SummaryThis article contains clinical guidelines and current approaches to diagnosis and treatment of idiopathic pulmonary fibrosis (IPF). The aims of devel opment this guidelines were to improve early detection and efficacy of pharmacological and non pharmacological therapy of IPF. Achieving these goals indicates improvement in medical care quality for these patients. These guidelines are intended to pulmonologists, therapeutists and other medical specialists, healthcare managers and other healthcare providers.

Autopsy data from 80 patients who died of the COVID-19 infection were analysed. Using macro- and microscopic studies, specific features of pathological processes in various organs were identified. The obtained experimental data, along with information from literature sources, allowed conclusions to be drawn about the mechanisms of damaging internal organs and body systems, as well as assumptions to be made about individual links in the pathogenesis of COVID-19. The thanatogenesis of the disease and the main causes of death are discussed, including acute cardiopulmonary failure, acute renal failure, pulmonary thromboembolism, shock involving multiple organ failure and sepsis. The critical importance of autopsy is emphasized, which provides valuable information on the morphological substrate for this infection closely associated with possible clinical manifestations.

Fifty-six primary neuroendocrine lung tumors were examined morphologically and histologically and their apoptosis level was determined. Malignant carcinomas were characterized by increased apoptotic index and enhanced expression ofBcl-2, Bak, p53, and Ki-67 compared to typical carcinoid. However, apoptosis in these tumors was not completed. Proteins of the Bcl family play an important role in the regulation of spontaneous apoptosis in neuroendocrine lung tumors. Bcl-2 accumulating in the nucleus is a morphological analogue of phosphorylated inactive form of this protein, which does not inhibit apoptosis. Expression of Bcl-2 and Bax decreases in small-cell lung carcinoma (SCLC) with metastases indicating attenuation of apoptosis and development of metastatic clones resistant to apoptosis induces.

The study is devoted to investigation of fluorescent and photodynamic properties of near-infrared photosensitizer bacteriochiorophyllide-serine. The peculiarities of its fluorescence under different laser excitation conditions, dynamics of concentration and selectivity of accumulation were investigated. Photodynamic therapy of mice and investigation of tissue deoxygenation during tumor irradiation were performed. It was shown that bacteriochiorophyllide-serine is an effective photosensitizer for PDT and fluorescent diagnostics of tumors.

Материалом для исследования послужили легкие от 232 аутопсий пациентов, страдавших инфекцией COVID-19, подтвержденной ПЦР при жизни и/или при исследовании парафиновых блоков ткани легкого. При помощи макрои микроскопического и иммуногистохимического исследований (CD3, CD20, TLR4, TLR9, Ki67, p63, OCT4, ALDH1) продемонстрированы особенности патологических процессов в легких. Полученные данные позволяют выдвинуть предположение, что такие патологические процессы в легких как диффузное альвеолярное повреждение (ДАП), лимфоцитарный альвеолит, сопровождающийся васкулитами веточек легочной артерии мелкого и среднего калибра, вирусно-бактериальная пневмония, распространенная коагулопатия с тромбозами и тромбоэмболией легочной артерии, интерстициальный фиброз и дисрегенераторные изменения легочного эпителия взаимосвязаны и могут быть формами-фазами патологии легких при COVID-19. Процесс в легких может развиваться по трем морфогенетическим путям, начиная с развития диффузного альвеолярного повреждения или лимфоцитарного альвеолита или коагулопатии. Последний вариант начала инфекции вероятнее всего связан с первичным поражением кишечника. При этом легкие вовлекаются вторично, после развития виремии, ДВС-синдрома и цитокинового шторма. Плоскоклеточная метаплазия с формированием сфероидных структур в легких носит дисрегенераторный характер, и в дальнейшем эпителий таких очагов может подвергаться злокачественной трансформации.