Causes of Death in Patients Asking for Polyclinic Care for Coronary Heart Disease.

AIM: Retrospective analysis of the underlying causes for death of patients who did and did not seek outpatient medical care (OPMC) for ischemic heart disease (IHD), and discussion of a possibility for using administrative anonymized but individualized databases for analysis. MATERIAL AND METHODS: The electronic database of the Central Administration of the Civil Registry Office of the Moscow Region (Unified State Register of the Civil Registry Office of the Moscow Region), including medical death certificates (MDC) for 2021, was used to select all cases of fatal outcomes with the disease codes of the International Classification of Diseases, Tenth Revision (ICD-10) (codes of external causes, injuries, poisonings excluded) that were indicated as the primary cause of death (PCD). Personalized data of the deceased were combined with data from electronic medical records of patients who sought OPMC at institutions of the Moscow Region within up to 2 years before death. In addition to IHD, the following PCD codes were taken into account: malignant tumors, COVID-19, diabetes mellitus, cerebrovascular diseases, hypertension, chronic obstructive pulmonary disease, alcohol-associated diseases, and, as examples of unspecified PCD, old age and unspecified encephalopathy.Results In total, among those who died from diseases, the proportion of those who died from IHD was 18.9%; for another 8.4%, IHD was indicated as a comorbid disease in Part II of the MDC. Among those who sought OPMC for IHD, the IHD proportion indicated as PCD was 27.5%, and among those who did not seek OPMC 17.4% (p <0.0001). Those who died from IHD and who had sought OPMC were older (mean age, 75.59 ± 10.94 years) than those who died from IHD and had not sought OMPM (mean age, 73.96 ± 10.94 years; p < 0.0001). The frequency of myocardial infarction as PCD among those who had and had not sought OPMC was the same (12%), chronic forms of IHD were 83.9% and 79.7%, the frequencies of "unspecified" acute forms of IHD (codes I24.8-9) were 4.1% and 8.3%, respectively. The proportion of deaths from COVID-19 was the highest (21.7% and 24.3%, respectively), from malignant neoplasms 11.6% and 12.7%, respectively, and from unspecified encephalopathy 10.6% and 10.7%, respectively. CONCLUSION: Only 25% of patients who had sought OPMC for IHD died from IHD, otherwise the causes of death were the same as for patients who had not sought OPMC for IHD. Analysis of administrative databases allows identifying disparities in the PCD structure and to direct the efforts of specialists to reconciling the criteria for death from various forms of IHD.

[Immunohistochemical signs of IgG4-related disease in patients with inflammatory bowel diseases]. / Immunogistokhimicheskie priznaki IgG4-svyazannogo zabolevaniya u patsientov s vospalitel'nymi zabolevaniyami kishechnika.

OBJECTIVE: To determine immunohistochemical features of IgG4-related disease in patients with inflammatory bowel diseases (IBD). MATERIAL AND METHODS: Immunohistochemical testing of colonic biopsy material from 35 patients with IBD (24 cases of ulcerative colitis and 11 cases of Crohn's disease) was carried out using IgG, IgG4 and CD138 antibodies. The number of IgG4- and CD138-positive cells was counted in high power field of microscope (×400). Patient selection was random. RESULTS: IgG4-positive cells were detected in the colonic mucosa of 5 patients with ulcerative colitis. The age of the patients ranged from 24 to 47 years. Two patients had a total, and three had a left-sided lesion of the colon. The anamnesis of the disease ranged from 3 to 13 years. The number of positively stained cells in the reaction with the antibody to IgG4 varied from 2 to 50 in high power field of microscope. We were able to detect over 10 IgG4-positive cells in 3 females aged 28, 30 and 31 years with a long history of ulcerative colitis (5, 4 and 3 years, respectively). Two patients had a total lesion of the colon, all three had an exacerbation of the disease, and a morphological study revealed chronic diffuse active erosive colitis. A high degree of histological activity and pronounced diffuse basal plasmacytosis were noted. In one of the cases, the infiltrate captured the muscular lamina of the mucosa and areas of the submucosa. CONCLUSIONS: IgG4-positive cells in the inflammatory infiltrate, including those with an excess of more than 10 in the field of view of the microscope at high magnification, can be observed in patients with ulcerative colitis with severe and prolonged course of the disease. To classify this colitis as a manifestation of an IgG4-related disease, the results of immunohistochemical studies alone are not enough. It is required to accumulate a larger number of observations, as well as to search for other diagnostic criteria for an IgG4-related disease in these patients.

[Features of the cell composition of inflammatory infiltrate in different phases of diffuse alveolar lung damage with COVID-19]. / Osobennosti kletochnogo sostava vospalitel'nogo infil'trata v raznye fazy diffuznogo al'veolyarnogo povrezhdeniya legkikh pri COVID-19.

BACKGROUND: Acute respiratory distress syndrome (ARDS) with COVID-19 has a worse prognosis than ARDS with other diseases. Mortality from ARDS with COVID-19 is 26.0 - 61.5%, and due to other causes - 35.3-37.2%. OBJECTIVE: To find of the correlation between polymorphonuclear leukocytes (PMNs), lymphocytes, and macrophages in the cellular composition of the inflammatory infiltrate at different stages and phases of diffuse alveolar damage (DAD) with COVID-19, analyzing the autopsy material. MATERIAL AND METHODS: The lung tissue of 25 patients who died from ARDS with COVID-19 without a secondary bacterial or mycotic infection, another thanatologically significant pathology of the lungs, was studied. To study the cellular composition of the inflammatory infiltrate and the dynamics of its changes a double immunohistochemical analysis of the expression of antibodies to CD15, CD3, and CD68 was used. RESULTS: The inflammatory infiltrate and intraalveolar exudate in the exudative phase of DAD was represented by 56.8% of PMNs (CD15-positive cells; hereinafter - the average value of the percentage of positive cells to the total number of cells of the inflammatory infiltrate), 6.9% - lymphocytes (CD3-positive cells) and 19.5% macrophages (CD68-positive cells). In the early stage of the proliferative phase: 14.1% PMNs, 38.7% lymphocytes and 13.5% macrophages. In the late stage of the proliferative phase: 11.3% PMNs, 14.5% lymphocytes and 39.3% macrophages. CONCLUSIONS: In the exudative phase of DAD a statistically significant predominance of PMN was revealed, which could determine the main volume of lung damage and the severity of ARDS with COVID-19. In the early stage of the proliferative phase of DAD, a statistically significant change in the composition of the inflammatory infiltrate was revealed to compare with the exudative phase: a significant decrease in the content of PMNs relative to the total number of cells in the inflammatory infiltrate; an increase in the number of lymphocytes, which is probably associated with the start of organization and repair processes. In the late stage of the proliferative phase of DAD, compared with its early stage, was revealed a statistically significant increase in the number of macrophages in ratio.

[Assessment of histologic activity in colitis]. / Otsenka gistologicheskoi aktivnosti kolitov.

The histological activity of the bowel inflammation is an extremely important morphological criterion that is encountered in the diagnosis of colitis. However, the determining of its degree is subjective and still does not have a generally accepted principle of gradation. The article describes the most common scale-schemes for assessing the severity of colitis, that include the degree of microscopic changes. The results of the analysis of the of histological activity degree on the material of colonobioptates in colitis of various etiologies (467 patients) are presented. It has been shown that the Geboes scale of ulcerative colitis can be used to assess histological activity in all forms of colitis. The histological features of inflammation should be reflected in the pathological diagnosis and are essential for clinical decision making. This index allows for a comparative analysis of clinical, endoscopic and morphological parameters and better control of the patient's condition during the treatment.

[A new look at colonic mucosal structural rearrangement and the stages of chronic colitis]. / Novyi vzglyad na strukturnuyu perestroiku slizistoi obolochki tolstoi kishki i stadii khronicheskogo kolita pri vospalitel'nykh zabolevaniyakh kishechnika.

OBJECTIVE: To revise the existing criteria to improve the definition of chronic colitis stages in inflammatory bowel diseases (IBDs). MATERIAL AND METHODS: A total of 100 cases of IBDs (ulcerative colitis (n=70) and Crohn's disease (n=30) diagnosed in 2017 to 2019 were examined. Thirty patients with colitis were selected for a comparison group, who were assigned to an infective colitis group or a drug-induced colitis one at the final diagnosis. RESULTS: The sequence of chronic colitis stages was defined from Stage 1 (early changes) to Stage 3, which are characterized by progressive mucosal structural rearrangement. Mainly at Stage 3 that characterizes the final stage of structural rearrangement in the mucous membrane, where dysplastic changes (the onset of tumor transformation) are detected. CONCLUSION: For the diagnosis of chronic colitis in IBD, it is mandatory to detect mucosal structural rearrangement. Stages 1 and 2 are characterized by early structural changes in the mucous membrane, whereas the process becomes irreversible at Stage 3. The identification of colitis stages is of diagnostic and, undoubtedly, prognostic value.

[Primordial odontogenic tumor is a new nosological entity in the 2017 WHO classification of Head and Neck Tumors]. / Pervichnaya odontogennaya opukhol' ­ novaya nozologicheskaya edinitsa v klassifikatsii VOZ opukholei golovy i shei (2017).

The paper describes a case of primordial odontogenic tumor of the mandible, a rare neoplasm that has been recently included into the WHO classification. It presents its clinical, radiological, morphological, and immunohistochemical characteristics.

Pathological Features in 100 Deceased Patients With COVID-19 in Correlation With Clinical and Laboratory Data.

Background: Autopsies on COVID-19 deceased patients have many limitations due to necessary epidemiologic and preventative measures. The ongoing pandemic has caused a significant strain on healthcare systems and is being extensively studied around the world. Clinical data does not always corelate with post-mortem findings. The goal of our study was to find pathognomonic factors associated with COVID-19 mortality in 100 post-mortem full body autopsies. Materials and Methods: Following necessary safety protocol, we performed 100 autopsies on patients who were diagnosed with COVID-19 related death. The macroscopic and microscopic pathologies were evaluated along with clinical and laboratory findings. Results: Extensive coagulopathic changes are seen throughout the bodies of diseased patients. Diffuse alveolar damage is pathognomonic of COVID-19 viral pneumonia, and is the leading cause of lethal outcome in younger patients. Extrapulmonary pathology is predominantly seen in the liver and spleen. Intravascular thrombosis is often widespread and signs of septic shock are often present. Conclusion: The described pathological manifestations of COVID-19 in deceased patients are an insight into the main mechanisms of SARS-CoV-2 associated lethal outcome. The disease bears no obvious bias in severity, but seems to be more severe in some patients, hinting at genetic or epigenetic factors at play.

[Takotsubo syndrome (stress-induced cardiomyopathy)]. / Sindrom Takotsubo (stress-indutsirovannaya kardiomiopatiya).

The article presents published and own data about Takotsubo syndrome, a relatively rare heart disease that is similar to acute coronary syndrome, but without significant damage of coronary arteries. The leading pathogenetic factor is the catecholamine-induced stress damage of myocardium with involvement of microvessels. There is a certain underestimation of Takotsubo syndrome by both clinicians and pathologists, so some cases of Takotsubo syndrome are misdiagnosed as acute coronary syndrome. Morphological manifestations of Takotsubo syndrome are characterized by mucoid edema of interstitial myocardial tissue, round-cell infiltration of stroma and focal damage of cardiomyocytes.

[Complex assessment of esophageal acidification and motor function in patients with Barrett's esophagus on antisecretory therapy].

AIM: To determine predictors of insufficient effectiveness of proton pump inhibitors based on the parameters of 24-hours pH-impedance and features of motor function of the esophagus in patients with Barrett's esophagus. MATERIALS AND METHODS: 17 patients with histologically verified Barrett's esophagus undergoing acid-suppressive therapy were examined. All patients underwent 24-hours pH-impedance and high-resolution esophageal manometry. RESULTS: According to daily pH-impedance, group 1 consisted of 11 patients with an adequate response to antisecretory therapy, group 2 6 patients with insufficient effectiveness of antisecretory therapy, 5 of whom had no clinical manifestations. The total number of reflux averaged 52 and 91, respectively, in groups 1 and 2. The average number of acid reflux in group 1 was 4.36, in group 2 40.5. The average number of non-acid reflux prevailed in patients of group 2, averaging 58, compared with group 1, where the average was 47. According to the results of high-resolution esophageal manometry, when assessing the structure and function of the esophageal-gastric junction, violations were detected in 6 out of 17 patients. Disorders of the motor function of the thoracic esophagus were detected in 10 out of 17 patients. The tone of the lower esophageal sphincter in group 1 patients was significantly higher in comparison with patients in group 2. CONCLUSION: A number of patients with Barrett's esophagus have insufficient effectiveness of antisecretory therapy, which may not manifest itself clinically and thereby increase the risk of progression. There was a tendency to more frequent motor disorders in the group with insufficient effectiveness of antisecretory therapy, as well as significantly lower tone of the lower esophageal sphincter, which may be a potential predictor of suboptimal effectiveness of antisecretory therapy.

[Antibiotic resistance of Helicobacter pylori in the European part of the Russian Federation: first results].

AIM: Determine the primary antibiotic resistance of Helicobacter pylori (H. pylori) strains isolated from patients living in the European part of the Russian Federation. MATERIALS AND METHODS: As part of a clinical laboratory study, from 2015 to 2018, 27 gastrobiopsy samples obtained from H. pylori-infected patients were analyzed. H. pylori infection was verified using a rapid urease test or a 13C-urea breath test. The values of the minimum inhibitory concentration (MIC) of antibiotics were determined by the diffusion method using E-test strips (BioMerieux, France) according to the recommendations of the manufacturer. The sensitivity of the isolates was determined for 6 antibacterial drugs (amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, rifampicin). RESULTS: According to the data obtained, resistance to amoxicillin was 0%, clarithromycin 11.1%, metronidazole 59.3%, levofloxacin 3.7%, tetracycline 0%, and rifampicin 14.8%. Dual resistance to clarithromycin and metronidazole was recorded in two isolates (7.4%). CONCLUSION: Thus, the first results of the evaluation of H. pylori antibiotic resistance in the European part of the Russian Federation indicate a low resistance of the microorganism to clarithromycin and quite high to metronidazole.

[Acute kidney injury in COVID-19: clinical and morphological comparisons based on autopsy data].

Severe Acute Respiratory Syndrome (SARS-CoV-2) has spread rapidly throughout the world, causing high morbidity and mortality. Analysis of clinical and autopsy data may allow to understand this disease. The results of pulmonary and renal autopsies in 37 deceased patients from COVID-19 are presented. MATERIALS AND METHODS: An autopsy was performed in Moscow in 37 deceased patients aged from 28 to 94 years. The microscopic features of the lungs and kidneys were examined using hematoxylin and eosin staining. RESULTS: Important findings include diffuse alveolar injury, pulmonary thrombosis and microangiopathy, as well as acute kidney injury in all cases, varying in severity. CONCLUSIONS: We report the presence of acute kidney injury in all cases, which requires correction of renal function in patients with SARS-CoV-2, with control of serum creatinine levels, urine volume, proteinuria and hematuria.

[Ways to solve the problem of heart failure statistics in clinical practice].

For organization of health care, it is important to know the requirement for its individual types, including the number of hospitalizations and the use of expensive technologies. Heart failure (HF) syndrome in patients with cardiovascular diseases often determines their severity and prognosis. However, being a complication of underlying disease, HF is not included into statistical reports and medical bills in the compulsory health insurance system. This article focuses on issues in evaluating HF prevalence and mortality in different countries and provides the authors' consensus on approaches to HF coding in the informational systems, which record morbidity and mortality.

[Multivisceral resection of lipoblastoma of four anatomical areas of the head and neck with simultaneous neurotization of the facial muscles in an 8-months child. Clinical case]. / Polivistseral'naya rezektsiya lipoblastomy chetyrekh anatomicheskikh oblastei golovy i shei s odnomomentnoi nevrotizatsiei myshts litsa u rebenka 8 mesyatsev. Klinicheskii sluchai.

The article describes diagnostics and surgical treatment of a rare benign tumor (lipoblastoma) of four anatomical areas of the head and neck in an 8-months child. Diagnostic data, surgical procedure performed using microsurgical techniques and intraoperative neuromonitoring and the patient's condition in the long-term postoperative period are presented. The histological conclusion about the removal of the tumor with negative resection margins suggests favorable prognosis of the disease.

[The strategy of the of surgical treatment of the cysts in the maxillary sinus]. / Taktika khirurgicheskogo lecheniia kist verkhnecheliustnoi pazukhi.

Based on the results of the retrospective analysis of 12 094 medical histories available from five large otorhinolaryngological clinics of the city of Moscow the authors arrived at the conclusion that the surgical treatment of maxillary sinus patholologies including the resection of retentional cysts accounts for 4.1% of the total number of surgical interventions on the ENT organs. The endonasal and extranasal approaches were used in 28.5% and 68.9% of the cases respectively. The combined approach to the maxillary sinus was applied in 2.6% of all the cases. The vector studies of the anatomical features of the ostiomeatal complex in 102 patients presenting with cystic lesions of the maxillary sinus with the use of computed tomography have demonstrated that the lumen of the complicated system communicating the maxillary sinus and the nasal cavity remains patent along its entire length; its part in the ethmoidal infundibulum region is as long as 1.31±0.03 mm and amounts to 2.09±0.02 mm in the region of natural anastomosis of the maxillary sinus (p<0,01). The results of the histological study of 81 histological preparations give evidence that the lesions of the mucous membrane in the regions of ethmoidal infundibulum and natural anastomosis of the maxillary sinus have a chronic character and manifest themselves as sclerosis of lamina propria and hyperplasia of mucous glands. The authors nave come to the conclusion that the surgical approach to the maxillary sinus through the middle meatus is not sufficiently well substantiated and therefore can not be recommended for the resection of the cysts from this air cavity in the body of the maxilla.

[Prevalence of hepatitis B and C viral infection according to the data on fetal outcomes in Moscow in 2015-2017]. / Rasprostranennost' infektsii, vyzvannoi virusami gepatita V i S, po materialam letal'nykh iskhodov v Moskve v 2015-2017 gg.

OBJECTIVE: To elucidate the prevalence of hepatitis B and C viral infection among the people who died in Moscow in 2015-2017, by studying the primary medical records of a representative sample of fatal outcomes, followed by the mathematical extrapolation of the data obtained to the total number of all deaths. MATERIAL AND METHODS: The 2015-2017 primary medical documentations from 8 therapeutic-and-preventive establishments with morbid anatomy units in the administrative districts and from 2 infectious diseases hospitals of the Moscow Healthcare Department were studied. The sample of those who died was 11.8-12.1% of the total number of all-cause deaths in Moscow during these years and was representative at a 0.95 confidence probability and a ±5% confidence interval. The Bernoulli theorem and the Laplace function for the 95% confidence probability were used to extrapolate the obtained data to the number of all those who died in these years. RESULTS: The mortality rates associated with acute viral hepatitis B and C were 0.04-0.07 and 0-0.008, respectively, per 100,000 population, which corresponds to the official statistical data. The mortality rates for chronic viral hepatitis and liver cirrhosis in their outcomes, including hepatocellular carcinomas in their presence, exceeded the official statistical data by many times, accounting for 0.5-1.6 and 10.4-12.1 persons with viral hepatitis B and C, respectively, per 100,000 population and rose by 22.5% over 3 years. The rates obtained for hepatitis B virus were 1.7-5.6 lower, and those for hepatitis C virus were, on the contrary, 1.3-1.5 times higher than average in the European Union countries. There was a manifold (7.4-24-fold) prevalence of hepatitis C virus in the etiology of chronic liver damage. The mortality from liver cirrhosis of alcoholic and unknown etiology was 14.4-19.5 persons per 100,000 population and declined by 21% over 3 years. The percentage of deaths caused by acute viral hepatitis was 0.5% per 100,000 population in Moscow in 2017; that caused by chronic viral hepatitis, including liver cirrhosis in the outcome and hepatocellular carcinoma, which had developed in their presence, was 46.3%; and that of liver cirrhosis of alcoholic and unspecified etiology was 48.7% of the total number of all liver lesions. CONCLUSION: The study of primary medical records of a representative sample of fatal outcomes, followed by the mathematical extrapolation of the data obtained to the number of all deaths, makes it possible to objectively estimate the burden of mortality from hepatitis B and C viral infection.

[Features of filiform papillary lesion of the tongue and its mucosal microflora biofilm in patients with gastroesophageal reflux disease]. / Osobennosti povrezhdeniia nitevidnykh sosochkov i bioplenki mikroflory slizistoi obolochki iazyka u bol'nykh gastroézofageal'noi refliuksnoi bolezn'iu.

OBJECTIVE: To identify filiform papillary lesions, localization changes, and the composition of the microflora of the dorsal lingual surface in patients with gastroesophageal reflux disease (GERD). MATERIAL AND METHODS: Dorsal lingual surface biopsy specimens were investigated in 7 patients with GERD (3 men, 4 women) and in 6 individuals without digestive diseases (3 men, 3 women). The diagnosis of GERD was based on a set of clinical data, daily pH-metry, EGDS, and the specialized GerdQ questionnaire. Scanning electron microscopy and fluorescence confocal microscopy were used. RESULTS: Intact filiform lingual papillae had a complex structure and consisted of primary and secondary papillae. Foci of increased epithelial desquamation with partial or complete loss of secondary papillae were detected in patients with GERD. There was a microflora biofilm only on the epithelium of the secondary papillae in the intact areas and in the areas with preserved secondary papillae in patients with GERD. On the contrary, the foci of lesion and those with completely lost secondary papillae in GERD patients exhibited the microflora (more diverse in its morphological characteristics) on the surface of the epithelial cells of primary papillae, except for their cup-shaped hollows in the area of the lost secondary processes. These cup-shaped hollows preserved dense intercellular contacts of epithelial cells. CONCLUSION: The lingual mucosal filiform papillae in GERD patients are characterized by the appearance of areas with partial or complete loss of secondary papillae and with increased desquamation of epithelial cells. There is microflora biofilm translocation to the primary papillae, except for their cup-shaped hollows (an area of the lost secondary papillae). Translocation of the microflora increased its morphological diversity.

[The expression of moesin, p21-activated kinase 4 (PAK 4), matrix metalloproteinases (MMP 2, MMP 9), and CD34 in the eutopic and ectopic endometrium in adenomyosis]. / Ékspressiia moézina, p21-aktivirovannoi kinazy 4 (PAK 4), matriksnykh metalloproteinaz (MMR 2, MMR 9) i CD34v éutopicheskom i éktopicheskom éndometrii pri adenomioze.

OBJECTIVE: To investigate the expression of moesin, p21-activated kinase 4 (PAK 4), matrix metalloproteinases (MMP 2, MMP 9), and CD34 in the eutopic and ectopic endometrium in different forms of adenomyosis. MATERIAL AND METHODS: Fifty uteri removed for diffuse adenomyosis and for adenomyomas were examined in reproductive-aged (n=25) and premenopausal (n=25) women. A comparison group included 20 uteri removed for intramural and subserosal fibroids in reproductive-aged and premenopausal women. The investigators performed histological and immunohistochemical (using antibodies to moesin, PAK 4, MMP 2, MMP 9, and CD34) examinations of the eutopic and ectopic endometrium. RESULTS: Different forms of adenomyosis were characterized by the irregular border of the endometrium and myometrium due to that there were multiple foci of ingrowth of the basal layer of the endometrium through the terminal plate into the myometrium. In both diffuse adenomyosis and adenomyomas, the basal layer of the eutopic and ectopic endometrium differed many (3-8.5) times, showing the higher expression of the enzymes in the epithelial and stromal cells, which affected their invasive activity (moesin, PAK 4, MMP 2 and MMP 9), and the increased number of CD34 cells in its stroma. At the same time, there were no statistically significant differences in their expression in the basal layer of the eutopic and ectopic endometrium in diffuse adenomyosis and adenomyomas. CONCLUSION: The findings favor the theory of the pathogenesis of adenomyosis due to the invasion of the eutopic endometrium into the myometrium.

[Trends in stroke mortality rates in Russia and the USA over a 15-year period]. / Dinamika pokazatelei smertnosti naseleniia ot ostrogo narusheniia mozgovogo krovoobrashcheniia v Rossii i SShA za 15-letnii period.

AIM: to comparatively analyze standardized mortality ratios (SMR) from stroke in the populations aged over 30 years in the Russian Federation and in the USA over a 15-year period. MATERIAL AND METHODS: The analysis included nontraumatic subarachnoid hemorrhage (NTSH) (a group of ICD-10 codes I60), nontraumatic intracerebral hemorrhage (NTIH) (I61), cerebral infarction (CI) (I63), and stroke, not specified as hemorrhage or infarction (SNSHI) (I64). The new European standard (European Standard Population.2013) was used for standardization. The data of the Federal State Statistics Service of the Russian Federation, those of the World Health Organization Mortality Database (WHO MD) and Human Mortality Database (HMD) for the USA were applied. RESULTS: During the considered period, 30-49-year-old Russian men showed a reduction in SMRs from NTSH (I61) by 9.0% (from 18.9 to 17.2 per 100,000 population), from SNSHI (I64) by 10 times (from 12.5 to 1.3); SMRs from CI (I63) increased by 4.3% (from 6.9 to 7.2). In men aged 50 years and older, SMRs from NTIH and SNSHI decreased by 32.3% (from 143.2 to 97.0) and by 10 times (from 580.8 to 60.6), respectively; those from CI increased by 13.8% (from 229.8 to 261.4). In the USA, 30-49-year-old men displayed 26.1% and 2-fold decreases in SMRs from NTIH (from 2.5 per 100,000 population in 1999 to 1.7 in 2013) and CI (from 1.8 to 0.9), respectively; those from SNSHI remained unchanged (1.3). In men aged 50 years and older, SMRs from NTIH, CI, and SNSHI reduced by 39.7% (from 29.0 to 17.5), by 2 times (from 1.8 to 0.9), and by 2 times (143.0 to 72.5), respectively. 30-49-year-old Russian women exhibited a 22.2% reduction in SMRs from NTIH (from 9.0 to 7.0), a 4.3% increase in those from CI (from 2.7 to 2.8), and an 11-fold decrease in those from SNSHI (from 5.5 to 0.5). Women aged 50 years and older showed changes in SMRs from the codes in the same sequence from 105.6 to 60.5, from 172.8 to 189.6, and from 466.5 to 43.7, respectively. In the USA, 30-49-year-old women displayed reductions in SMRs from NTIH by 10.0% (from 1.5 to 0.9), from CI by 33.3% (from 0.3 to 0.2), and from SNSHI by 10% (from 1.0 to 0.9). Women aged 50 years and older exhibited changes in SMRs from the codes in the same sequence from 24.0 to 14.8), n those from CI (from 20.6 to 6.7) and from SNSHI (from 6.5 to 10.3). CONCLUSION: In Russia, the reduction in mortality rates from the above causes (which is most significant from that in NTSH may be associated with both medical and socioeconomic factors, including with the improved prevention and organization of medical care. The differences in SMRs between the two countries may be related to the principles in the organization and control of coding of the causes of death.

[Morphological evaluation of singlet phototherapy in the treatment of periodontal diseases in an experimental study]. / Morfologicheskaia otsenka singletnoi fotooksiterapii pri lechenii zabolevanii parodonta v éksperimental'nom issledovanii.

The aim of the study was to compare the effectiveness of laser singlet phototherapy and traditional photodynamic therapy the treatment of periodontal diseases in an animal model. The experimental model involved 70 male rats Wistar in which periodontitis was modeled and treated: in group I (30 animals) a nanosecond laser device for medical use with a wavelength of 1270 nm was used for 7 sessions in a 400 ns pulse mode, an average radiation power of 2 W, and a radiation density of 200 J/cm2, group II (30 animals) received photodynamic therapy with the administration of a photosensitizer, followed by irradiation with a laser wavelength of 660 nm for 7 sessions 2 Wt average radiation power, group III (controls, 10 animals) - traditional drug therapy. Morphological studies were performed on 7, 14 and 21 day after treatment. On day 7th and 14th the study revealed In group I the presence of full blood vessels and diffuse expressed leukocyte infiltration with an admixture of macrophages, in group II - pronounced edema of the tissue and vasoconstriction. On day 21 the picture included in group I regenerated periodontal ligament with dilated full blood vessels on the border with the bone beams of the alveolar bone, in group II a moderately pronounced edema of the periodontal ligament with single dilated vessels, in controls significantly destroyed periodontal ligament substituted with granulation tissue and periodontal ligament. Thus, the treatment of periodontitis with the methods of singlet phototherapy leads to the development of reactive inflammation and significant vascularization of periodontal tissues which contributes to the rapid regeneration and stability of remission.

[Diagnostic problems of histological remission in patients with inflammatory bowel disease]. / Problemy diagnostiki gistologicheskoi remissii u bol'nykh s vospalitel'nymi zabolevaniiami kishechnika.

AIM: to analyze the generally accepted histological criteria for diagnosing the activity of inflammatory bowel disease (IBD) in patients with therapy-induced endoscopic remission. SUBJECTS AND METHODS: Colon biopsy specimens from 57 patients aged from 19 to 52 years (mean age 31±2.5 years), including 41 patients with ulcerative colitis (UC) and 16 with Crohn's disease (CD) affecting the colon, were examined. All the patients had no clinical signs of disease activity; endoscopic examination diagnosed remission (none or minimal changes). The biopsy specimens were taken from all colon segments during colonoscopy and processed by conventional methods. RESULTS: Persistence in chronic inflammation with signs of its activity (neutrophils in an infiltrate and cryptitis) and mucosal structural changes (no histological remission) were found in 29.3% of the patients with UC and 37.5% of those with CD (only in 31.6% of the patients). Persistence in chronic inflammation without signs of its activity and/or mucosal structural changes (incomplete histological remission) were detected in 80.5, 81.25, and 80.7% of the patients, respectively. Complete histological remission without mucosal inflammatory and structural changes was observed only in 19.5, 18.75, and 19.3% of the patients, respectively. CONCLUSION: The investigation shows that histological remission is still difficult to achieve to date, despite the use of the present-day treatment protocols for IBD. On the other hand, the conventional morphological criteria for the diagnosis of histological remission in IBD are quite subjective and need further discussion and agreement. Whether there may be a complete structural and functional recovery of the colon mucosa remains open.