Background: Sudden cardiac death (SCD) refers to unanticipated death as a consequence of cardiac failure which takes place over a brief time period (typically within an hour of the commencement of symptoms) in an individual, who may or may not be known to be subject to cardiac disease, but in whom no fatal condition has been diagnosed. The objective of this investigation was to identify the potential cause of SCD in the young population in Moscow. Result: Analysis revealed that the mean age of the deceased amongst men was 24.6 years, and amongst women was 29.1 years. Seventy-six percent of sudden deaths were found to result from some previously undiagnosed pathology of the cardiovascular system, and cardiomyopathy is the most common cause of death in young people. Coronary heart disease is the most common cause of death in people above 40 years old. Conclusion: Investigation to diagnose the causes of SCD constitutes a relevant, comprehensive, and multidisciplinary undertaking, which ought to be founded upon the application of novel and current diagnostic methodologies. An integrated strategy to the quest for the underlying reason for sudden death ought to be founded upon the outcomes of biochemical, anatomical, genetic, pathophysiological, and other investigations. The search and development of objective risk factors will permit timely therapeutic intervention for patients with cardiovascular pathology to minimise and prevent the risk of sudden cardiac death.

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.

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.

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.

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).

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.

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.

Sudden death among young people attracts attention of doctors of different specialties - cardiologists, neurologists, pediatricians, doctors of sport medicine. Determination of the cause of death in such cases is legally performed only through forensic medical examination. As a rule, the deceased fall under the category of young, able odied, of reproductively and economically promising age - schoolchildren, students, cadets of higher military institutions, sportsmen or persons engaged in sports activities. The circumstances of the onset of death in young people often include physical activities of different nature. The onset of death occurs against in allegedly healthy people, without any pathology diagnosed intra vitam. However, forensic medical examination always reveals either latent or not diagnosed in time pathology of the cardiovascular system. It is established that among all young people who died suddenly, there are signs of connective tissue dysplasia that are revealed both in external and internal examination of the corpse. The article describes the main clinical and morphological manifestations of connective tissue dysplasia, the pathology of various organs and systems, as well as the causes of sudden death of young people with this pathology.

Were studied 24 cases of sudden death of young military personnel and military cadets. The main cause of sudden death in the performance of military service is a sudden cardiac death from the pathology of the heart and blood vessels, not diagnosed during life or proceeding concealed. The manifestation of this pathology is promoted by a sharp change in the habitual way of life with high physical loads and the development of life-threatening conditions-fatal arrhythmias and the onset of sudden death. Connective tissue dysplasia, as a genetically determined pathology with predominant involvement of the heart and vessels, is the main pathology that creates a high risk of sudden cardiac death. Comparison of clinical signs, constitutional manifestations, as well as functional changes in the heart and blood vessels at the clinical level will allow preventing the development of life-threatening conditions and the onset of sudden death among young military personnel.

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.

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.

Background:The sudden death of young persons always results in a problem of detection of the cause of death and a lot of controversial questions of close relatives and doctors of various specialties: cardiologists, internists, neurologists, pediatricians.The death comes suddenly, very quickly, before the arrival of the ambulance, under an apparent external health, unexpectedly for other people, and in the absence of an external factor.Place of death -physical education classes, sports field, institutions for learning activities and public place.A 10-year-old study of the causes of sudden death in young persons has been carried out.Objective: An objective of the work is to study the structure, causes and risk factors of the sudden death in a young age. Results:The result of our own investigations of death cases of persons aged up to 39 years on the basis of forensic autopsies for 10 years allowed to find that the pathology of the cardiovascular system caused by connective tissue dysplasia is one of the causes of the sudden death of young persons.Arrhythmia is the main mechanism of sudden cardiac death in young persons.The factors that trigger the onset of death: sports activity, physical exercise, psycho-emotional stress, intake of low-alcoholic drinks. Conclusions:Early detection of signs of connective tissue pathology and heart disease will allow to develop preventive measures against the onset of sudden death.

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.

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.

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.

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.

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.