gasket when P-like suture was applied on the anterior wall of the right ventricle in the course of surgical intervention for closure of the aortic-right-ventricular fistula. The latter had formed after the rupture of Valsalva's sinus aneurysm into the right ventricle this being the cause of the surgery. The authors propose how to document the diagnosis and medical death certificate in similar cases.