[Morphofunctional vascular changes associated with sudden death in the young]. / Morfofunktsional'nye izmeneniia sosudov pri vnezapnoi smerti u lits molodogo vozrasta.

Diagnosis of sudden death in the young is based on the results of a set of research methods. Immunohistochemical, histochemical and histochemical methods are fundamental to the diagnosis of hidden forms of connective tissue pathology. These methods allow the sequence of initial and irreversible changes in connective tissue structures to be determined. The aim of this study was to determine the abnormalities of the vascular wall structure when using immunohistochemical and histological methods for the verification of congenital anomalies of various types of vessels, which expand the criteria for the diagnostic detection of individuals with connective tissue dysplasia. These investigation methods allow the diagnosis of hidden forms of congenital connective tissue pathology in the young. The main morphological signs of pathology of the aorta, carotid arteries, coronary and cerebral arteries are the disturbance of structural elements of the connective tissue.

[Molecular genetic basis of sudden cardiac death in the young with cardiomyopathy of various origins]. / Molekuliarno-geneticheskie osnovy vnezapnoi serdechnoi smerti lits molodogo vozrasta s kardiomiopatiei razlichnogo geneza.

This paper provides a review of the modern literature devoted to the problem of forensic medical interpretation of the molecular genetic research of the young who died suddenly. The authors attempted to draw a parallel between the morphological markers of different variants of cardiomyopathy as the most common disease in sudden death at a young age and the association with genetic mutations in the genes responsible for the synthesis of sarcomer proteins, desmos and membrane channels. Based on the results of the analysis, further research is proposed to improve the accuracy of forensic diagnosis in cases of young deaths.

[The sudden death among the young persons under effect of the different forms of physical loads]. / Vnezapnaia smert' lits molodogo vozrasta pri razlichnykh vidakh fizicheskoi nagruzki.

The present review of the literature publications concerns the problem of sudden death (SD) among the young persons under effect of the different forms of physical loads. The statistical data on the frequency of sudden death are presented together with information about risk factors of SD, the morphological substrates and structural changes that promote death coming. The cases of sudden death among the young persons associated with the amateur sports activities and the professional sport of records are presented. The role of physical exercises and psycho-emotional stresses in the development of the terminal processes is considered with special reference to the risk factors and genetic predisposition to sudden cardiac death, largely among male athletes. The questions of sudden death in connection with cardiac pathologies as its main causes are discussed.

[Dissection of the internal carotid artery in a patient with connective tissue dysplasia having risk variants of several candidate genes]. / Dissektsiia vnutrennei sonnoi arterii u patsientki s displaziei soedinitel'noi tkani i nositel'stvom potentsial'no znachimykh variantov neskol'kikh polimorfnykh genov-kandidatov.

Spontaneous dissection of the vessels of the neck is one of the main causes of ischemic stroke in young patients under 45 years of age. According to morphological studies, dissection of the vessels of the neck can be based on dysplastic changes in the arterial wall in arteriopathies, Marfan syndrome, Ehlers-Danlos syndrome, undifferentiated connective tissue dysplasia. The article presents a case of spontaneous dissection of the internal carotid artery in a 30-year-old patient with clinical manifestations of undifferentiated connective tissue dysplasia and carriage of homozygous variants of candidate genes: 4G/4G of the PAI-1 (-675, 4G/5G), T/T of the MTHFR C677T, 5A/5A of the MMP-3 (-1171 5A/6A) and A/A of the MMP-9 (8202A/G).

[The synopsis of results of the 20 year activities of the Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University (Sechenovsky University)]. / Itogi 20-letnei raboty kafedry sudebnoi meditsiny Sechenovskogo universiteta.

The present article was designed to summarize the results of the 20 year scientific, practical, and educational activities of the Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University (Sechenovsky University). The main directions of the research work and achievements of the Department's staff are described, and the prospects for its further development are highlighted. The new approaches to and technologies for the teaching and training specialists in forensic medicine are introduced to meet the novel requirements imposed in the framework of the ongoing reform of higher medical education in accordance with the main principles of the Bologna declaration.

[Changes in the brain vascular bed associated with sudden death of young subjects]. / Izmeneniia sosudistogo rusla golovnogo mozga pri vnezapnoi smerti lits molodogo vozrasta.

This article presents an overview of the literature publications concerning pathological changes in the cerebral blood vessels and the factors underlying the development of hemorrhagic complications leading to sudden death of young people. The special emphasis is placed on the most important causes behind the changes in the vascular wall (including the congenital ones) responsible for the high risk of rupture of the intracerebral vessels associated with the development of hemorrhagic complications.

[Vascular pathology in the aspect of sudden death in young adults and connective tissue dysplasia: anatomical, physiological, and morphological parallels]. / Patologiia sosudov v aspekte vnezapnoi smerti lits molodogo vozrasta i displaziia soedinitel'noi tkani: anatomo-fiziologicheskie i morfologicheskie paralleli.

Vascular pathology in young adults has during the last 10 years been diagnosed more often during forensic medical examination of sudden death. Major morphological alterations are revealed in cerebral vessels, coronary vessels, and at the level of the ascending portion of the aorta. Generally, in the young age there is no stenosing atherosclerosis inducing vascular lesions and the development of complications. It was determined that connective tissue dysplasia is pathology wherein weakness of the vascular wall is genetically preconditioned, thus promoting formation of vascular aneurysms and rupture of the latter under conditions of provoking factors such as going in for sports, physical loads, and psychoemotional stress.

[The forensic medical evaluation of traumatic and spontaneous ruptures of the organs affected by the tumours]. / Sudebno-meditsinskaia otsenka travmaticheskikh i spontannykh razryvov organov pri porazhenii opukhol'iu.

The present article was designed to report the results of the analysis of the cases of traumatic and spontaneous ruptures of the organs affected by the tumours based on the original observations and the literature data. It is shown that the probability of the tumour rupture depends on its histological type, localization, the size, and the distance from the capsule of the affected organ, the degree of involvement of the major blood vessels, the severity of the necrotic changes, the presence of cysts in the neoplasm, and the regimens of radio- and chemotherapy. Moreover, the rupture can be facilitated by anticoagulation therapy, intake or oral contraceptives, pregnancy, concomitant diseases, alcoholic intoxication, splenomegaly, and hypocoagulation resulting from dissemination of the neoplastic process or the metastatic lesions of the liver. Even a minimal injury to the skin can provoke the tumour rupture associated with the fatal hemorrhage. A delayed rupture within a few hours or days is possible.

Immunotropic Properties of Immobilized Interferon-α2b.

Course treatment with IFN-α2b immobilized on polyethylene glycol stimulates phagocytic activity of peritoneal macrophages and neutrophils, enhances humoral immune response in CBA/CaLac mice, stimulates IL-4 synthesis, and suppresses IFN-γ production by mitogenstimulated splenocytes from experimental animals.

[Forensic medical characteristic of the causes behind sudden death in the young subjects]. / Sudebno-meditsinskaya kharakteristika prichin vnezapnoi smerti u lits molodogo vozrasta.

The objective of the present study was to analyze the causes of sudden death in the general population and in the fraction of the young subjects (below 39 years of age). The results of the original retrospective study were obtained in the course of forensic medical autopsies of the subjects aged below 39 years that had been carried out during a period of 10 years. It was shown that one of the causes behind sudden death among the young subjects is cardiovascular disorders associated with the pre-existing pathological condition in the form of connective tissue dysplasia. The principal mechanism underlying sudden death among the young subjects has an arrhythmogenic nature. The development of terminal symptoms is promoted by a number of provocative factors including sporting activities, physical loading, psychoemotional stress, and alcohol consumption.

[Aortic aneurysm in Erdheim's idiopathic cystic medial necrosis in autopsy and forensic medical practice]. / Anevrizma aorty pri idiopaticheskom kistoznom medionekroze Erdgeima v patologo-anatomicheskoi i sudebno-meditsinskoi praktike.

UNLABELLED: To date, the modern Russian literature has not covered morphological studies of aortic aneurysm in Erdheim's idiopathic cystic medial necrosis on autopsy and surgical materials, by using immunohistochemical studies, and it has not estimated the magnitude of pathohistochemical changes in the aortic media either. AIM: to conduct a morphological examination of aortic aneurysm in Erdheim's idiopathic cystic medial necrosis, by using the material of pathology and forensic medical departments. MATERIAL AND METHODS: 41 surgical samples from patients with idiopathic cystic medial necrosis of the ascending aorta and autopsy samples from 17 sudden deaths from aortic rupture were examined. The aortic wall was histologically and histochemically studied. Immunohistochemical examination was done using antibodies to smooth muscle actin, collagens types I and III, elastin, CD3 (T lymphocytes), CD20 (B lymphocytes), CD45 (leukocyte common antigen), CD68 (macrophages), apoptotic marker p53, tumor necrosis factor-α (TNF-α), and intercellular adhesion molecule-1 (ICAM-1). RESULTS: Morphological examination showed lamellar unit destruction, fibrosis, medial necrosis, and elastic fiber fragmentation. These signs were assessed by their degree. The immunohistochemical examination of collagens types I and III determined fascicles of randomly positioned fibers. The multidirectional orientation of smooth muscle cells was confirmed by the expression of smooth muscle actin. There was an obvious expression of the apoptotic marker p53 in the smooth muscle cells of the aortic media and in the aortic adventitia. The expression of TNF-α was revealed in the cells of an inflammatory infiltrate in the aneurysm wall and that of ICAM-1 was found in the aortic endothelium, vasa vasorum, and in the cells of an inflammatory infiltrate in the media and adventitia. The paper proposes a design of postmortem and forensic medical diagnosis, which reflects the components of pathogenesis and tanatogenesis in Erdheim's idiopathic cystic medial necrosis and which allows ICD-10 diagnosis coding. CONCLUSION: The main histopathological signs of aortic aneurysm in Erdheim's idiopathic cystic medial necrosis were presented; structural changes in the primary components of the aortic wall were characterized; the cells of an inflammatory infiltrate were investigated; and the formulation of autopsy and forensic medical diagnoses was proposed.

Sudden death in cancer pathology forensic-medical characteristics.

The article presents a review of references on causes of sudden death of persons suffering from oncological diseases. The paper describes the main mechanisms of sudden death of persons with cancer who are subjected to forensic-medical research. Data on the structure of sudden death for the last 10 years are demonstrated. The authors have identified the increase of a number of sudden deaths in the group with oncological pathology 2. 2 times more in comparison with 2005. There are showed peculiarities of forensic-medical diagnostics of reasons of sudden death in cancer.

[Sudden Cardiac Death of Young Persons: Risk Factors, Causes, Morphological Equivalents].

The article contains literature review on the problem of causes of sudden cardiac death (SCD) among young people as well as results of author's own retrospective study of deaths of persons before 39 years based on forensic autopsies performed during 10 year period. The study of structure and dynamics of causes of death, its risk factors and the role of connective tissue dysplasia in development of terminal symptomocomlexes allowed to establish that main mechanism of SCD in young people was arrhythmogenic developing as a response to provoking factors--physical effort, psychoemotional stress, consumption of light alcoholic beverages.

[Experience with clinical administration of new drug Thrombovasim® in vascular surgery].

Recent years have witnessed an increased worldwide interest in medical use of unique naturally occurring enzymes - subtilisins possessing pronounced fibrinolytic and anti-inflammatory properties. The article deals with experience in clinical administration in vascular surgery of new therapeutic agent Thrombovasim® containing pegylated subtilisin as an active substance. Thrombovasim® has a favourable profile of safety, good tolerance and causes no severe haemorrhagic complications. The pharmacological action of Thrombovasim® consists in combination of the targeted effect on the fibrin carcass of the thrombus without participation of the own system of haemostasis and anti-inflammatory effect. In the Russian Federation Thrombovasim® has been used for 6 years predominantly in vascular pathology of lower limbs accompanied by the development of chronic venous insufficiency.

[Membrane-bound forms of serine proteases of Bacillus intermedius]. / Membranno-sviazannye formy serinovykh proteinaz Bacillus intermedius.

Proteolytic proteins solubilized from the membrane of Bacillus intermedius were studied by electrophoresis. The content of membrane-bound proteinases was lower in cells grown in the presence of glucose. Proteinase enzymograms revealed four molecular forms of subtilisin and four molecular forms of glutamyl endopeptidase. The electrophoretic mobility of one of the molecular forms was similar to those of the mature extracellular proteinases. Chromatography of membrane proteins on a MonoS column yielded four protein fractions that caused hydrolysis of Z-Glu-pNA and four fractions that caused hydrolysis of Z-Ala-Ala-Leu-pNA, which is in agreement with the results of electrophoresis. The molecular forms of proteinases identified in the membrane may reflect various stages of biogenesis of the corresponding extracellular enzymes.

[Hydrolytic enzymes and spore formation in Bacillus intermedius]. / Gidroliticheskie fermenty i sporoobrazovanie u Bacillus intermedius.

The investigation of the activity of extracellular hydrolytic enzymes and sporulation in the bacterium Bacillus intermedius 3-19 showed that the activity of ribonuclease is maximal in the glucose-containing growth medium, in which sporulation is suppressed. At the sporulation stages II-IV, the synthesis of phosphatase was not regulated by the factors that influence this synthesis in the phase of growth retardation. Caseinolytic activity exhibited two peaks. The first peak was observed when thiol-dependent proteinase began accumulating in the medium. The second peak corresponded to the late stages of sporulation, i.e., the stages of spore maturation and the autolysis of sporangium. The regulatory relationship between proteinase synthesis and sporulation and the possible role of extracellular phosphatases and proteinases in the sporulation are discussed.

[Localization of proteolytic enzymes in cells of Bacillus intermedius]. / Lokalizatsiia proteoliticheskikh fermentov v kletkakh Bacillus intermedius.

The activities of proteinases in the culture fluid and cellular fractions of Bacillus intermedius 3-19 grown under various conditions were studied. Thiol-dependent serine proteinase was the prevalent enzyme in the total pool of extracellular proteinases (70%); its catalytically active form was also detected in the cell membrane and, during active enzyme production, in the cell wall. Another enzyme, glutamyl endopeptidase (10% of the total pool), was detected in the cell membrane; it was also found in the cell wall and cytoplasm during active enzyme secretion into the growth medium. Production of these enzymes was maximal on medium containing inorganic phosphate and gelatin and decreased 2- to 4-fold on medium with glucose and lactate. The level of activity of extracellular enzymes correlated with that of corresponding membrane-bound proteins. The addition of CoCl2 (2 mM) into the medium caused an essential increase in extracellular glutamyl endopeptidase activity and promoted the release of the membrane-bound enzyme into the culture fluid. Proteolytic activity towards casein was also detected in the cytoplasm. The proteinases localized in the cytoplasm were shown to differ in their properties from those secreted.