[The analysis of the results of the medical criminalistics expertises of the blood stains performed at the Bureau of Forensic Medical Expertise of the Moscow Health Department during the period from 2011 till 2015]. / Analiz mediko-kriminalisticheskikh ékspertiz sledov krovi, vypolnennykh v Biuro sudebno-meditsinskoi ékspertizy Departamenta zdravookhraneniia Moskvy za period 2011-2015 gg.

The objective of the present study was the analysis of the results of the medical criminalistics expertises of the blood stains with reference to their different characteristics including the occurrence across the years, variability, the forms and parameters of the traumatizing impacts, the properties of the objects with which the injuries were inflicted, etc. The majority of the data necessary for the analysis were extracted from the archive materials of the Medical and Criminalistic Department of the Bureau of Forensic Medical Expertise of the Moscow Health Department for the period from 2011 till 2015. A total of 5749 expertises performed during this time included 107 analyses of blood stains, 98 trace-evidence and 9 situational analyses. The specific features of such expertises include a large number of objects carrying blood stains available for the analysis. In the majority of the cases, such objects are stained with blood of several types differing in the mechanisms of their formation. 3D-scanning of the scene of the event with the subsequent three-dimensional computer-assisted simulation of the actions of each participant of the accident is considered to be the most promising method for the medical criminalistic expertise of the blood stains. The application of this approach is believed to make the work of the forensic medical experts significantly easier.

Systemic Inflammation: Methodological Approaches to Identification of the Common Pathological Process.

We defined Systemic inflammation (SI) as a "typical, multi-syndrome, phase-specific pathological process, developing from systemic damage and characterized by the total inflammatory reactivity of endotheliocytes, plasma and blood cell factors, connective tissue and, at the final stage, by microcirculatory disorders in vital organs and tissues." The goal of the work: to determine methodological approaches and particular methodical solutions for the problem of identification of SI as a common pathological process. SI can be defined by the presence in plasma of systemic proinflammatory cell stress products-cytokines and other inflammatory mediators, and also by the complexity of other processes signs. We have developed 2 scales: 1) The Reactivity Level scale (RL)-from 0 to 5 points: 0-normal level; RL-5 confirms systemic nature of inflammatory mediator release, and RL- 2-4 defines different degrees of event probability. 2) The SI scale, considering additional criteria along with RL, addresses more integral criteria of SI: the presence of ≥ 5 points according to the SI scale proves the high probability of SI developing. To calculate the RL scale, concentrations of 4 cytokines (IL-6, IL-8, IL-10, TNF-α) and C-reactive protein in plasma were examined. Additional criteria of the SI scale were the following: D-dimers>500ng/ml, cortisol>1380 or <100nmol/l, troponin I≥0.2ng/ml and/or myoglobin≥800ng/ml. 422 patients were included in the study with different septic (n-207) and aseptic (n-215) pathologies. In 190 cases (of 422) there were signs of SI (lethality 38.4%, n-73). In only 5 of 78 cases, lethality was not confirmed by the presence of SI. SI was registered in 100% of cases with septic shock (n-31). There were not significant differences between AU-ROC of CR, SI scale and SOFA to predict death in patients with sepsis and trauma.

[Fundamental-applied aspects of systemic inflammation in terms of physiologic and typical pathological process].

The concept of systemic inflammatory response syndrome (SIRS) by sepsis as well as quality of SIRS criteria, classification, and PIRO system has been a subject to analytical criticism in terms of theory of physiologic and typical pathological process. It has been disclosed SIRS can be considered only as the syndrome, that solves particular clinical tasks, but not as a basic model of pathogenesis of critical states. In authors' opinion it is more correctly to discuss systemic inflammation as a typical pathologic process that appears as a complex of one or another "resuscitation" syndrome in a clinical course.

[Spontaneous aneuploidy level in blood cells of fertile females].

In this study we present the results of molecular-cytogenetic investigation of blood cells of fertile women of reproductive age. We used cultivated and uncultivated cells and two sets of FISH probes with direct and indirect labeling. The mean aneuploidy levels of 4 chromosomes were determined and statistical limits were scored. Aneuploidy levels determined in cultivated lymphocytes by multicolor FISH varied from 0.1 to 1.3%. The mean aneuploidy level for all chromosomes (13, 18, 21 and X) was 1.39%. The limit mutation detection was 3.4%. We found differences in results obtained with the use of direct and indirect labeling. It was shown that cultivating process influenced the aneuploidy level. Absolute error of FISH technique was 0.13%, relative error - 4.08%.

[Comparative analysis of molecular genetic studies using DNA samples isolated from blood treated with EDTA or heparin].

A molecular genetic investigation of five genes: CFTR, GSTM1, GCTT1, MTHFR, and TP53 using DNA samples isolated from blood treated with either EDTA or stabilized heparin was conducted. Twenty DNA samples obtained from 10 persons. The results prove that heparin used as an anticoagulant instead of EDTA had no inhibitory effect on PCR and PCR/RFLP results, at least when DNA was isolated with a DNA-sorb-B kit. The results suggest that heparin-treated blood samples can be also used to study other genes.

[Lymphocyte metabolism in patients with acute pancreatitis with different genotypes of GSTM1 and GSTT1 genes].

In this study, we have investigated correlation between enzymatic activity of NAD(P)-dependent dehydrogenases of lymphocytes and polymorphic variants of glutathione S-transferase M1 (GSTM1) and T1 (GSTT1) genes in the group of unrelated patients with acute pancreatitis in comparison with healthy Russians from Krasnoyarsk. Thus, genotype GSTM1 0/0 is the marker of predisposition to the acute pancreatitis, wheras polymorphism of the GSTT1 gene is not involved in the development of the pancreatitis, at least in our group. The bioluminescence analysis showed statistically significant decrease of the levels of G3PD, NAD(+)MDH and the increase of NADH(+)LDH, NAD(+)GDH, NADH(+)GDH in lymphocytes of pancreatic group. Development of pancreatitis in patients with different genotypes GSTM1 and GSTT1 genes showed the rearrangement of the basic intracellular processes: dominance of a plastic metabolism in the patients with GSTM1--deletions and predominance of energetic processes at GSTT1 0 - pancreatitis.

[Multiple sclerosis: acute state or malignant course?]. / Rasseiannyi skleroz: ostrye formy ili zlokachestvennoe techenie?.

Multiple sclerosis (MS) which had developed in a 19-year-old female patient took a malignant course and terminated fatally three years after first symptoms. The case was characterized by an acute onset, seven severe exacerbations against combined pyramidal, cerebellar, visual, psychopathological and hyperkinetic disorders. The authors believe improper application of the term "acute" to rapid lethal outcome cases. In their opinion, they should be called cases of MS malignant course, the latter implying an unfavourable outcome of MS due to primarily truncal location of the demyelination process.

[Surgical interventions in abdomino-mediastinal lipomas]. / Khirurgicheskie vmeshatel'stva po povodu abdominomediastinal'nykh lipom.

The leading role in the recognition of abdomino-mediastinal lipomas is given to roentgenological examinations. Great significance is attached to thoracoscopy. Operations are fulfilled by the transpleural or transrectal accesses. The latter is the method of choice and must be accompanied by active drainage of the bed of the removed tissues during a day.