Romanova ES, Vasilyev VV, Startseva G, Karev V, Rybakova MG, Platonov PG. Cause of death based on systematic post-mortem studies in patients with positive SARS-CoV-2 tissue PCR during the COVID-19 pandemic. J Intern Med 2021;Importance. Assessment of the causative association between the COVID-19 and cause of death has been hampered by limited availability of systematically performed autopsies. We aimed to present autopsy-confirmed causes of death in patients who died with COVID-19 and to assess the association between thrombosis and diffuse alveolar damage consistent with COVID-19 (DAD).Methods. Consecutive forensic (n = 60) and clinical (n = 42) autopsies with positive post-mortem SARS-CoV-2 PCR in lungs (age 73 AE 14 years, 50% men) were included. The cause of death analysis was based on a review of medical records and histological reports. Thrombotic phenomena in lungs were defined as pulmonary thromboembolism (PE), thrombosis in pulmonary artery branches or microangiopathy in capillary vessels.Results. COVID-19 caused or contributed to death in 71% of clinical and 83% of forensic autopsies, in whom significant DAD was observed. Of the patients with COVID-19 as the primary cause of death, only 19% had no thrombotic phenomena in the lungs, as opposed to 38% amongst those with COVID-19 as a contributing cause of death and 54% amongst patients whose death was not related to COVID-19 (p = 0.002). PE was observed in 5 patients. Two patients fulfilled the criteria for lymphocyte myocarditis. Conclusions.Vast majority of all PCR-positive fatalities, including out-of-hospital deaths, during the SARS-CoV-2 pandemic were related to DAD caused by COVID-19. Pulmonary artery thrombosis and microangiopathy in pulmonary tissue were common and associated with the presence of DAD, whilst venous PE was rarely observed. Histologyconfirmed lymphocyte myocarditis was a rare finding.

Desmin cardiomyopathy is a rare cause of congestive heart failure. Its clinical manifestation in adulthood often is associated with conduction disorders and a neuromuscular phenotype. Only a few cases have been reported, with early manifestation in childhood mostly due to severe cardiomyopathy dilation and conduction abnormalities. However, the disease can result in the variety of clinical phenotypes, including hypertrophic, restrictive, and arrhythmogenic cardiomyopathy. This report describes the first case of desmin cardiomyopathy with early manifestation in adolescence and transformation of several clinical phenotypes over time, representing sufficient difficulties for the correct clinical diagnosis and treatment of the disease at an early stage.

Fractional lasers have become widespread in dermatology owing to their efficacy and safety. Comparative analysis of histological features after laser rejuvenation using a 1064‐nm fractionated handpiece picosecond laser with different energy fluence levels (1.1 or 2.1 J/cm2). An open‐label, study of 28 women aged 36 to 60 years with signs of age‐related photodamage and skin changes of the face and neck was conducted using a fractional picosecond 1064 nm laser in low vs high fluence. The clinical assessment at 3 weeks showed more pronounced effect on facial skin rejuvenation with the higher fluence of 2.1 J/cm2 compared to 1.1 J/cm2. The effect and safety of laser rejuvenation using a picosecond laser has been shown with more pronounced histological effects at higher fluences.

The natural course of transitional cell bladder cancer is highly variable. The clinical approach to treatment is based mainly on the tumour stage and grade.1 2 However, the data obtained from these parameters are insuYcient to predict the biological behaviour of an individual tumour. Therefore, additional criteria have been proposed as potential instruments for more accurate grading.3 Argyrophilic nucleolar organiser regions (AgNORs) are segments of DNA that are sites of ribosomal RNA transcription. Counting silver stained interphase AgNORs provides an estimate of cellular proliferation, and has been found to correlate with tumour grade and stage, and to bear independent predictive value in patients with urinary bladder carcinoma. 4 However, the data obtained are controversial. 5-7The aim of our study was to estimate how the AgNOR and nucleolar counts in the tumour cells of transitional cell bladder carcinoma correlate with patients' sex, tumour grade, disease stage, recurrence pattern, and tumour related survival. Materials and methodsOur study comprised 62 patients (48 men and 14 women), mean age 63.9 years (range, 32-88), with primary transitional cell bladder carcinoma who had been operated upon in the urological department, State Pavlov Medical University between 1985 and 1990. Patients were included if their specimens contained sufficient tumour material for AgNOR staining and if they could be followed for at least five years. Patients with invasive neoplasia were treated by radical and partial cystectomy. In cases with superficial tumours, transurethral resection was performed.Follow up examination of patients with preserved bladder included cystoscopy every three months during the first year after surgery, cystoscopy every six months for the next two years, and then ultrasound sonography of the bladder followed by cystoscopy in suspect cases every one to two years. Thirty eight patients survived five years. Thirty seven patients developed recurrences, the mean (SD) recurrence rate being 24.8 (24.1) months (range, 2-90). TISSUEThe tumour samples were fixed in 10% buVered formalin and embedded in paraYn wax. Sections (5 µm thick) were stained with haematoxylin and eosin. The tumours were graded as recommended by Mostofi and colleagues 8 and staged postoperatively according to the TNM staging system. 9 In 17 cases, specimens were too small to confirm the tumour stage.AgNOR STAINING AND COUNTING Sections (5 µm thick) cut in series with the haematoxylin and eosin stained sections were fixed in methanol/acetic glacial acid mixture (3/1) for 15 minutes and rinsed thoroughly with distilled water. After air drying, the sections were transferred to 2% formic acid and incubated for 10 minutes, rinsed again, and impregnated with silver nitrate solution, according to Howell and Black, 10 with a slight modification, namely: two drops of gelatin solution were placed on the slide and mixed with four drops of freshly prepared 50% aqueous AgNO 3 solution. The slides were covered

РЕЗЮМЕ К настоящему времени появились описательные результаты клинико-морфологического изучения проявлений новой коронавирусной инфекции COVID-19, преимущественно в легких. Однако и в других органах, в первую очередь в сердечно-сосудистой системе, возникают значительные структурные изменения, приводящие к полиорганной недостаточности и способствующие наступлению летального исхода. Цель исследованияанализ танатогенетического значения новой коронавирусной инфекции COVID-19 в разных возрастных и гендерных группах и описание ее основных патоморфологических проявлений в различных органах. Материал и методы. Выполнен комплексный анализ 700 аутопсий при новой коронавирусной инфекции COVID-19, включающий изучение макроскопических изменений, отраженных в протоколах патолого-анатомических вскрытий и судебномедицинских актах, а также микроскопических изменений, выявленных при гистологическом исследовании органов. В части наблюдений использовали иммуногистохимический метод с применением мышиных или кроличьих антител к CD34, CD68, EMA, Ki67, Caspase-3 и VEGF. Результаты. В 43% случаев новая коронавирусная инфекция COVID-19 являлась единственной первоначальной причиной смерти. Ведущими танатогенетическими механизмами при COVID-19 стали острая дыхательная и легочно-сердечная недостаточность, полиорганная дисфункция. Наиболее частыми заболеваниями у больных с COVID-19 были сердечнососудистая патология, сахарный диабет и ожирение. Максимально выраженные изменения при COVID-19 определялись в легких с преобладанием множественного тотального двустороннего поражения нижних долей легких, что проявлялось вирусиндуцированными изменениями паренхимы и стромы, а также нарушениями микроциркуляции. В паренхиматозных органах доминировали острые дисциркуляторные и ишемические изменения на фоне вирусного поражения ткани. Заключение. В различных органах у умерших от новой коронавирусной инфекции COVID-19 изменения стереотипны и включают проявления вирусиндуцированного действия и системной воспалительной реакции с альтерацией преимущественно сосудов микроциркуляторного русла, что приводит к развитию гемокоагулопатических расстройств и, соответственно, к тотальной гипоксии. Ключевые слова: новая коронавирусная инфекция COVID-19, патологическая анатомия.