Background. Benign prostatic hyperplasia (BPH) is a common disease in older men. Transurethral surgery in BPH is the gold standard for treatment, but the techniques differ in the energy used. Considering the different mechanisms of action of bipolar plasma and thulium fiber laser energy on prostate tissue, the study of structural changes under their influence is relevant.The aim. To study the features of structural changes in the prostate during bipolar plasma and thulium fiber laser enucleation of benign prostatic hyperplasia.Methods. Thirty one patients with BPH were divided into two groups. Group 1 (n = 17) underwent transurethral plasma enucleation of the prostate; Group 2 (n = 14) underwent transurethral thulium fiber laser enucleation. Fragments of the surgical prostate capsule were collected intraoperatively and were processed according to standard examination protocols using light and electron microscopy. The width of coagulation necrosis, the relief of the dissection line, the severity of cell and the prostate intercellular matrix destruction were taken into account.Results. Studies have shown the clinical and functional perioperative homology of the compared methods of surgical treatment of BPH. Data from light and electron prostate microscopy showed a greater damaging effect of bipolar plasma energy, which is manifested by a larger width of the zone of coagulation necrosis, a torn and raised appearance of the dissection line, and pronounced integrity violations of cellular elements and intercellular matrix components. Laser exposure causes less pronounced changes, which indicates a more gentle effect of the thulium fiber laser on the prostate components.Conclusion. The obtained microscopy results indicate that the intraoperative action of a thulium fiber laser is less traumatic for the cells and intercellular matrix of the surgical prostate capsule compared to bipolar plasma exposure.

Introduction. The development of a novel coronavirus infection (COVID-19) is not limited to respiratory damage. Adverse outcomes in patients with COVID-19 may be associated with cardiac damage. Aim. Study of the structural changes in the myocardium and the molecular biological characteristics of the endothelium of blood capillaries in severe forms of COVID-19. Materials and methods. An analysis of the medical documentation – inpatient records of 73 deceased with bilateral multisegmental viral pneumonia caused by the SARS-CoV-2 virus, as well as data from 43 autopsies of patients who died (sudden coronary death) between September 2020 to July 2021, was performed. An assessment of some clinical and laboratory data (degree of lung damage; levels of C-reactive protein, troponin I, D-dimer; left ventricular ejection fraction, etc.), structural changes in the myocardium and molecular biological characteristics (CD31, CD34) of the endothelium of blood capillaries in severe forms of COVID-19 was carried out. Results. The analysis of clinical and laboratory data has shown that a decrease in myocardial contractility in severe forms of COVID-19 due to an extensive lung damage was accompanied by an increase in the level of C-reactive protein, D-dimer, troponin I and indicated acute myocardial damage. According to electrocardiography (ECG) monitoring and echocardiography, repolarization disorders and a decrease in myocardial contractility were noted, which was accompanied by a decrease in ejection fraction by 32%. In more than 70% of cases, various arrhythmic disorders (atrial fibrillation, etc.) were observed during ECG. Light microscopy revealed the presence of sludge phenomenon, as well as swelling, desquamation and proliferation of the endothelium of blood capillaries, formation of diapedetic and focal hemorrhages, in some places leukocyte margination and their migration beyond vascular bed. Fibrin masses were observed in the lumen of blood vessels. Polarization microscopy, along with contractures in cardiomyocytes, revealed groups of cells with myocytolysis and primary granularity. In all observations, lipofuscinosis of cardiomyocytes was detected. Immunohistochemical examination showed a marked decrease in the expression level of CD31 (PECAM-1) and CD34 proteins – markers of blood vessels. Conclusion. The performed clinical and morphological analysis in severe forms of COVID-19 allowed us to obtain new data on degenerative changes in the myocardium and the structure of endothelial cells of blood capillaries, which can be used as a basis for methodological approaches to studying the mechanisms of development of heart failure in a novel coronavirus infection.

The ultrastructural organization endotheliocytes of pulmonary blood capillaries in COVID-19 was studied on autopsy material using electron microscopy. Swelling of the cytoplasm and mitochondria with destruction of the cristae, dilation of the Golgi complex cisternae, a decrease in the volume density of the luminal and basal caveolae and free transport vesicles, an increase of the rough endoplasmic reticulum, as well as the presence of elements of coronavirus replication (reticulovesicular structures, zippered endoplasmic reticulum, electron-dense particles in the Golgi cisternae, and vacuoles with viral particles) were revealed. Further studies of the intracellular mechanisms used by the virus to replicate could help to develop antiviral drugs for the treatment of the new coronavirus infection.

Introduction. An effective way to reduce the volume of infusion (restrictive strategy) in hypovolemic shock, in particular in burn shock, is invasive hemodynamic monitoring and choosing the appropriate regimen for the use of inotropic agents, considering the data obtained. However, the use of inotropic agents in hypovolemic shock is still controversial. The most cutting issue is the choice of effective doses of inotropic agents. Aim. Justification of the need to use inotropic agents and assessment of the safety and effectiveness of dobutamine use in burn shock. Materials and methods. The pilot clinical study conducted in 2021–2022 included 9 patients aged 15–70 years who were admitted to the intensive care unit (ICU) of the Burn Center of the Novosibirsk State Regional Clinical Hospital with a total body surface area burned > 40% (II–III degree), in most cases – thermal inhalation injury, who were in the ICU for over 3 days. Intensive care of burn injury in the acute phase was performed according to conventional clinical recommendations. Myocardial samples for morphological and immunohistochemical studies were taken from 34 patients who died from burn shock (27 men and 7 women, aged from 21 to 51 years) from 2015 to 2019. The samples were taken post mortem, and with minimal atherosclerotic changes of the coronary arteries (lesions no more than 20–25%). The control group for morphological and immunohistochemical studies comprised samples which were taken from 25 individuals who died because of sudden circulatory arrest (19 men, 6 women). Results. Studies have shown a decrease in myocardial contractility in patients with burn shock. Morphological examination revealed contraction lesions of individual cardiomyocytes of varying degree, as well as foci of primary clumping of myofibrils’ cytoplasm and myocytolysis. The immunohistochemical study of myocardial sections showed a decrease in the actin expression by 2.4 times (p < 0.05) and desmin – by 2 times (p < 0.05) in comparison with the control group. The results of the clinical study showed that dobutamine at a rate of up to 5.0 μg/kg/min does not cause an arrhythmogenic effect and/or lactic acidosis. Conclusion. The data obtained on structural changes of the myocardium confirm the need for the use of inotropic agent in burn shock. Dobutamine at a rate of up to 5.0 μg/kg/min allows for a restrictive strategy of fluid resuscitation and rapid recovery from burn shock.

НИИ клинической и экспериментальной лимфологии -филиал ФГБНУ «Федеральный исследовательский центр Институт цитологии и генетики Сибирского отделения

Burn injury and its consequences are an important medical and social problem, given the high mortality and disability rates. The leading cause of death in patients with extensive and deep burns is burn septicotoxemia. Material and methods. The material was the heart muscle of the anterior, posterior and lateral walls of the left ventricle of those who died from burn disease during septicotoxemia. The control group included cases of male mortality as a result of "acute coronary death". The study of the ultrastructure of endotheliocytes of blood capillaries of the myocardium has been carried out. Results and discussion. Ultrastructural analysis of endotheliocytes of blood capillaries of the myocardium showed that in burn septicotoxemia, intracellular degradation processes are observed in the form of swelling of the cytoplasm and organelles, a decrease in the concentration of vesicular structures, as well as activation of autophagy due to the appearance of autophagosomes and autolysosomes in the cytoplasm. Activation of autophagy should be considered as a naturally developing compensatory reaction aimed at preserving the cellular pool of endotheliocytes of the blood capillaries of the myocardium in response to the alterative effect caused by burn septicotoxemia. Conclusion. The obtained data can serve as a justification for the manifestation of left ventricular contractile insufficiency, which is a consequence of endothelial dysfunction and microcirculatory disorders in the myocardium in burn septicotoxemia.

НИИ клинической и экспериментальной лимфологии -филиал ФГБНУ «Федеральный исследовательский центр Институт цитологии и генетики Сибирского отделения Российской академии наук»

OBJECTIVE:Assessment of pathological and morphological changes in those who died from COVID-19 including persons received therapy in medical and preventive institutions (LPI) and who died suddenly from this pathology at home. The analysis data of the pathological and anatomical changes in 57 deaths from COVID-19 in hospitals and 74 forensic medical examinations where infectious pathology was established as the main cause of death are presented. For microscopy the sections were stained with hemotoxylin and eosin, OCG, immunohistochemical study with markers for CD3, CD 4, CD 20, SK-7. The mixed viral and bacterial lesions of the lungs were detected more often than pure viral infection in those who died suddenly from COVID-19 compared with people whose death occurred in medical facilities. This allows speaking about the lack of adequate antibiotic therapy out-patiently. Features of mononuclear lung infiltration in COVID-19 with a predominance of a moderately pronounced reaction of T-lymphocytes and a mild B-lymphocytic reaction indicate a decrease in immunological reactivity. Conducting clinical and anatomical analysis allows determining the features of pathogenesis and morphogenesis in each specific fatal case and informing the clinicians of health facilities (clinics and hospitals) allows the autopsy doctor (pathologist, forensic physician) to provide significant assistance in improving the quality of diagnosis and treatment of patients with this highly contagious severe viral disease.

Burn injury is an important medical problem, as it is accompanied by high mortality rates in burn shock. Aim of the study was to conduct an ultrastructural stereological analysis of changes in the blood microvessels of the left ventricular myocardium in burn shock.Material and methods. Myocardial samples during the early section were collected 2 hours after the detection of biological death in the victims from severe burn shock (3 men and 2 women); age group 32-44 years. An ultrastructural study of endothelial cells of the microvasculature of the left ventricular myocardium was carried out.Results and discussion. The development of severe burn shock is accompanied by changes in the ultrastructure of the endothelial cells of the blood microvessels of the left ventricular myocardium, which is associated with intracellular degradation and exocytosis. These ultrastructural changes may indicate impairment of vesicular transport in the endothelium of the myocardial microvessels in burn shock. A feature of the ultrastructure of the endothelium was the heterogeneity of the endothelial cells of the blood capillaries due to the revealed dark and light endothelial cells, which differ in the saturation of the cytoplasm with organelles. The new data obtained on changes in the ultrastructure of the endothelium of the microvasculature of the left ventricular myocardium can be informative in the development of approaches to intensive therapy of cardioprotective direction in combustiological patients with burn shock.

Pulmonary embolism (PE) is one of the most common fatal complications in a wide variety of pathologies along the most common death causes of the population - diseases of the circulatory system and oncology. The development of PE in the postoperative and postpartum periods can also be fatal. The diagnosis of PE is very difficult and in 50-80% of cases it is not diagnosed at all. During autopsies it is important not only to diagnose PE but also to establish the source of its origin. An example of PE in a 34-year-old pregnant woman is given; the PE source was thrombosis of the right deep femoral vein facilitated by varicose veins of the lower extremities and severe preeclampsia. The presence of severe preeclampsia in a pregnant woman caused the development of venous sinus thrombosis accompanied by bilateral exophthalmos, necrosis of a pituitary gland part and progressive cerebral edema.

We studied ultrastructure and vesicular structures in endothelial cells of myocardial micro-vessels in burn patients. Electron microscopy revealed a significant decrease in volume density of vesicular structures in the endotheliocytes of myocardial capillaries in patients with burn septicotoxemia. The observed structural signs of endothelial dysfunction revealed in this category of patients can be a promising area for further research and for the development of methods of pathogenetic correction of myocardial disorders in the case of burn injury.

The study involved 107 women aged 20 to 52 years with chronic recurrent cystitis (57 of them with leukoplakia) developing under conditions of a pathogenic and/or opportunistic infection. All patients underwent a conventional clinical and instrumental examination. Biopsy samples for culture-based and microscopic examination were taken from the area of the Pawlik’s trigone of the vagina and the Lieutaud’s trigone of the urinary bladder, in case of leukoplakia — from the fi eld of visually healthy tissue. The carried out cytomorphological analysis and assessment of pathological processes in the adjacent tissues suggest that the infection from the vagina penetrates through the intersynaptic clefts, interstitial cell nests, the blood and lymphatic microcirculatory system into the bladder, causing cystitis inherent changes — from initial morphological forms to rough ones, up to leukoplakia. A complex of clinical, functional and pathomorphological changes that fi t into the framework of the chronic cystovaginitis concept was identified.

The study involved 107 women aged 20 to 52 years with chronic recurrent cystitis (57 of them with leukoplakia) developing under conditions of a pathogenic and/or opportunistic infection. All patients underwent a conventional clinical and instrumental examination. Biopsy samples for culture-based and microscopic examination were taken from the area of the Pawlik’s trigone of the vagina and the Lieutaud’s trigone of the urinary bladder, in case of leukoplakia — from the field of visually healthy tissue. The carried out cytomorphological analysis and assessment of pathological processes in the adjacent tissues suggest that the infection from the vagina penetrates through the intersynaptic clefts, interstitial cell nests, the blood and lymphatic microcirculatory system into the bladder, causing cystitis inherent changes — from initial morphological forms to rough ones, up to leukoplakia. A complex of clinical, functional and pathomorphological changes that fit into the framework of the chronic cystovaginitis concept was identified.

ПАТОМОРФОЛОГИЯ МИОКАРДА И УЛЬТРАСТРУКТУРА ЭНДОТЕЛИОЦИТОВ КРОВЕНОСНЫХ КАПИЛЛЯРОВ МЫШЦЫ СЕРДЦА ПРИ ОЖОГОВОЙ СЕПТИКОТОКСЕМИИСавченко С.В. 1 , Гребенщикова А.С. 1 , Бгатова Н.П. 2 , Таскаева Ю.С. 2 , Летягин А.Ю. 2 , Новоселов В.П

OBJECTIVE To identify the structural organization of connective tissue and vascular bed of the external genitalia in primary massive localized lymphedema. To analyze a clinical case of the development of massive localized lymphedema of the external genitalia concurrent with primary lymphedema of the lower limb in a patient with a normal body mass index. MATERIAL AND METHODS The samples obtained by resection during volume reduction surgery were used to study the morphological features of the lymphatic bed and extracellular matrix of the scrotal skin and testicular dartos versus the samples without pathological changes. Biological samples were processed using standard techniques for histological, immunohistochemical and ultrastructural analyses. Lymphatic vessels were differentiated using the molecular lymphatic endothelial marker Podoplanin. RESULTS In lymphedema, there was an increase in the thickness of all scrotal skin layers, a decrease in the volumetric lymphatic vessel density, an expansion of the interstitial spaces, and a change in the structure of collagen fibers that were homogenized, loosened, and swollen and did not form a three-dimensional network. The testicular dartos exhibited intermuscular fibrosis, expansion of the interstitial spaces, and perivascular leukocytic infiltration. CONCLUSION Histological and immunohistochemical analyses revealed changes in the structural organization of the connective tissue matrix and lymphatic bed of the scrotal skin and testicular dartos in long-standing massive localized lymphedema. The feature of the described clinical case was the absence of signs of chronic inflammation and severe diffuse fibrosis in primary scrotal massive localized lymphedema in a patient with a normal body mass index.

Objective: to study the relationship between metalloproteinases and expression TIMP1 expression and intensity of inflammatory response in the cervical stroma of women with cervical intraepithelial neoplasia and microinvasive carcinoma. Material and methods. Morphological, morphometric and immunohistochemical examination of cervical biopsies in patients with cervical epithelial neoplasia (cINI–III) and microinvasive carcinoma was carried out. all patients were divided into two age groups: group 1 consisted of 95 patients of early reproductive age ranged from 18 to 35 years (mean age 28.5 ± 0.58 years) and group 2 consisted of 85 perimenopausal and menopausal patients aged 49 to 65 (mean age 55.4 ± 0.98 years). Results. In women of both age groups, the density of inflammatory cell infiltrate was shown to increase, being significantly higher in women of group 1 than in women of group 2. the increase in the expression level of metalloproteinases-2, -3, -7, and -9 with dysplasia progression was observed in women of both age groups, being also higher in group 1 women. the tIMP1 expression level was higher in group 2 women and increased with disease progression. Conclusion. In young women, pronounced and active inflammation in the cervical stroma contributes to a high potential for metalloproteinase synthesis. a higher level of tIMP1 expression in perimenopausal and menopausal women may be one of the factors contributing to a decrease in the metalloproteinase synthesis in these women.

АННОТАЦИЯИшемическая болезнь сердца является ведущей причиной смертности населения развитых стран, поэтому изучение различных аспектов этой патологии представляется важной медико-биологической задачей.Материалом в проведенном исследовании послужила сердечная мышца левого желудочка 37 лиц, скоропостижно умерших от острых форм ишемической болезни сердца: в результате острой коронарной недостаточности и острого инфаркта миокарда в донекротической стадии.Контрольная группа: сердечная мышца 5 лиц, умерших вследствие черепно-мозговой травмы.Кроме светового и поляризационного исследования срезов миокарда, применяли иммуногистохимический анализ, позволяющий оценивать выраженность экспрессии клеточных белков: актина, десмина, коннексина 43

Academy of Sciences, Novosibirsk, Russia 2 Novosibirsk State Medical University, Novosibirsk, Russia BACKGROUND: Adipose tissue (AT) dysfunction plays an important role in metabolic disorders in obesity and type 2 diabetes. The role of distribution, hypertrophy and vascularization of AT in adipokine secretion disturbances remain to be clarified. AIMS: To determine the relationships between serum concentrations of adipokines and the mass and distribution of AT, diameter of adipocytes and vascularization of subcutaneous AT in patients with type 2 diabetes. MATERIALS AND METHODS: A total of 125 patients were examined, including 82 subjects with obesity. Thirty persons without diabetes and obesity, matched by sex and age, were acted as control. Concentrations of leptin, resistin, visfatin, adipsin and adiponectin in fasting serum were determined using multiplex analysis. Mass and distribution of AT was assessed by dual-energy X-ray absorptiometry. Samples of SAT were obtained from umbilical region using a knife biopsy in 25 patients and in 15 individuals who died in accidents. Blood and lymphatic vessels in SAT were revealed with immunohistochemistry, using antibody to CD-34 and podoplanin respectively. The volume and numerical density, ultrastructure of blood and lymphatic vessels, and mean diameter of subcutaneous adipocytes were evaluated. RESULTS: Patients with diabetes, as compared to control, had significantly higher levels of leptin, resistin, adipsin and visfatin (all p<0.001). Adiponectin showed no differences. Concentrations of leptin, resistin, visfatin, adipsin and adiponectin correlated positively with gynoid fat mass. Additionally, leptin and adipsinshowed positive correlations with truncal and central abdominal fat mass. Concentration of leptin, but not other adipokines, was associated with hypertrophy of subcutaneous adipocytes. A decrease in volumetric density of microvessels(р=0.01) and increase in volume and numerical density of lymphatic vessels (both р=0.02) was observed in subcutaneous AT from diabetic subjects. The swelling of cytoplasm, mitochondria, cisterns of granular endoplasmic reticulum and reduced content of micropinocytotic vesicles was revealed in lymphatic capillaries. Resistin and visfatin showed inverse associations with density of microvessels. CONCLUSION: Endocrine dysfunction of AT in patients with type 2 diabetes, manifested by elevation of serum concentrations of leptin, resistin, visfatin and adipsin, is associated with mass and distribution of AT, hypertrophy of subcutaneous adipocytes and vascularization abnormalities of subcutaneous AT.

AIM:to investigate diagnostically significant for atherosclerotic plaques (ASP) of various types parameters of activity of matrix metalloproteinases (MMP-3, MMP-7, MMP-9) in homogenates, as well as tissue expression of MMP-2, MMP-9 and collagen type IV.MATERIALS AND METHODS:We included in this study 54 men with coronary atherosclerosis without acute coronary syndrome who underwent coronary artery bypass surgery with endarterectomy. In the obtained samples we determined levels of MMP-3, MMP-7, and MMP-9 (by enzyme immunoassay), as well as tissue expression of antibodies to MMP-2, MMP-9 and collagen type IV.RESULTS:In unstable plaques we observed increased activity of MMP-7 and MMP-9, significant increase of tissue expression of MMP-2 and MMP-9, and decreased expression of type IV collagen. Of three types of unstable ASP the highest tissue expression of MMP-9 was found in plaques of lipid type compared with plaques of necrotic and inflammatory-erosive types. Expression of type IV collagen predominated in plaques of necrotic type.CONCLUSION:The data obtained allows us to speak about tissue expression of collagen as the marker of fibrous cap stability; the presence of metalloproteinases in necrotic detritus, collagen fibers, and cellular elements can characterize an ASP as unstable or being in the transitional structural state. The immunohistochemical method helps to detect structural elements that characterize instability in various types of ASP.