The Number of Syncytial Knots and VEGF Expression in Placental Villi in Parturient Woman with COVID-19 Depends on the Disease Severity.

A comparative morphological study was carried out to analyze the number of syncytial knots and VEGF expression in placental villi in parturient women with COVID-19 categorized by the disease severity. The number of syncytial knots was assessed on specimens stained with hematoxylin and eosin. VEGF expression was determined by immunohistochemical analysis in syncytiotrophoblast and villous endothelial cells. Morphological study of the placenta tissue of parturient women with COVID-19 showed increased numbers of syncytial knots in the villi, indicating the development of preplacental hypoxia. High VEGF expression in syncytiotrophoblast and vascular endotheliocytes reflects a stereotyped response to hypoxia and can underlie the development of a preeclampsia-like syndrome. The number of syncytial knots and VEGF expression in placental villi in parturient women with COVID-19 depended on the disease severity.

Postmortem MRI Evaluation of Maceration Degree of Deceased Fetus.

We studied the possibilities of postmortem MRI for assessing the degree of maceration and determining the duration of intrauterine fetal death. Postmortem radiological and pathoanatomic study of the bodies of 38 stillbirths who died antenatally (main group, n=31) and intranatally (control group, n=5), who were born at gestational periods of 22-40 weeks was performed. Before the autopsy, MRI was performed in standard T1 and T2 modes. The tissue of the liver, kidney, brain, femoral muscle, lung, and skin in the hip, abdomen, and skull were studied on T1- and T2-weighted images (WI), followed by calculation of the of MR signal intensity ratio in T2- and T1-WI (SIR). The duration of intrauterine fetal death was determined based on the results of autopsy and analysis of histological preparations. It was found that the calculated values of SIR depended on the evaluated organ and the duration of intrauterine fetal death. Unfortunately, the revealed dynamics of changes in SIR does not allow unambiguous assessment of the severity of maceration processes and, accordingly, the time of fetal death due to its non-linear nature. Nevertheless, the use of SIR indicators of several organs and areas of the body makes it easier to determine the duration of intrauterine fetal death and, hence, to clarify the links of thanatogenesis of the stillborn. The advantages of post-mortem MRI compared to autopsy include non-invasive nature of the study, the possibility of archiving and subsequent multiple delayed analysis of tomograms, as well as the speed of MRI analysis, in contrast to microscopic stage of pathological examination associated with the need to prepare histological preparations.

Postmortem Computed Tomography Angiography of Newborns.

We propose an original method of postmortem computed tomography angiography of the body of a deceased newborn. The work is based on the analysis of the results of comprehensive postmortem computed tomography and pathological examination of 30 newborns, who died from congenital malformations. The key to a full-fledged postmortem radiation study using intravascular contrasting of deceased newborns and infants is the presence of vascular catheters established during life, as well as conducting it no earlier than 12 h and no later than 48 h after death. As a contrast agent, we recommend to use an iodine-containing water-soluble radiopaque drug containing at least 250 mg of iodine per 1 ml. The volume of contrast agent is calculated based on body weight, taking into account the general edema syndrome. The introduction of a contrast agent is carried out through vascular catheters in 3 stages in various positions of the body. The analysis of tomograms and 3D-reconstruction of blood vessels using their pseudocoloring allows accurate assessment of the topography of blood vessels with the possibility of separate study of the arterial and venous vessels, and to identify both congenital abnormalities of the heart and blood vessels, and their acquired pathology. CT angiography in some cases is superior to traditional autopsy in the diagnosis of blood vessel pathology. Postmortem CT angiography should be considered as an important stage of postmortem radiology in the structure of comprehensive pathological analysis of newborns and infants.

Complex Method of CT and Morphological Examination of Placental Angioarchitechtonics.

We propose an original method of complex assessment of the placental angioarchitechtonics based on computed tomography (CT) and morphological examination. A prerequisite condition of successful examination and assessment of the placental angioarchitechtonics is the pre-preparative stage including clearing of the placental and umbilical cord vessels from blood clots by placement of placenta into 10% hypertonic NaCl solution and then on a hygroscopic substrate. The major stage of this method is injection of contrast staining mixtures into the umbilical vessels followed by CT. The concentration of radiocontrast agent in water solution of gouache should be 70% for arteries and 15% for veins. The volumes of mixtures for contrast staining should be calculated according to the weight of the placenta. The contrast staining mixture was first injected into the catheterized unpaired umbilical vein, and then into both umbilical arteries. Each injection of the contrast staining mixture was visually inspected; then branching of the stained vessel was photographed and scanned by CT. The CT scans were used to construct 3D models of placental vessels and spectral color maps, which made it possible to examine the peculiarities of placental angioarchitechtonics, to identify and evaluate anastomoses of placental vessels, and to establish the type of these anastomoses.

Possibilities of Postmortem Magnetic Resonance Imaging for Evaluation of Anasarca in Newborns.

We studied the possibilities of postmortem magnetic resonance imaging (MRI) for evaluation of anasarca in newborns. Before the autopsy, MRI in T1 and T2 standard modes was performed, signal intensity tomograms in the subcutaneous tissue were analyzed, and tissue hydration index was calculated. Using 3D reconstruction, we determined the values of hydrothorax, hydropericardium, and ascites, as well as specific volumes of fluid in the abdominal and thoracic cavities. It has been established that postmortem MRI of deceased newborns provides objective quantitative assessment of anasarca, as well as absolute and relative volumes of hydrothorax and ascites, which improves the diagnostic capacities of pathoanatomical autopsy or forensic examination of a corpse and contributes to the determination of tanatogenesis. However, postmortem MRI cannot fully replace traditional autopsy that allows conducting complex macroscopic and microscopic analysis of organs and tissues.

Potentialities of Postmortem Magnetic Resonance Imaging for Identification of Live Birth and Stillbirth.

The potentialities of postmortem MRI for differential diagnosis of stillbirth and death of a live newborn are studied. The results of MRI and pathomorphological studies of autopsy material from 20 stillborns dead at weeks 22-40 of gestation (group 1) and 19 newborns dead at the age of 2 h to 36 days (group 2) are analyzed. Control group has been formed from 7 live newborns aged 1-7 days. Postmortem MRI provides an objective quantitative evaluation of the intensity of MR signal in various tissues and regions. Calculation of the proportions of MR signal intensities in the lung tissue and environmental air and/or pleural fluid and the respiration values promotes an objective differential diagnosis of stillbirth and death of a live newborn. These data are expected to facilitate clearing out the circumstances and the direct cause of death. However, postmortem MRI cannot completely replace autopsy with complex macroscopic and microscopic studies of organs and tissues.

The Possibility of Postmortem Magnetic Resonance Imaging for the Diagnostics of Lung Hypoplasia.

We explored the possibility of using postmortem MRI for the diagnostics of lung hypoplasia associated with innate diaphragmatic hernia in neonates. The main experimental group consisted of 17 newborns with innate diaphragmatic hernia including 10 non-operated newborns and 7 newborns died after surgery for innate diaphragmatic hernia. It was demonstrated that postmortem MRI allows objective quantitative assessment of the absolute and relative dimensions of the lungs in the thoracic cavity and thereby reveals their hypoplasia, which contributes to the determination of tanatogenesis. Surgery for congenital diaphragmatic hernia leads to an increase in the mass and volume of the lungs, but does not always eliminate their hypoplasia.

[Pathological estimation of the time of fetal death]. / Patologo-anatomicheskaia otsenka davnosti vnutriutrobnoi gibeli ploda.

The paper analyzes the data available in the literature on the possibilities of determining the time of fetal death during an autopsy study. It presents gross changes in the appearance and internal organs of the fetus, as well as histological changes in the organs and placenta, which develop during maceration. The microscopic characteristics of the development of lung and kidney tissues are given in relation to the gestational age of the fetus. Changes in the mass of internal organs during maceration, as well as their standard values are indicated depending on gestational age and degree of maceration.

Specific Features of TLR4 Expression in Structural Elements of Placenta in Patients with Preeclampsia.

We studied the expression of TLR4 (Toll-like receptor 4) in the syncytiotrophoblast and vascular endothelial cells of terminal and stem placental villi in severe preeclampsia and normal pregnancy. In women of both groups, the expression of TLR4 was higher in the syncytiotrophoblast that in placental endothelial cells. In patients with severe preeclampsia, TLR4 expression in endothelial cells of terminal villi was 1.3-fold lower than in normal pregnancy. Lower TLR4 expression in the terminal villi endothelium in preeclampsia can underlie impaired recognition of damaging molecules with subsequent development of endothelial dysfunction and changes in immunological tolerance.

[Histological hanges in the placenta and vascularization of its villi in early- and late-onset preeclampsia].

AIM: to make a comparative histological study of the placenta and a morphometric analysis of its terminal villi in early- and late-onset preeclampsia. MATERIAL AND METHODS: Placentae from patients whose pregnancy had been complicated by the development of early- (n=26) or late-onset (n=84) preeclampsia were examined. A control group comprised placentae from 28 patients with physiological pregnancy and no extragenital diseases. The authors made a comparative histological study of placental tissue and a morphometric analysis of the terminal villi using the sections immunohistochemically stained for CD31. RESULTS: It was determined that there was a preponderance of branching angiogenesis in the preeclamptic chorionic villi and an increase in the number of syncytial nodules and microcysts in the septae in late-onset preeclampsia. Morphometric analysis of immunohistochemical placental specimens established a reduction in the sizes and vascularization indicators of terminal villi that determine the development of placental hypoxia and are more pronounced in cases of early-onset preeclampsia.

[Twin reversed arterial perfusion syndrome in the monochorionic diamniotic placenta with the development of an acardiac fetus]. / Sindrom obratnoi arterial'noi perfuzii v monokhorial'noi diamnioticheskoi platsente s razvitiem ploda-akardiusa.

The article describes an acardiac fetus in a patient with monochorionic diamniotic twin pregnancy with reversed arterial perfusion syndrome at 30 weeks' gestation. It gives postmortem fetal computed tomographic and pathoanatomic data. Microarray of acardiac fetal tissues revealed that there was deletion of chromosome 19 - arr [hg19] 19p13.3q11 (260,911-23,005,001) x1; size, 23 Mbp; the signal level in about 30% of fetal tissue cells containing deletion.

Expression of insulin-like growth factors in the placenta in preeclampsia.

Comparative morphological study of the placentas in women with preeclampsia and small-for-date fetuses was carried out. Expression of insulin-like growth factor-1 (IGF-1), insulin-like growth factor-2 (IGF-2), and insulin-like growth factor binding protein-3 (IGFBP-3) was detected by immunohistochemical methods. Low expression of IGF-1 and high expression of IGF-2 and IGFBP-3 in the placental tissue depending on preeclampsia severity were detected. The most pronounced changes were found in preeclampsia associated with small-for-date fetuses.

Vascular endothelial growth factor and its receptors in the placental villi of pregnant patients with pre-eclampsia.

Comparative morphological study of the placentas from women with pre-eclampsia of different severity was carried out. The expression of vascular endothelial growth factor and its receptors (VEGFR-1, VEGFR-2, VEGFR-3) was studied by immunohistochemical methods. Branched angiogenesis processes predominated in the placentas of patients with pre-eclampsia. The syncytiocapillary membranes were thickened, the number of syncytial buds was greater than normally. Immunohistochemical studies showed high expression of VEGF and VEGFR-1 and low expression of VEGFR-2 in the placental villous structures.

Expression of antiangiogenic factors in the placental structures in pre-eclampsia.

Comparative morphological study of the placentas was carried out in women with pregnancy aggravated by the development of pre-eclampsia. Immunohistochemical methods showed increased expression of endoglin (CD105) and VEGFR1 in all placental structures. The intensity of endoglin and VEGFR1 expression was maximum in the syncytiotrophoblast and extravillous cytotrophoblast cells in severe pre-eclampsia.

Morphometric characteristics of terminal villi of the placenta in pre-eclampsia.

Comparative morphological study of the placentas from women suffering from pre-eclampsia was carried out. Morphometric studies of histological preparations showed shrinkage and low vascularization of the placental terminal villi determining the development of hypoxia.