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1
Vanezis, Peter. "The Hospital AutopsyA Manual of Fundamental Autopsy Practice." Medicine, Science and the Law 52, no. 4 (October 2012): 244–45. http://dx.doi.org/10.1258/msl.2012.012078.
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Gibson, A. "Perinatal Autopsy Manual." Journal of Clinical Pathology 38, no. 11 (November 1, 1985): 1319. http://dx.doi.org/10.1136/jcp.38.11.1319-b.
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Kan, A. E. "Perinatal Autopsy Manual 1983." Pathology 18, no. 1 (1986): 170. http://dx.doi.org/10.1016/s0031-3025(16)36857-x.
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Vlasov, A. A. "Experimental rationale for colocolonic anastomosis formation by a compression suturing device." Kazan medical journal 95, no. 6 (December 15, 2014): 875–81. http://dx.doi.org/10.17816/kmj1997.
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Aim. To experimentally compare the durability and biological integrity of compressional and manually made anastomoses, and to find out morphological features of their regeneration. Methods. Experimental studies were performed on 54 non-pedigree dogs of both gender and on autopsied specimens in prosectorium. Colocolonic anastomoses were formed by compression suturing device, Ziganshin-Gunter device, compression anastomosis device, and manually. Results. Compression anastomoses had higher durability compared to manual sutures (р 0.05). A test for microbial penetration showed only minimal signs of bacterial contamination of colocolonic anastomoses made by compression suturing device. Bacterial contamination of colocolonic anastomoses performed by compression anastomosis device and compression suturing device, was significantly less common compared to anastomoses formed by Ziganshin-Gunter device and manually (р 0.05). Examination of compression anastomoses morphogenesis revealed that healing of colocolonic anastomoses is accompanied by homogenous standard morphologic pattern. No scarring occurs due to absence of inflammation and low amount of connective tissue at the anastomosis region. Study of colocolonic anastomoses formation by compression devices on an autopsied specimens confirmed the opportunity for anastomosis formation on any part of colon. Conclusion. Compression colocolonic anastomosis formed by compression suturing device is characterized by low bacterial permeability, provides good durability and does not cause scarring in the anastomosis region. Revealed advantages of compression colonic suture allow recommending it for clinical use.
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Hoda, Syed A. "Autopsy Pathology: A Manual and Atlas." JAMA 301, no. 22 (June 10, 2009): 2391. http://dx.doi.org/10.1001/jama.2009.823.
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Siebert, Joseph R. "Book Review: The Pediatric and Perinatal Autopsy Manual." Pediatric and Developmental Pathology 17, no. 6 (November 2014): 496. http://dx.doi.org/10.2350/14-08-1541-br.1.
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Puerto Sanabria, Carlos Roberto, and Alejandro Daniel Barahona Munguía. "Femicidio y Overkill: A Propósito de un caso." Revista de Ciencias Forenses de Honduras 6, no. 2 (December 30, 2020): 33–37. http://dx.doi.org/10.5377/rcfh.v6i2.10715.
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Introducción: El femicidio es todo homicidio intencional de una mujer por razones de su género. El término overkill se utiliza en los casos donde se observa gran cantidad de heridas, excediendo lo necesario para causar la muerte. Presentamos este caso médico-legal con el objetivo de ejemplificar la relación entre el overkill y los femicidios. Resultados: Los hallazgos de autopsia revelaron lesiones compatibles con estrangulación manual e instrumentalizada y heridas por arma blanca. Esto permitió calificarla como overkill. Conclusión: Este tipo de caso llama a la reflexión sobre los factores de riesgo y formas de cómo prevenirlos.
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Flach, Patricia M., Steffen G. Ross, Stephan A. Bolliger, Ulrich S. Preiss, Michael J. Thali, and Danny Spendlove. "Postmortem Whole-Body Computed Tomography Angiography Visualizing Vascular Rupture in a Case of Fatal Car Crash." Archives of Pathology & Laboratory Medicine 134, no. 1 (January 1, 2010): 115–19. http://dx.doi.org/10.5858/2008-0503-crr3.1.
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Abstract In addition to the increasingly significant role of multislice computed tomography in forensic pathology, the performance of whole-body computed tomography angiography provides outstanding results. In this case, we were able to detect multiple injuries of the parenchymal organs in the upper abdomen as well as lesions of the brain parenchyma and vasculature of the neck. The radiologic findings showed complete concordance with the autopsy and even supplemented the autopsy findings in areas that are difficult to access via a manual dissection (such as the vasculature of the neck). This case shows how minimally invasive computed tomography angiography can serve as an invaluable adjunct to the classic autopsy procedure.
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Langner, Cord. "Book Review—Autopsy pathology: a manual and atlas, 3rd edition." Virchows Archiv 469, no. 1 (April 25, 2016): 123. http://dx.doi.org/10.1007/s00428-016-1944-7.
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Godoy, Jorge, Joshué Pérez, Enrique Onieva, Jorge Villagrá, Vicente Milanés, and Rodolfo Haber. "A DRIVERLESS VEHICLE DEMONSTRATION ON MOTORWAYS AND IN URBAN ENVIRONMENTS." TRANSPORT 30, no. 3 (January 28, 2015): 253–63. http://dx.doi.org/10.3846/16484142.2014.1003406.
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The constant growth of the number of vehicles in today’s world demands improvements in the safety and efficiency of roads and road use. This can be in part satisfied by the implementation of autonomous driving systems because of their greater precision than human drivers in controlling a vehicle. As result, the capacity of the roads would be increased by reducing the spacing between vehicles. Moreover, greener driving modes could be applied so that the fuel consumption, and therefore carbon emissions, would be reduced. This paper presents the results obtained by the AUTOPIA program during a public demonstration performed in June 2012. This driverless experiment consisted of a 100-kilometre route around Madrid (Spain), including both urban and motorway environments. A first vehicle – acting as leader and manually driven – transmitted its relevant information – i.e., position and speed – through an 802.11p communication link to a second vehicle, which tracked the leader’s trajectory and speed while maintaining a safe distance. The results were encouraging, and showed the viability of the AUTOPIA approach.
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Ruwanpura, Rohan, and Chathura Nandasiri. "Homicidal Paraquat Poisoning Following Ligature Strangulation." Academic Forensic Pathology 9, no. 3-4 (September 2019): 212–16. http://dx.doi.org/10.1177/1925362119891704.
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We report a case of homicidal paraquat poisoning preceded by attempted manual strangulation. The poison had been forcibly ingested when the victim was unconscious due to pressure on the neck. The victim survived for ten days and died due to development of fibrosing alveolitis. The autopsy showed classic features of proliferative stages of paraquat poisoning and healing signs of ligature strangulation.
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Chatzaraki, Vasiliki, Lars C. Ebert, Michael J. Thali, Anna-Bettina Haidich, and Garyfalia Ampanozi. "Evaluation of the mediastinal-thoracic volume ratio on postmortem computed tomography." International Journal of Legal Medicine 135, no. 5 (April 28, 2021): 1903–12. http://dx.doi.org/10.1007/s00414-021-02593-0.
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Abstract Objectives The aim of this study was to measure the mediastinal-thoracic volume ratio (CTR_VOL) on PMCT as a more accurate version of traditional CTR, in order to assess the terminal positional relationship between the heart and lungs in the different causes of death with regard to age, gender, BMI, cardiomegaly, and lung expansion. Materials Two hundred fifty consecutive postmortem cases with pre-autopsy PMCT and full forensic autopsy were retrospectively evaluated. The lungs and the mediastinum were manually segmented on the PMCT data and the correspondent volumes were estimated in situ. CTR_VOL was calculated as the ratio of the mediastinal to the thoracic volume. The volume measurements were repeated by the same rater for the evaluation of the intrarater reliability. Age, gender, body weight and height, heart weight at autopsy, and cause of death were retrieved from the autopsy reports. Presence of lung expansion was radiologically evaluated in situ. Results CTR_VOL was positively associated with age and BMI but not with gender and was higher for cardiomegaly compared to normal hearts, lower for asphyxiation-related deaths compared to cardiac deaths and intoxications, and lower for cases with lung expansion. The intrarater reliability was excellent for the calculated volumes of both lungs and mediastinum. Conclusion The results of the present study support CTR_VOL as a tool to assess the relationship between the heart and lungs in situ, which differs significantly between the studied cause of death categories.
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Lowman, Allison, Samuel Bobholz, Jennifer Marie Connelly, Elizabeth Cochran, Wade Mueller, Michael Brehler, Fitzgerald Kyereme, John Sherman, Savannah Duenweg, and Peter S. LaViolette. "Measurement of treatment dependent glioblastoma cell density in T1- weighted contrast enhancement at autopsy." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e14035-e14035. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e14035.
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e14035 Background: With an average overall survival of 12-18 months, glioblastoma has a particularly grim diagnosis. Standard treatment of glioblastoma, following detection on MRI, is surgical resection followed by radiation therapy and chemotherapy and is monitored through MR imaging. Glioblastoma has a unique heterogenous nature that complicates visualization of subtly enhancing tumor. This study used autopsy tissue samples taken from glioblastoma patients with varying treatment, to examine the effects of treatment on cell density within regions of contrast enhancement, using T1-weighted subtraction maps (T1S) from the last MR images to death. Methods: Eight patients diagnosed with glioblastoma at autopsy were recruited for this study. Two patients had no treatment and six received a combination of chemo-radiation and other treatments, including but not limited to bevacizumab (Bev) and TTFields therapy. At autopsy, whole brain samples were sliced axially aligned to the patient’s final MRI to death. Time between last MRI and death ranged from 4-27 days (mean 16 days). Overall survival (OS) ranged from 4-538 days (mean 307 days). Large tissue samples were taken from regions of suspected tumor or treatment effect, for a total of 18 tissue samples. Tissue samples were processed, H&E stained, and digitized at 40X resolution (Huron Slide Scanner). Cell density (cells/mm2) was calculated using digital histology. T1S were created for each patient by subtracting intensity normalized T1 weighted images from T1 post contrast images (T1C). Digital histology was aligned and resampled into MRI space using manual control point registration. Mixed effect models were used to compare differences in cell density across contrast enhancement (T1SE vs. NE) as well as across treatment groups (treatment vs. no treatment). Results: Cellularity was compared across regions of T1S enhancement (T1SE) and non-enhancement (NE) within manually selected regions of interest. Cell density compared between regions of T1SE and NE was not different (p=0.219). Total cell density was increased in patients who had received treatment compared to no treatment in both regions of T1SE and NE (p=0.014). Conclusions: Overall, cell density was increased in patients who had received treatment after diagnosis of glioblastoma. Additional research is needed to examine the extent of treatment’s effect on cellularity of glioblastoma. This work begins to characterize the use of T1S in evaluating glioblastoma tumor burden in patients with varying treatment histories.[Table: see text]
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Ortel, Thomas L., Katie Arnold, Michele Beckman, Audrey Brown, Nimia Reyes, Ibrahim Saber, Ryan Schulteis, Bhavana Pendurthi Singh, Andrea Sitlinger, and Elizabeth H. Thames. "Design and Implementation of a Comprehensive Surveillance System for Venous Thromboembolism in a Defined Region Using Electronic and Manual Approaches." Applied Clinical Informatics 10, no. 03 (May 2019): 552–62. http://dx.doi.org/10.1055/s-0039-1693711.
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Background Systematic surveillance for venous thromboembolism (VTE) in the United States has been recommended by several organizations. Despite adoption of electronic medical records (EMRs) by most health care providers and facilities, however, systematic surveillance for VTE is not available. Objectives This article develops a comprehensive, population-based surveillance strategy for VTE in a defined geographical region. Methods The primary surveillance strategy combined computerized searches of the EMR with a manual review of imaging data at the Duke University Health System in Durham County, North Carolina, United States. Different strategies of searching the EMR were explored. Consolidation of results with autopsy reports (nonsearchable in the EMR) and with results from the Durham Veterans' Administration Medical Center was performed to provide a comprehensive report of new VTE from the defined region over a 2-year timeframe. Results Monthly searches of the primary EMR missed a significant number of patients with new VTE who were identified by a separate manual search of radiology records, apparently related to delays in data entry and coding into the EMR. Comprehensive searches incorporating a location-restricted strategy were incomplete due to the assigned residence reflecting the current address and not the address at the time of event. The most comprehensive strategy omitted the geographic restriction step and identified all patients with VTE followed by manual review of individual records to remove incorrect entries (e.g., outside the surveillance time period or geographic location; no evidence for VTE). Consolidation of results from the EMR searches with results from autopsy reports and the separate facility identified additional patients not diagnosed within the Duke system. Conclusion We identified several challenges with implementing a comprehensive VTE surveillance program that could limit accuracy of the results. Improved electronic strategies are needed to cross-reference patients across multiple health systems and to minimize the need for manual review and confirmation of results.
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K., Valsala, C. S. Sreedevi, and Sreelekshmi J. "Analysis of railway track deaths-an autopsy based study." International Journal of Research in Medical Sciences 5, no. 3 (February 20, 2017): 935. http://dx.doi.org/10.18203/2320-6012.ijrms20170639.
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Background: Railway related deaths account for approximately one percentage of all fatalities submitted to medicolegal autopsies. The study is undertaken with the aim of better understanding of railway track deaths by analyzing the demographic details of victims and other contributing factors which favours the occurrence of railway track deaths.Methods: A cross sectional descriptive study of all railway track deaths brought for medicolegal autopsy at Thiruvananthapuram Medical College, Kerala, India from 1st March 2010 to 28th February 2011 was done. A total of 104 cases of railway track deaths were studied excluding cases with advanced decomposition. Clinical case records were studied in treated cases. details regarding nature dimensions and location of injury was entered in a proforma. The data were entered in MS Excel and statistical analysis was done.Results: Out of 104 cases studied 83 (79.8%) victims were male and 21 (20.2%) victims were female. The lowest and highest age of the victim involved in the study was 15 years and 90 years respectively. Elderly people with impairment of vision and hearing are most vulnerable to such accidents 12.5%. The highest frequency of incidence of railway deaths occurred while crossing the Railway track (32.7%), followed by jumping in front of the train (19.2%) and walking along the side or through track (16.3%). In 17.3% of the cases there was no exact history regarding the incident. The most common types of external injuries were lacerated wound and abrasion. In all the cases head showed lacerated wounds and the upper limbs showed abrasion.Conclusions: Present study concludes that majority of victims were males showing a female ratio 4:1, The peak incidence was noted in the 6th decade. Most of the victims were manual labourers. Travelling, moving and crossing near railway tracks in intoxicated condition is very usual practice. Survival period was found to be very less.
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Arif, Mariam. "LIGATURE MARK ON THE NECK." Professional Medical Journal 22, no. 06 (June 10, 2015): 798–803. http://dx.doi.org/10.29309/tpmj/2015.22.06.1252.
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Introduction: There are three types of compression of neck which are of primeforensic importance – (1) Manual strangulation (2) Hanging (3) Ligature strangulation. Ligaturemark is found in the latter two types.1 Ligature mark is a pressure mark on the neck underneaththe ligature. Initially it appears as a pale groove which on drying becomes yellowish brownparchment like.2,5 Objective: The aim is to study the information provided by a ligature markin ligature asphyxial deaths. Methodology: Study Design: A retrospective study on ligatureasphyxial deaths. Setting: Forensic Medicine and Toxicology Departments of King EdwardMedical University, Lahore and Nishtar Medical College, Multan. Period: January, 2012 toDecember, 2013. Results: The incidence of violent ligature asphyxial deaths was 4.21% of thetotal medicolegal deaths autopsied. Age group 21 to 30 years accounted for the maximumcases (37.6%). Male: female ratio was 1.02. Nylon rope (44.7%) was the most common ligaturematerial used. Ligature mark was single in all cases and was situated above thyroid cartilage in82.92% cases of hanging. In ligature strangulation deaths, mark was one in number in 93.18%cases and was below thyroid cartilage in 97.72% cases. The manner of death in hangingwas mostly suicidal (90.24%) as compared to homicidal in all cases of ligature strangulation.Ligature mark was incompletely encircling the neck in 85.36% cases and obliquely present in100% cases of hanging. In all deaths due to ligature strangulation, it was completely encirclingand transversely present around the neck. Underlying soft tissues of neck were glisteningwhite in all hanging deaths while it showed extravasations of blood in all ligature strangulationcases. Conclusions: A meticulous examination of the ligature mark during autopsy, though notconclusive, can give valuable information that can be very helpful in diagnosing deaths due tohanging and ligature strangulation.
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Litman, Kerry C., Helen Lau, Michael H. Kanter, and Jason P. Jones. "E-Autopsy: Using Structured Hybrid Manual/Electronic Mortality Reviews to Identify Quality Improvement Opportunities." Joint Commission Journal on Quality and Patient Safety 40, no. 10 (October 2014): 444—AP4. http://dx.doi.org/10.1016/s1553-7250(14)40057-6.
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Islam, MM, and AM Khan. "Gender Disparity in Autopsy Findings: How Much is It?" Faridpur Medical College Journal 7, no. 1 (April 8, 2012): 23–25. http://dx.doi.org/10.3329/fmcj.v7i1.10293.
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Bangladesh is densely populated country where male and female ratio is closer to each other. This descriptive study investigates the gender disparity of postmortem examination findings among 7 districts in the Rajshahi division of Bangladesh. Postmortem (PM) examination stations were located in Rajshahi, Rangpur, Bogra and Dinajpur Medical Colleges & Pabna, Natore and Chapai Nawabganj Sadar Hospitals. The findings of the autopsy reports (Total 3164) over the two years (2004 & 2005) were collected retrospectively from the register book of the authority. In this study we wanted to find out gender disparity - if exists in PM examination findings and, to what extent. Manually verified data were analyzed employing SPSS/WIN V-11.5. An obvious gender disparity existed in overall occurrence of unnatural deaths, male predominate female victims (M: F ratio = 1.51:1). A significant association existed in death circumstances & gender (p<0.0001); male (634) outnumbered female (250) in homicidal deaths, in suicidal deaths female (612) outnumbered male (364) and in accidental deaths male (583) outnumbered female (135). This classical gender difference in death circumstances remains similar to our national context. Findings of this study revealed an obvious gender difference in the overall numbers of cadaveric PM examination. Males were more victimized than females in majority of medico-legal aspects analyzed, except in suicidal cases.DOI: http://dx.doi.org/10.3329/fmcj.v7i1.10293Faridpur Med. Coll. J. 2012;7(1): 23-25
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Xin-zhe, Xie. "Reading the Corpse in Forensic Casebooks of Nineteenth Century China." East Asian Science, Technology, and Medicine 45, no. 1 (June 25, 2017): 49–89. http://dx.doi.org/10.1163/26669323-04501004.
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This article examines two forensic casebooks from nineteenth century China. Forensic cases are among the favored sources for progressive narratives sketching out the development of forensic knowledge as a process through which anomalies are detected and explained, and new facts are ultimately incorporated into the existing corpus of knowledge. This article is aimed at providing an alternative view. It first argues that cases revealing a serious discrepancy vis-à-vis the official manual for autopsies are extremely few. It later demonstrates that, instead of accumulating facts challenging the authoritative manual, forensic case compilers primarily addressed the question of weighing evidence. They singled out cases which shed light on how to make a decision in the face of several competing, but already-known symptoms. Each case displays how the weighing process worked out depending on its particular and unrepeatable circumstantial configuration, with no intent to convey generalizable information. Collecting precedents is thus not intended to form new claims as opposed to the canonical manual, but to make it more applicable to a complex reality. Forensic case compilers, therefore, did not evaluate the official manual in terms of correctness or inaccuracy, exhaustiveness or deficiency. What really mattered was flexibility in using the book depending on the actual circumstances.
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Bronisch, Thomas. "The Typology of Personality Disorders — Diagnostic Problems and Their Relevance for Suicidal Behavior." Crisis 17, no. 2 (March 1996): 55–58. http://dx.doi.org/10.1027/0227-5910.17.2.55.
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Personality disorders (PD) play an important role in clinical psychiatry. The typologies of personality disorders (PDs) found in different classification systems, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD), are quite congruent. There are many methodological problems with reliability and validity of the diagnosis of PD. However, having a typology seems to be very helpful. Recent psychological autopsy studies reported that about one third of suicide victims met the criteria for a PD. Antisocial PD, borderline PD, narcissistic PD, and depressive PD in particular were often clinically associated with suicidal behavior.
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Durrani, Muhammad I. A., Tabbasum Naz, Muhammad Atif, Numra Khalid, and Alessia Amelio. "A Semantic-Based Framework for Verbal Autopsy to Identify the Cause of Maternal Death." Applied Clinical Informatics 12, no. 04 (August 2021): 910–23. http://dx.doi.org/10.1055/s-0041-1735180.
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Abstract Objective Verbal autopsy is a technique used to collect information about a decedent from his/her family members using questionnaires, conducting interviews, making observations, and sampling. In substantial parts of the world, particularly in Africa and Asia, many deaths are unrecorded. In 2017, globally pregnant women were dying daily around 810 and 295,000 in a year because of pregnancy-related problems, pointed out by World Health Organization. Identifying the cause of a death is a complex process which requires in-depth medical knowledge and practical experience. Generally, medical practitioners possess different knowledge levels, set of abilities, and problem-solving skills. Additionally, the medical negligence plays a significant part in further worsening the situation. Accurate identification of the cause of death can help a government to take strategic measures to focus on, particularly increasing the death rate in a specific region. Methods This research provides a solution by introducing a semantic-based verbal autopsy framework for maternal death (SVAF-MD) to identify the cause of death. The proposed framework consists of four main components as follows: (1) clinical practice guidelines, (2) knowledge collection, (3) knowledge modeling, and (4) knowledge codification. Maternal ontology for the framework is developed using Protégé knowledge editor. Resource description framework application programming interface (API) for PHP (RAP) is used as a Semantic Web toolkit along with Simple Protocol and RDF Query Language (SPARQL) is used for querying with ontology to retrieve data. Results The results show that 92% of maternal causes of deaths assigned using SVAF-MD correctly matched manual reports already prepared by gynecologists. Conclusion SVAF-MD, a semantic-based framework for the verbal autopsy of maternal deaths, assigns the cause of death with minimum involvement of medical practitioners. This research helps the government to ease down the verbal autopsy process, overcome the delays in reporting, and facilitate in terms of accurate results to devise the policies to reduce the maternal mortality.
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van der Vos, Wessel, Koen Stein, Nicolas Di-Poï, and Constanze Bickelmann. "Ontogeny of Hemidactylus (Gekkota, Squamata) with emphasis on the limbs." Zoosystematics and Evolution 94, no. 1 (March 9, 2018): 195–209. http://dx.doi.org/10.3897/zse.41.22289.
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Squamate reptiles constitute a major component of the world’s terrestrial vertebrate diversity, encompassing many morphotypes related to ecological specialization. Specifically, Gekkota, the sister clade to most other squamates, have highly specialized autopodia, which have been linked to their ecological plasticity. In this study, a developmental staging table of the gecko Hemidactylus, housed at the Museum für Naturkunde, is established. Twelve post-ovipositional stages are erected, monitoring morphological embryological transitions in eye, ear, nose, heart, limbs, pharyngeal arches, and skin structures. Ecomorphological specializations in the limbs include multiple paraphalanges, hypothesized to aid in supporting the strong muscles, that are situated adjacent to metacarpal and phalangeal heads. Furthermore, some phalanges are highly reduced in manual digits III and IV and pedal digits III, IV, and V. Development, composition, and growth of limb elements is characterized in detail via µCT, histochemistry, and bone histological analysis. Using known life history data from two individuals, we found an average lamellar bone accretion rate in the humeral diaphysis comparable to that of varanids. Various adult individuals also showed moderate to extensive remodeling features in their long bone cortices, indicating that these animals experience a highly dynamic bone homeostasis during their growth, similar to some other medium-sized to large squamates. This study of in-ovo development of the gecko Hemidactylus and its ecomorphological specializations in the adult autopodia, enlarges our knowledge of morphological trait evolution and of limb diversity within the vertebrate phylum.
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van der Vos, Wessel, Koen Stein, Nicolas Di-Poï, and Constanze Bickelmann. "Ontogeny of Hemidactylus (Gekkota, Squamata) with emphasis on the limbs." Zoosystematics and Evolution 94, no. 1 (March 9, 2018): 195–209. http://dx.doi.org/10.3897/zse.94.22289.
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Squamate reptiles constitute a major component of the world’s terrestrial vertebrate diversity, encompassing many morphotypes related to ecological specialization. Specifically, Gekkota, the sister clade to most other squamates, have highly specialized autopodia, which have been linked to their ecological plasticity. In this study, a developmental staging table of the geckoHemidactylus, housed at the Museum für Naturkunde, is established. Twelve post-ovipositional stages are erected, monitoring morphological embryological transitions in eye, ear, nose, heart, limbs, pharyngeal arches, and skin structures. Ecomorphological specializations in the limbs include multiple paraphalanges, hypothesized to aid in supporting the strong muscles, that are situated adjacent to metacarpal and phalangeal heads. Furthermore, some phalanges are highly reduced in manual digits III and IV and pedal digits III, IV, and V. Development, composition, and growth of limb elements is characterized in detail via µCT, histochemistry, and bone histological analysis. Using known life history data from two individuals, we found an average lamellar bone accretion rate in the humeral diaphysis comparable to that of varanids. Various adult individuals also showed moderate to extensive remodeling features in their long bone cortices, indicating that these animals experience a highly dynamic bone homeostasis during their growth, similar to some other medium-sized to large squamates. This study of in-ovo development of the geckoHemidactylus and its ecomorphological specializations in the adult autopodia, enlarges our knowledge of morphological trait evolution and of limb diversity within the vertebrate phylum.
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Pacha, N. Ali. "Algeria, from social issue to self-immolation; autopsy of a “fashionable” suicide." European Psychiatry 41, S1 (April 2017): s884. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1788.
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IntroductionSelf-immolation has been practised for several centuries in some cultures. Tolerated by Mahayana Buddhism and Hinduism. It is practised for many reasons: Sati (rituals), political protests, devotion and renouncement. In addition, it is also observed in some warrior cultures, like Rajputs.The self-immolation trend began in Tunisia during government protests (“Arab spring” revolution) when a man named Bouazizi set himself on fire and died. Fiery copycat suicides spread throughout other countries. Algeria has also discovered this form of protest and faced a wave of self-immolation considered by some commentators to have reached epidemic proportions.ObjectiveOur goal is to show the kind of support that political and health authorities, with the help of psychiatrists, are trying to set up in order to achieve efficient prevention.MethodsIn a case-control study, 20 consecutive case of deliberate self-inflicted burns admitted to the regional burn centre (Douera Hospital, Algeria) were compared with 20 controls who were selected from the community and matched by sex, age and living area. Diagnostic and statistical manual of mental disorders (DSM IV) Axis I (clinical disorders) and Axis II (personality and mental retardation) diagnoses were assessed via detailed clinical interview.ResultsThere have been 69 cases of self-immolation, with an average age of 26 including 87% of men and from which 13% with a psychiatric history. Unemployment and housing crisis are the most common causes. Here, we will provide specific explanations about our country.ConclusionIt turns out that self-immolation is an extreme form of protest against the social malaise to make things change and does not due in the most cases to mental disease.Disclosure of interestThe author has not supplied his/her declaration of competing interest.
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López, Alfonso, and Shawn McKenna. "Bovine pancreatolithiasis: case report and review of the literature." Journal of Veterinary Diagnostic Investigation 30, no. 5 (June 7, 2018): 760–62. http://dx.doi.org/10.1177/1040638718780190.
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An 8-y-old lactating Holstein cow was presented to the herd veterinarian with a history of acute ataxia, and because of poor prognosis, the animal was euthanized and submitted for postmortem examination. A lumbar vertebra was incompletely fractured and had an adjacent subdural hematoma. The pancreas had a hard texture with exaggerated nodular appearance, and on cut surface, the pancreatic ducts appeared fibrotic and contained scores of round-to-faceted pancreatoliths of 0.5–2.0 mm diameter. These calculi extended from the major ducts to the pancreatic duct, sphincter, and into the duodenal lumen. Microscopically, the pancreas had severe acinar atrophy and dissecting glandular fibrosis. The major pancreatic ducts were ulcerated with fibrosis and inflammation. In humans, chronic pancreatitis has been linked to osteoporosis and increased risk of bone fractures. Manual evaluation of ribs at the time of autopsy did not reveal abnormalities in bone pliability or fragility in our cow.
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Ananev, I. S. "TIME LIMITS FOR VETERINARY WORK IN FISH FARMING." Scientific Notes Kazan Bauman State Academy of Veterinary Medicine 247, no. 3 (September 5, 2021): 16–20. http://dx.doi.org/10.31588/2413-4201-1883-247-3-16-20.
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Building a modern system of veterinary services for fish farms is impossible without evaluat-ing the personnel, rationing the work of veterinary specialists, and scientifically-based planning of their staffing levels. We have developed 45 time standards for veterinary work carried out in the conditions of fish farms, including determining the average weight of undergrown juveniles in the control batch, catching yearlings and two-year-olds from a half-lowered pond with manual loading on transport, conducting diagnostic autopsy of fish, applying bleach in the form of a solution to the pond from the shore, sanitary and preventive treatment with ammonia solution of yearlings and yearlings in antiparasitic baths, etc. They are recommended for use in the calculation of scientifical-ly-based prices when servicing fish farming enterprises by third-party public or private veterinary institutions, as well as when planning the number of veterinary staff on the farms themselves.
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Bobholz, Samuel, Allison Lowman, Jennifer Connelly, Elizabeth Cochran, Wade Mueller, Sean McGarry, Michael Brehler, Cassandra Gliszinski, Anna Wilczynski, and Peter LaViolette. "NIMG-23. COMPARISON OF A RADIO-PATHOMIC MODEL VERSUS A RADIOLOGY-ONLY TUMOR SEGMENTATION MODEL FOR THE DETECTION OF INFILTRATIVE TUMOR IN GLIOMA PATIENTS." Neuro-Oncology 22, Supplement_2 (November 2020): ii152. http://dx.doi.org/10.1093/neuonc/noaa215.636.
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Abstract This study used large format autopsy tissue samples to compare radio-pathomic maps of brain cancer to a current tumor segmentation algorithm. We hypothesized that an MRI-based machine learning model trained with actual histology rather than radiologist annotations cellularity would 1) improve delineation between tumor and treatment effect, and 2) detect abnormal pathology beyond the contrast-enhancing tumor region. Seventeen patients with pathologically confirmed glioma were included in this study. At autopsy, 43 tissue samples were collected from 17 subjects from whole brain slices sectioned to align with the last axial MRI prior to death. Cellularity was calculated using a color deconvolution on 40X digitized H&E stained slides from the tissue samples. In-house custom software was used to align tissue samples and cellularity information to the FLAIR image using manually defined control points. The DeepMedic algorithm was trained to segment tumors using the BraTs 2017 dataset, and then applied to our patients in order to create automated tumor probability maps. An MRI-based ensemble algorithm using a 5x5 voxel searchlight (input: T1, T1C, FLAIR, ADC) was used to predict cellularity at each voxel, using tissue samples from 14 subjects as ground truth. Both models were applied to 3 withheld test subjects in order to compare tumor probability and cellularity predictions to the pathological ground truth. The mutual information between tumor probability and actual cellularity was 1X10-15, relatively low compared to the rad-path predicted cellularity (=0.16), despite the tumor prediction model accurately highlighting regions of contrast enhancement. Additionally, the radio-pathomic ensemble model correctly identify regions of hypercellularity beyond the tumor segmentation model as well as regions of within the segmented tumor area. This study demonstrates the utility of training machine learning models with pathological ground truth rather than radiologist annotations for predicting localized tumor information, particularly in the post-treatment stage.
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Ahmad, Mushtaq, Farial Naima Rahman, Md Anwar Hussain, Md Habibuzzaman Chowdhury, and BH Nazma Yasmeen. "A Medico Legal Study of Hanging Cases at Dhaka Medical College." Northern International Medical College Journal 7, no. 1 (November 16, 2015): 110–14. http://dx.doi.org/10.3329/nimcj.v7i1.25705.
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This retrospective study was conducted among 574 Autopsy cases of hanging victims at the Dhaka Medical College Morgue during the period January 2008-December 2009. Objective : The objective of this study was to find out the physical charecteristics, cause, place as well as the injuries specially in neck structures, variation of ligature materials, ligature marks, position of knot in the study subjects.Methods : A total of 5114 autopsies were performed during the study period, out of which 574(11.22%) were hanging cases. Ligature strangulation and manual strangulation cases were excluded from this study. Various Data of this hanging victims regarding places of incidence, time, suspected causes of death (related information were gathered from the victims attendants), type of suspension were noted from the inquest report accompanying the dead bodies. Points regarding ligature material, position of knot, pattern of ligature marks, injury to neck structures,fracture of hyoid bone and thyroid cartilages were collected from the 3rd copy of post mortem reports preserved in the Forensic Medicine & Toxicology Department of DMC. Finally data were analyzed and presented in table,graph and in pie chart.Results : Out of 574 hanging cases female were predominant (72.29%). Among them 304( 52.96%) were married. Marital disharmony/quarrel between couples was the main cause 172(29.96%) of hanging. Most of the victims 269(46.86%) were in the age group 21-30 years.Dopatta (orna) was the commonest 237(41.28%) ligature material. Considering the knot, most were situated at right side of neck 281 ( 48.95%).In this study single ligature mark has been found in 511(89.02%) cases and was non continuous in 478(83.27%) study subjects. In 520(90.59%) cases ligature was found above thyroid cartilage level. The mark was oblique in 509(88.68%) cases and impression corresponding to ligature material found in 126(21.95%) cases. Considering injury to neck structures most of them 448(78.04%) had stretching and elongation of neck, haemorrhage in underlying layers of neck skin in 372(64.81%). Injury to the other structures of neck were variable. Most of the victims 401(69.86%) hanged themselves at night. 545 body (94.95%) were recovered from inside the living room. Most victims had complete suspension 472 (82.23%).Conclusion : This retrospectivemedico legal study find out various data of hanging victims of one of the largest heath care center, Dhaka Medical College, which cover a large area of population. Though multi center prospective study should be carried out to find out our real situation.Northern International Medical College Journal Vol.7(1) Jul 2015: 110-114
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Xanthos, Theodoros, Ioannis Pantazopoulos, Hara Roumelioti, Pavlos Lelovas, Nicoletta Iacovidou, Ismene Dontas, Theano Demestiha, and Hara Spiliopoulou. "A comparison of autopsy detected injuries in a porcine model of cardiac arrest treated with either manual or mechanical chest compressions." European Journal of Emergency Medicine 18, no. 2 (April 2011): 108–10. http://dx.doi.org/10.1097/mej.0b013e32833e79cf.
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Fleischer, Heidi, Christoph Lutter, Andreas Büttner, Wolfram Mittelmeier, and Kerstin Thurow. "Semi-Automated Determination of Heavy Metals in Autopsy Tissue Using Robot-Assisted Sample Preparation and ICP-MS." Molecules 26, no. 13 (June 23, 2021): 3820. http://dx.doi.org/10.3390/molecules26133820.
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The endoprosthetic care of hip and knee joints introduces multiple materials into the human body. Metal containing implant surfaces release degradation products such as particulate wear and corrosion debris, metal-protein complexes, free metallic ions, inorganic metal salts or oxides. Depending on the material composition of the prostheses, a systemic exposure occurs and may result in increasing metal concentrations in body fluids and tissues especially in the case of malfunctions of the arthroplasty components. High concentrations of Cr, Co, Ni, Ti and Al affect multiple organs such as thyroid, heart, lung and cranial nerves and may lead to metallosis, intoxications, poly-neuropathy, retinopathy, cardiomyopathy and the formation of localized pseudo tumors. The determination of the concentration of metals in body fluids and tissues can be used for predicting failure of hip or knee replacements to prevent subsequent severe intoxications. A semi-automated robot-assisted measurement system is presented for the determination of heavy metals in human tissue samples using inductively coupled plasma mass spectrometry (ICP-MS). The manual and automated measurement processes were similarly validated using certified reference material and the results are compared and discussed. The automation system was successfully applied in the determination of heavy metals in human tissue; the first results are presented.
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Ferreira, Sara, Mário Antunes, and Manuel E. Correia. "Exposing Manipulated Photos and Videos in Digital Forensics Analysis." Journal of Imaging 7, no. 7 (June 24, 2021): 102. http://dx.doi.org/10.3390/jimaging7070102.
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Tampered multimedia content is being increasingly used in a broad range of cybercrime activities. The spread of fake news, misinformation, digital kidnapping, and ransomware-related crimes are amongst the most recurrent crimes in which manipulated digital photos and videos are the perpetrating and disseminating medium. Criminal investigation has been challenged in applying machine learning techniques to automatically distinguish between fake and genuine seized photos and videos. Despite the pertinent need for manual validation, easy-to-use platforms for digital forensics are essential to automate and facilitate the detection of tampered content and to help criminal investigators with their work. This paper presents a machine learning Support Vector Machines (SVM) based method to distinguish between genuine and fake multimedia files, namely digital photos and videos, which may indicate the presence of deepfake content. The method was implemented in Python and integrated as new modules in the widely used digital forensics application Autopsy. The implemented approach extracts a set of simple features resulting from the application of a Discrete Fourier Transform (DFT) to digital photos and video frames. The model was evaluated with a large dataset of classified multimedia files containing both legitimate and fake photos and frames extracted from videos. Regarding deepfake detection in videos, the Celeb-DFv1 dataset was used, featuring 590 original videos collected from YouTube, and covering different subjects. The results obtained with the 5-fold cross-validation outperformed those SVM-based methods documented in the literature, by achieving an average F1-score of 99.53%, 79.55%, and 89.10%, respectively for photos, videos, and a mixture of both types of content. A benchmark with state-of-the-art methods was also done, by comparing the proposed SVM method with deep learning approaches, namely Convolutional Neural Networks (CNN). Despite CNN having outperformed the proposed DFT-SVM compound method, the competitiveness of the results attained by DFT-SVM and the substantially reduced processing time make it appropriate to be implemented and embedded into Autopsy modules, by predicting the level of fakeness calculated for each analyzed multimedia file.
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Inyang Etoh, Emmanuel C., Iniobong E. Ettete, Christian A. Adeneye, Imaobong O. Inwang, and Augustine V. Umoh. "Innovative use of tourniquet in the management of an advanced abdominal pregnancy to achieve an unusually normal postoperative outcome: a case report." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 3 (February 27, 2020): 1292. http://dx.doi.org/10.18203/2320-1770.ijrcog20200919.
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Mrs. UVG was an un-booked G3P1+1 petty trader, who presented with an obstetric ultrasound scan report, with an incidental diagnosis of abdominal pregnancy at 32 weeks of gestation with the placenta attached to the fundus of the uterus. Her admission packed cell volume was 24%. She had pre-operative preparation and 2 units of compatible blood were transfused to correct the anemia. Four additional units of compatible blood were made available before she was scheduled for an exploratory laparotomy at 33 weeks of gestation. A grossly normal male infant weighing 2.2 kg was delivered from the peritoneal cavity with Apgar scores of 2 at 1 minute and the same at 5 minutes. The placenta which was attached to the fundus of the uterus was removed manually completely after a tourniquet had been applied distal to the point of separation. Intra-operative blood loss was 1000 ml. The infant died 1 hour after delivery due to respiratory failure. Autopsy report revealed massive intracerebral hemorrhage and pulmonary hypoplasia. The post-operative period was uneventful and the decline in serum assay of β-human chorionic gonadotrophin postpartum was normal. She was discharged home on the 8th post-operative day and seen at the postnatal clinic twice at weekly intervals with normal serum assay of β-human chorionic gonadotrophin. Her 6 weeks postnatal visit was also uneventful.
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Cohen, Alexander T., Gabriel J. Weston, Andrew J. Tasker, Greg A. Fellows, and Rosalind Wilmott. "Fatal Pulmonary Embolism and Cancer - a Post Mortem Study." Blood 104, no. 11 (November 16, 2004): 2593. http://dx.doi.org/10.1182/blood.v104.11.2593.2593.
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Abstract Introduction: During the period of 1965–1990 and 1991–2000, two separate analyses were carried out at King’s College Hospital, London, taking a retrospective review of all autopsy reports during this time. The initial aims of these reviews were to determine the number of deaths from autopsy-confirmed fatal pulmonary embolism (FPE) in hospitalised patients, and the clinical characteristics of these patients. Methodology: Cases for inclusion were identified and data derived from manually examining copies of post-mortem reports. The data form recorded the patient gender, age, race, height, weight and surgical status. In addition, evidence of DVT, myocardial infarction (MI), stroke, chronic obstructive pulmonary disease (COPD), cardiac failure, infection or cancer was recorded from the autopsy report. Cases of fatal PE were classified as occurring in either surgical (if death occurred within 8 weeks of surgery), or non-surgical patients. The outcome of fatal pulmonary embolism was recorded as the cause of death only when the post-mortem stated that embolism was the main or contributing cause of death and identified emboli present either in the main pulmonary trunk or in the proximal right or left pulmonary arteries formed from the bifurcation of the main trunk. Emboli found in the distal pulmonary arteries after further division of the right and left pulmonary arteries were not included. Emboli derived from bone marrow, fat, tumour, or amniotic fluid were also excluded from the analysis. Ethical approval for the study was obtained from the local research ethics committee. The identity of deceased patients was protected by the use of code numbers on the data forms. Results: Over the 35 year period there were 45,575 hospital deaths and 16,862 (37%) post-mortems. FPE was recorded as cause of death in 1,040 (6.2%) adult patients. Of these 85% (n=885) were in non-surgical patients, and 15% (n=155) in post-operative patients. Of the fatal pulmonary emboli, 347 of 1040 (33%) had either cancer (active malignancy) or a past history of cancer. Of this cancer group, 93% (n= 323) had an active malignancy, with 7% (n= 24) giving a past history of cancer. Cancer sites were gastro-intestinal in 34% (n= 119), lung 24% (n= 82), urological 10% (n= 33), gynaecological 8% (n= 29) and breast 8% (n= 28), 5% haematological (n= 17) endocrine 5% (n= 16), and dermatological 1% (n= 3). The majority of active cancers were found within the peritoneal cavity (60%, n= 194). Infection was the additional risk factor that was most prevalent in all those with FPE occurring in 32% (n=334), 76.3% (n=808) had one or more additional risk factors. Conclusions: Most fatal pulmonary emboli occur in non-surgical patients, cancer is a very common association (33%). Active cancer is seen in 93% of all FPE deaths associated with cancer. Intra-peritoneal cavity tumours are the commonest type to be associated with FPE. Infection is a common associated risk factor.
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Ondruschka, Benjamin, Christina Baier, Ronny Bayer, Niels Hammer, Jan Dreßler, and Michael Bernhard. "Chest compression-associated injuries in cardiac arrest patients treated with manual chest compressions versus automated chest compression devices (LUCAS II) – a forensic autopsy-based comparison." Forensic Science, Medicine and Pathology 14, no. 4 (September 10, 2018): 515–25. http://dx.doi.org/10.1007/s12024-018-0024-5.
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Gascho, Dominic, Jakob Heimer, Carlo Tappero, and Sarah Schaerli. "Relevant findings on postmortem CT and postmortem MRI in hanging, ligature strangulation and manual strangulation and their additional value compared to autopsy – a systematic review." Forensic Science, Medicine and Pathology 15, no. 1 (January 9, 2019): 84–92. http://dx.doi.org/10.1007/s12024-018-0070-z.
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Singh, Hardeep, Saurabh Sethi, Martin Raber, and Laura A. Petersen. "Errors in Cancer Diagnosis: Current Understanding and Future Directions." Journal of Clinical Oncology 25, no. 31 (November 1, 2007): 5009–18. http://dx.doi.org/10.1200/jco.2007.13.2142.
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Purpose Errors in cancer diagnosis are likely the most harmful and expensive types of diagnostic errors. We reviewed the literature to understand the prevalence, origins, and prevention of errors in cancer diagnosis, focusing on common cancers for which early diagnosis offers clear benefit (melanoma and cancers of the breast, colon, and lung). Methods We searched the Cochrane Library and PubMed from 1966 until April 2007 for publications that met our review criteria and manually searched references of key publications. Our search yielded 110 studies, of which nine were prospective studies and the remaining were retrospective studies. Results Errors in cancer diagnosis were not uncommon in autopsy studies and were associated with significant harm and expense in malpractice claims. Literature on prevalence was scant. For each type of cancer, we classified preventable errors according to their origins in patient-physician encounters in the clinic setting, diagnostic test or procedure performance, pathologic confirmation of diagnosis, follow-up of patient or test result, or patient-related delays. Conclusion The literature reflects advanced knowledge of contributory factors and prevention for diagnostic errors related to the performance of procedures and imaging tests and emerging understanding of pathology errors. However, prospective studies are few, as are studies of diagnostic errors arising from the clinical encounter and patient follow-up. Future research should examine further the system and cognitive problems that lead to the many contributory factors we identified, and address interdisciplinary interventions to prevent errors in cancer diagnosis.
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Smekal, David, Jakob Johansson, Tibor Huzevka, and Sten Rubertsson. "No difference in autopsy detected injuries in cardiac arrest patients treated with manual chest compressions compared with mechanical compressions with the LUCAS™ device—A pilot study." Resuscitation 80, no. 10 (October 2009): 1104–7. http://dx.doi.org/10.1016/j.resuscitation.2009.06.010.
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Gomes, Everli P. S. Gonçalves, Carlos Eduardo Rochitte, Clerio F. Azevedo, Pedro A. Lemos, Paulo Sampaio Gutierrez, and Luiz Antonio M. César. "Ex-vivo Assessment of Coronary Artery Atherosclerosis by Magnetic Resonance Imaging: Correlation with Histopathology." Open Cardiovascular Medicine Journal 8, no. 1 (April 4, 2014): 26–34. http://dx.doi.org/10.2174/1874192401408010026.
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Introduction:In recent years, high-resolution magnetic resonance imaging (MRI) has emerged as a very promising technique for studying atherosclerotic disease in humans.Aim:In the present study we sought to determine whether MRI allowed for the morphological characterization of the coronary vessel wall and atherosclerotic plaques using histopathological assessment as the reference standard.Methods:The study population consisted of 13 patients who died of acute myocardial infarction and underwent autopsy. The proximal portions of the coronary arteries were excised and were evaluated both by MRI and by histopathology. For each arterial segment, the following parameters were calculated through manual planimetry: 1. total vessel area (TVA); 2. luminal area (LA) and 3. plaque area (PA).Results:A total of 207 coronary artery cross-sections were found to be suitable for analysis by both MRI and histopathology and were included in the final analyses. Both methods demonstrated moderate to good agreement for the quantification of TVA (mean difference = 2.4±2.4 mm2, 95‰ limits of agreement from -2.4 to +7.2 mm2; CCC = 0.69, 95‰ CI from 0.63 to 0.75), LA (mean difference = 0.0±1.7 mm2, 95‰ limits of agreement from -3.3 to + 3.3 mm2; CCC = 0.84, 95‰ CI from 0.80 to 0.88) and PA (mean difference = 2.4±2.4 mm2, 95‰ limits of agreement from -2.3 to + 7.1 mm2; CCC = 0.64, 95‰ CI from 0.58 to 0.71).Conclusion:In thisex vivoexperimental model we demonstrated good agreement between coronary artery morphometrical measurements obtained by high-resolution MRI and by histopathology.
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Wang, W. John, Y. Albert Yeh, Paul Stout, and Kang Fan. "Inverse Relationship Between Leydig Cell Density and Metastatic Potential of Prostatic Adenocarcinoma." Analytical Cellular Pathology 19, no. 3-4 (1999): 169–73. http://dx.doi.org/10.1155/1999/417640.
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Purpose: Evaluate the relationship between metastatic potential of prostatic adenocarcinoma (PC) and testicular Leydig cell density.Materials and methods: Tissue samples from 111 men, age 52–85, with PC and bilateral orchiectomy were evaluated for Leydig cell density. The patients were divided into two groups: Group A were patients with metastasis (n=36) and Group B were patients without metastasis (n=75). Leydig cell density was determined by direct manual microscopic cell count on the tissue sections. The means of cell counts by four pathologists, expressed as cell/0.78 mm2were used for analysis. The normally distributed data were analyzed by two‐tail Student’s t‐test. Thirty‐eight age‐compatible autopsy cases who died of unrelated causes served as normal controls.Results: The mean of Leydig cell count in group A patients was 14.43 (14.43 ± 1.19 SE). Mean of Group B was 47.05 (47.05 ± 4.05 SE) whereas normal controls displayed a mean of 48.66 (48.66 ± 2.94 SE). Group A was significantly different from control (p<0.00001). Group A and Group B were also significant different (p<0.001) whereas control was not significantly different from Group B (p>0.75).Conclusions: Patients with metastatic adenocarcinoma of prostate, as a group, have a significantly lower Leydig cell density than patients without metastasis or patients without PC in compatible age groups. The hormonal relationship between this observation is however unknown. One possible explanation is that PC subpopulation with metastatic potential may require different level of endogenous androgen or are androgen‐independent.
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Wagner, Wolfgang, and Manfred Georg Krukemeyer. "Treatment of liver cancer by nanomedicine." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e13091-e13091. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e13091.
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e13091 Background: Oncological surgery as a therapy branch of general surgery is registering a rapid development in the form of neoadjuvant treatment. Therapies of liver tumors display diverse treatment alternatives. Methods: The administration of cytostatics coupled with and without iron oxides (Fe3O4) has been presented in an experimental series with 36 animals with prior implantation of an R1H rhabdomyosarcoma in the liver, since iron undergoes selective phagocytosis in the liver. In Group I, mitoxantrone is injected into the lateral tail vein of the animals (n = 12) in a dosage of 1 mg/kg of body weight. Group III (n = 12 animals) received mitoxantrone coupled with iron oxide (Fe3O4), and Group II (n = 12 animals) received NaCl, in the same dosage for all groups. In the sonography and in the measurement of the volume, a significantly smaller tumor growth is found in Group II compared with Group I and III. The volume was measured manually postmortally in mm3(length x breadth x height). Results: The tumor volume showed the lowest growth in Group II, which was treated with mitoxantrone-coupled iron oxides. 3 animals from Group II died. The autopsy revealed no indication of the cause of death. There were neither thromboses nor allergic reactions in any of the animals. It can be clearly seen that Group I has a smaller mean volume and less scatter than Group II. The mean of Group I is also below that of Group II. Conclusions: It has been possible to demonstrate in animal studies that mitoxantrone-coupled iron oxide (Fe3O4) reduces the tumor volume in the liver to a greater extent that administration solely of mitoxantrone. The studies should be verified in a clinical study on humans.
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Torphy, Robert J., Zhen Wang, Aisha True-Yasaki, Keith E. Volmar, Naim Rashid, Benjamin Yeh, Julia S. Johansen, Michael A. Hollingsworth, Jen Jen Yeh, and Eric A. Collisson. "Stromal Content Is Correlated With Tissue Site, Contrast Retention, and Survival in Pancreatic Adenocarcinoma." JCO Precision Oncology, no. 2 (November 2018): 1–12. http://dx.doi.org/10.1200/po.17.00121.
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Purpose Desmoplastic stroma is a cardinal feature of primary pancreatic ductal adenocarcinoma (PDA), but its effects on the biology, prognosis, and therapeutic outcomes in the disease are not known. We developed an automated method to assess tumor stroma density (TSD) and investigated computed tomography (CT) correlates of stroma in PDA. Patients and Methods We collected PDA samples from rapid autopsy and resection series and digitally annotated samples to quantify TSD. A series of patients who had undergone resection also underwent preoperative multiphasic CT imaging. Results Automated and manual assessments of TSD were highly correlated (ρ = 0.65; P < .001). Solid organ metastases had a lower median TSD than primary tumors ( P < .001). Patients whose tumors had high TSD had prolonged recurrence-free survival (hazard ratio [HR] = 0.51; P = .003) and overall survival (HR = 0.57; P = .008). In another independent dataset, patients whose tumors had high TSD had decreased risk for recurrence (HR = 0.03; P = .003) and death (HR = 0.03; P = .003) at time of resection; however, the protective effect of high TSD diminished over time. Patients with a normalized portovenous phase CT tumor enhancement ratio ≥ 0.40 had a longer time to recurrence after resection ( P = .020). Normalized portovenous phase CT tumor enhancement ratio was significantly correlated with TSD ( P = .003). Conclusion Objective quantitative assessment of stroma in PDA revealed several clinically relevant observations. Stroma was less abundant in metastatic PDA, the primary cause of mortality associated with PDA. High stromal content correlated with favorable outcome in patients with resected tumors, implying a protective effect of stroma and suggesting careful consideration of active stromal depletion therapies. Standard, multiphase CT imaging correlated with stroma content and clinical outcome, indicating that noninvasive assessment of stroma is a feasible sensitivity enrichment approach in PDA.
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Jackson, Tanya, Danika Deibert, Graeme Wyatt, Quentin Durand-Moreau, Anil Adisesh, Kamlesh Khunti, Sachin Khunti, et al. "Classification of aerosol-generating procedures: a rapid systematic review." BMJ Open Respiratory Research 7, no. 1 (October 2020): e000730. http://dx.doi.org/10.1136/bmjresp-2020-000730.
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In the context of covid-19, aerosol generating procedures have been highlighted as requiring a higher grade of personal protective equipment. We investigated how official guidance documents and academic publications have classified procedures in terms of whether or not they are aerosol-generating. We performed a rapid systematic review using preferred reporting items for systematic reviews and meta-analyses standards. Guidelines, policy documents and academic papers published in english or french offering guidance on aerosol-generating procedures were eligible. We systematically searched two medical databases (medline, cochrane central) and one public search engine (google) in march and april 2020. Data on how each procedure was classified by each source were extracted. We determined the level of agreement across different guidelines for each procedure group, in terms of its classification as aerosol generating, possibly aerosol-generating, or nonaerosol-generating. 128 documents met our inclusion criteria; they contained 1248 mentions of procedures that we categorised into 39 procedure groups. Procedures classified as aerosol-generating or possibly aerosol-generating by ≥90% of documents included autopsy, surgery/postmortem procedures with high-speed devices, intubation and extubation procedures, bronchoscopy, sputum induction, manual ventilation, airway suctioning, cardiopulmonary resuscitation, tracheostomy and tracheostomy procedures, non-invasive ventilation, high-flow oxygen therapy, breaking closed ventilation systems, nebulised or aerosol therapy, and high frequency oscillatory ventilation. Disagreements existed between sources on some procedure groups, including oral and dental procedures, upper gastrointestinal endoscopy, thoracic surgery and procedures, and nasopharyngeal and oropharyngeal swabbing. There is sufficient evidence of agreement across different international guidelines to classify certain procedure groups as aerosol generating. However, some clinically relevant procedures received surprisingly little mention in our source documents. To reduce dissent on the remainder, we recommend that (a) clinicians define procedures more clearly and specifically, breaking them down into their constituent components where possible; (b) researchers undertake further studies of aerosolisation during these procedures; and (c) guideline-making and policy-making bodies address a wider range of procedures.
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Borst, Alexandra, Ibrahim Saber, Elizabeth Thames, Nimia Reyes, Michele Beckman, and Thomas L. Ortel. "Incidence of Pediatric VTE in Durham County, North Carolina." Blood 126, no. 23 (December 3, 2015): 5562. http://dx.doi.org/10.1182/blood.v126.23.5562.5562.
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Abstract Introduction There is no national surveillance system for venous thromboembolism (VTE) despite the associated morbidity, mortality and economic burden on the health care system. Estimates of the incidence of VTE in the U.S. range from 1-2 cases per 1,000 people, or approximately 300,000-600,000 cases per year. The estimated incidence in children is lower, ranging from 1-10 per 100,000, with the period of greatest risk for VTE < 1 year and in the teenage years. It has been observed that most children with VTE have a serious underlying medical condition. The contribution of inherited thrombophilia to VTE in children remains not well established. Methods All patients with VTE in Durham County, North Carolina (NC), were identified as part of a VTE Surveillance Project supported by the Centers for Disease Control and Prevention from April 2012 through March 2014. Surveillance included an information technology-based electronic medical record review of diagnosis and specific treatment codes combined with manual review of radiographic imaging and autopsy reports. De-identified data were collected from the three hospitals in the county (Duke, Duke Regional, and the Durham VAMC) and entered into a REDCap database for analysis. Results The estimated population of Durham County during the study period was ~268,000, and ~69,000 of these individuals were < 20 years of age (25.7%). There were a total of 726 new cases of VTE in the county during the study period, for an estimated overall annual incidence of 0.135% (1.35 cases per 1000 per year). Of the total cohort, 19 individuals were less than 25 years of age (Figure 1), but only 8 patients were younger than 20 years, for an estimated annual incidence of VTE in the pediatric subset of 0.006% (6 cases per 100,000 per year). All pediatric VTE cases were identified at Duke University Medical Center. Table 1 lists characteristics of the pediatric population identified. The majority of patients were in their teenage years (75%) and there were no infants. One patient had a prior history of VTE and was taking warfarin at the time of diagnosis. None of the patients received primary pharmacologic thromboprophylaxis. One patient with intracranial hemorrhage did not receive any anticoagulant therapy after diagnosis of a deep vein thrombosis (DVT). One patient was treated with argatroban because of a history of heparin-induced thrombocytopenia, and the remainder were treated with enoxaparin or heparin. None were treated with fibrinolytic therapy or implantation of an IVC filter. Three patients underwent a thrombophilia evaluation, and one was heterozygous for the prothrombin gene mutation. Table 1. Pediatric Patient Characteristics Age (yrs) Sex Race/Ethnicity VTE Event Diagnostic Imaging Prothrombotic Risk Factors Hemorrhagic Risk Factors 4 M White DVT MRI Hemoglobinopathy, CVC 5 M Hispanic DVT US CVC ICH, DIC 17 F White DVT; PE MRI;VQ Scan OCP, Prothrombin gene mutation 18 F White DVT US Immobility ICH 18 M African American DVT US CVC; relative immobility, trauma 19 M African American PE CT CrohnÕs disease, smoking 19 M African American DVT US Prior VTE; ?Protein S deficiency, obesity 19 F African American PE CT Contraceptive patch PE = pulmonary embolus, US = ultrasound, CT = computed tomography scan, VQ = ventilation/perfusion scan, MRI = magnetic resonance imaging, CVC = central venous catheter, OCP = oral contraceptive pill, ICH = intracranial hemorrhage, DIC = disseminated intravascular coagulation Discussion Although 25.7% of individuals living within Durham County, NC are < 20 years of age, this age group represents only ~1.1% of the total number of individuals identified with VTE. The incidence of pediatric VTE was approximately 6 per 100,000 per year, consistent with prior reports. VTE was more common in African Americans in the pediatric patients, which we have observed in all age groups in this surveillance study. Most patients were teenagers, and one or more acquired prothrombotic risk factors were present in all. We did not identify any infants (age < 1 year) in this study, likely reflecting the small sample size and geographic restriction of the study. The type of VTE events observed and initial treatment strategies were similar to adult patients studied. A more accurate assessment of pediatric VTE within a tertiary care academic medical center will need to capture patients from a broader geographic distribution to represent the referral patterns for these complex patients. Disclosures Ortel: Instrumentation Laboratory: Consultancy; Instrumentation Laboratory: Research Funding; Eisai: Research Funding; Daiichi Sankyo: Consultancy.
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Karasek, J., B. Blankova, A. Doubkova, T. Pitasova, D. Nahalka, T. Bartes, R. Polasek, and T. Adamek. "CPR related injuries." European Heart Journal 41, Supplement_2 (November 1, 2020). http://dx.doi.org/10.1093/ehjci/ehaa946.1827.
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Abstract Introduction CPR related injuries were not properly observed since were established new guidlines for resuscitation (CPR) 2015 Objectives To describe incidency and seriousness of injuries related to CPR, compare it and try identify factors for seriousness of injury. Methods Multicentric study, retrospective analysis of autopsy reports of patients after CPR, trauma were excluded. We objectivised the most serious injury with Abbreviated injury scale (AIS)and summary of all injuries with New injury severity score (NISS). Results We have analyzed 628 autopsies: 80,4% men, age median 67 years, out of hospital cardiac arrests 89,2%, bystander CPR 56,8% and cardiac ethiology 78,2%. Ribs injury were founded by 94,6%, injury of lung by 9,9%, sternal injury by 62,4%, liver by 2,5% and spleen by 1,8% Median of the most serious injury was 3 (AIS) and median of summry of injuries was 13 by NISS-low risk of fatal injury. By out of hospital cardiac arrest was hifgher incidency of pleural injury and thorax vessles injuries without influence on total seriousness of injury compared to hospital cardiac arrests. Bystanders provided CPR had similar incidency and seriousness of injury like CPR provided only by professional emergency stuff. Women are significant older (p=0,0001), frequency of their injuries are similar to men, but seriousness of their injuries by NISS is significant higher (p=0,01). Patients with life threatening injury (AIS 4 and more) has similar baseline profil to their without injury (AIS 0), except of significant higher cardiac etiology of cardiac arrest by AIS 4+. Manually CPR were provided by 559 patients and mechanical by 64 (11,4%) patients. Both groups are no diferent in baseline. Mechanical CRP was significantly longer (p=0,0005). Both groups have no diferences in incidency of injuries of visceral organs. We have observed injuries by 80% of manual and 87,5% of mechanical CPR (p=0,18). The most frequent was thorax sceleton injury 85,5% vs. 87,5%. Median of the most seriuos injury was 3 (serious by AIS), median of summary of injuries (NISS) was 13 in both groups (low probability of fatal injury). If we analysed CPR by LUCAS 2 compared to manual, results are similar, only pericard injuries are higher with LUCAS 2. Conclusion Incidency of CPR related injuries from autopsy reports is very high, but life threatening injuries create only 3%. The highest incidency have injuries of thoreax sceleton, especially ribs. There is no difereneces if patients were resuscitated by bystander or compared to those by professional stuff or manually. Women has similar frequency of injuries like men, but significant more serious by NISS. Incidency a seriousness of CPR related injuries according to autopsy reports are no diferent in comapring of manually and mechanical CPR. Mechanical CPR is significant longer a LUCAS 2 leads to significant more pericard injuries without influence to total seriousness of injury Funding Acknowledgement Type of funding source: None
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Robi, Marisna, James F. Siwu, and Erwin G. Kristanto. "Gambaran kasus asfiksia mekanik di Bagian Forensik RSUP Prof. Dr. R.D. Kandou periode tahun 2010 -2015." e-CliniC 4, no. 2 (July 12, 2016). http://dx.doi.org/10.35790/ecl.4.2.2016.14348.
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Abstract: Asphyxia is a condition characterized by the disturbance of gas exchange in the respiratory tract resulted in reduced oxygen accompanied by increased carbon dioxide in the blood. Mechanical asphyxia is suffocation that occurs when the airway was obstructed by various circumstances (which are mechanical), as follows: choking, smothering, strangulation by ligature, manual strangulation, and hanging. This study was aimed to obtain the profile of mechanical asphyxia cases at Forensic Department of Prof. Dr. R. D. Kandou Hospital period 2010-2015. This was a descriptive retrospective study. The results of the external examination and autopsy showed that there were 22 cases of death due to mechanical asphyxia. The highest percentage of asphyxia cases was in 2011 as many as 8 cases (36.5%). Most cases were in the age group of 17-25 years old (7 cases; 31.8%). Males (12 cases; 54.5%) were slightly more frequent than females (10 cases; 45.5%). The most cases of mechanical asphyxia were hanging (15 cases; 68.2%). The most common sign of asphyxia was congestion of the organs (19 cases; 86.4%).Keywords: asphyxia, mechanical asphyxia, forensic Abstrak: Asfiksia adalah suatu keadaan yang ditandai dengan terjadinya gangguan pertukaran udara dalam saluran pernapasan yang berakibat menurunnya oksigen dalam darah berkurang disertai dengan meningkatnya karbon dioksida. Asfiksia mekanik adalah mati lemas yang terjadi bila udara pernapasan terhalang memasuki saluran pernapasan oleh berbagai kekerasan (bersifat mekanik), yaitu pembekapan, penyumpalan, jeratan, cekikan dan gantung. Penelitian ini bertujuan untuk mengetahui gambaran kasus asfiksia mekanik di Bagian Forensik RSUP Prof. Dr. R. D. Kandou periode tahun 2010-2015. Jenis penelitian ialah deskriptif retrospektif menggunakan data hasil pemeriksaan luar dan autopsi. Hasil penelitian mendapatkan 22 kasus kematian akibat asfiksia mekanik. Kasus terbanyak pada tahun 2011 yaitu 8 kasus (36,5%). Kelompok usia terbanyak ialah 17-25 tahun dengan 7 kasus (31,8%). Jenis kelamin laki-laki sedikit lebih banyak yaitu 12 kasus (54,5%) dibandingkan perempuan yaitu 10 kasus (45,5%). Kasus asfiksia mekanik tersering ialah gantung dengan jumlah 15 kasus (68,2%). Tanda asfiksia yang sering ditemukan ialah pembendungan organ dalam yaitu 19 kasus (86,4%). Kata kunci: asfiksia, asfiksia mekanik, forensik
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Di Paolo, M., B. Guidi, L. Bruschini, G. Vessio, R. Domenici, and N. Ambrosino. "Unexpected delayed death after manual strangulation: need for careful examination in the emergency room." Monaldi Archives for Chest Disease 71, no. 3 (January 21, 2016). http://dx.doi.org/10.4081/monaldi.2009.359.
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The aim of this case report was to demonstrate the importance of detailed clinical assessment in victims of attempted manual strangulation, to prevent the occurrence of delayed death due to an airway collapse; and to provide an update on clinical management of these patients. An elderly male patient presented with a sore throat and speech impairment after attempting manual strangulation. Physical examination showed reddish skin of the neck, an extensive haematoma of the hard palate and anterior tongue. Flexible laryngoscopy failed to show any swelling of the hypopharynx or larynx. A few hours after presentation, the patient developed acute dyspnoea and died. Autopsy and post-mortem CT scan showed a haematoma in the thyro-epiglottal space. In conclusion, victims of manual strangulation can survive despite internal neck injury which can lead to delayed fatal airway collapse. This is because often there are few or no signs of assault, therefore medical evaluation should be thorough and timely. Sometimes immediate tracheotomy can be life saving.
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Makidono, Kimitaka, Yoshihiro Miyata, Takuhiro Ikeda, Yasuhiro Tsutani, Yuichiro Kai, Kei Kushitani, Yukio Takeshima, and Morihito Okada. "Bronchial mucosal ablation for bronchial stump closure in right pneumonectomy: a case report." Journal of Medical Case Reports 15, no. 1 (February 18, 2021). http://dx.doi.org/10.1186/s13256-020-02652-x.
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Abstract Background Bronchial fistula is a severe complication of pneumonectomy with a high mortality rate. We previously reported a technique for bronchial closure to prevent bronchial fistula in a canine model. We described that mucosal ablation could result in primary wound healing and involve mucosal tight adhesions histologically. In this paper, the pathologic findings of one patient, who underwent autopsy 4 years after surgery, were reviewed. Case presentation A 70-year-old Japanese man was diagnosed with malignant pleural mesothelioma and underwent right extra-pleural pneumonectomy. The right main bronchus was cut using a scalpel. When closing the bronchial stump, the bronchial mucosa was ablated by electric cautery and sutured manually using 3-0 absorbable sutures. The bronchial fistula was not found after pneumonectomy. Four years after surgery, the patient died of recurrent malignant pleural mesothelioma and underwent autopsy. Macroscopic evaluation showed tight adhesions and white scars on the bronchial stump. Microscopic findings showed few inflammatory cells and α-smooth muscle actin (α-SMA)-positive cells. Conclusions The results from this case suggested that bronchial mucosal ablation leads to robust agglutination of bronchial stump over years. This technique is not only simple but also reliable to prevent bronchial fistula.
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Petrovich, Polina, Per-Olav Berve, Gitta Erika Turowski, Arne Stray-Pedersen, Jo Kramer-Johansen, and Lars Wik. "Abstract 267: Injuries Associated With Mechanical Chest Compressions in Patients With Out-Of-Hospital Cardiac Arrest: A Comparison of LUCAS 2 and LUCAS 2 Active Decompression." Circulation 140, Suppl_2 (November 19, 2019). http://dx.doi.org/10.1161/circ.140.suppl_2.267.
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Background: Skeletal injuries (rib or sternum fractures) are common complications after cardiopulmonary resuscitation (CPR). Visceral injuries are also reported. During manual chest compressions, incidence of rib fractures is reported to be 13-97% and sternal fractures 1-43%. Studies on active compression decompression (AD) devices report incidence on rib fractures ranging from 4-87% and sternal fractures 0-93%. The aim of the present study is to describe and compare injury patterns caused by two mechanical, piston-based chest compression devices; LUCAS 2 and LUCAS 2AD in patients with out-of-hospital cardiac arrest. Method: In the randomized clinical trial comparing standard LUCAS 2 with LUCAS 2AD, patients who died were eligible for medical or forensic autopsy. The pathologists described injury pattern in each patient focusing on CPR-related injuries, but was blinded for the device used. We used Pearson X 2 test with an alpha level of 0.05 to evaluate our findings. Results: Of the 221 patients included between April 2015 and April 2017, 204 patients died of whom 115 were autopsied, LUCAS 2 n=62 and LUCAS 2 AD n=53. Median age was 63 (range: 19-91) and men represented 70%. CPR related rib fractures occurred in 70%, and sternal fractures in 45% of all patients. When comparing LUCAS 2 to LUCAS 2AD we found no difference in incidence of rib fractures (69% vs. 70%; p-value: 0.9) or in sternal fractures (44% vs. 47%; p-value: 0.7). Most frequent non-skeletal complication was bleeding in pleura (25), pericardium (13), mediastinum (7), abdomen (5), and ventricle (3). Many patients had bleedings reported from more than one location, but the amount of blood was mostly small and considered to not contribute to the cause of death. A total of 10 patients had injuries on internal organs such as lungs (6), liver (2), spleen (1), and diaphragm (1). Conclusion: Comparing LUCAS 2 with LUCAS 2AD we found no difference in rib- or sternal fractures. CPR related injuries on internal organs were rare. We conclude that LUCAS 2AD do not cause more skeletal or non-skeletal injuries compared to LUCAS 2.
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Leyh, Judith, Sabine Paeschke, Bianca Mages, Dominik Michalski, Marcin Nowicki, Ingo Bechmann, and Karsten Winter. "Classification of Microglial Morphological Phenotypes Using Machine Learning." Frontiers in Cellular Neuroscience 15 (June 29, 2021). http://dx.doi.org/10.3389/fncel.2021.701673.
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Microglia are the brain’s immunocompetent macrophages with a unique feature that allows surveillance of the surrounding microenvironment and subsequent reactions to tissue damage, infection, or homeostatic perturbations. Thereby, microglia’s striking morphological plasticity is one of their prominent characteristics and the categorization of microglial cell function based on morphology is well established. Frequently, automated classification of microglial morphological phenotypes is performed by using quantitative parameters. As this process is typically limited to a few and especially manually chosen criteria, a relevant selection bias may compromise the resulting classifications. In our study, we describe a novel microglial classification method by morphological evaluation using a convolutional neuronal network on the basis of manually selected cells in addition to classical morphological parameters. We focused on four microglial morphologies, ramified, rod-like, activated and amoeboid microglia within the murine hippocampus and cortex. The developed method for the classification was confirmed in a mouse model of ischemic stroke which is already known to result in microglial activation within affected brain regions. In conclusion, our classification of microglial morphological phenotypes using machine learning can serve as a time-saving and objective method for post-mortem characterization of microglial changes in healthy and disease mouse models, and might also represent a useful tool for human brain autopsy samples.
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Friberg, Niklas, Charles Walther, and Elisabet Englund. "Abstract 103: Rib and Sternum Fractures After Cardiopulmonary Resuscitation: An Autopsy Study." Circulation 130, suppl_2 (November 25, 2014). http://dx.doi.org/10.1161/circ.130.suppl_2.103.
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Introduction: Chest compression during cardiopulmonary resuscitation (CPR) is associated with skeletal chest injury. The aim of this study was to investigate the incidence of rib and sternum fractures after mechanical active compression-decompression CPR (aCPR) and standard manual CPR (mCPR). Method: This prospective study was conducted from January 1 2005 through December 31 2013. We included adult patients (age ≥18 years) who did not survive after CPR and were referred for clinical autopsy. The patients had been treated with either the aCPR device Lund University Cardiac Arrest System (LUCAS) or mCPR only. Patient and CPR data was drawn from autopsy referral documents or the patient medical records. Out of many referred cases, inclusion required examination by one of two pathologists with experience of CPR-related injuries. Autopsy was performed with special attention given to skeletal chest injuries and a standardized written protocol was used. Results: In the period 2005-2013 we included 362 cases treated with aCPR and 52 cases treated with mCPR. Sternum fracture was found in 291/362 cases (80 %) in the aCPR group and in 20/52 cases (38 %; p<0.001) in the mCPR group. Rib fracture was found in 349/362 cases (96 %) in the aCPR group and in 40/52 cases (77 %; p<0.001) in the mCPR group. Fracture on ≥ three ribs was present in 334/362 cases (92 %) in the aCPR group and in 36/52 cases (69 %; p<0.001) in the mCPR group. In the majority of cases there were multiple bilateral rib fractures, with a median of 10 fractures per case (interquartile range 7 to 13 fractures) in the aCPR group and 7 fractures per case (interquartile range 1 to 9.75 fractures; p<0.001) in the mCPR group. There was no fracture in 6/362 cases (1.7 %) in the aCPR group and in 10/52 cases (19 %; p<0.001) in the mCPR group. Conclusion: The incidence of rib and sternum fracture was significantly higher after aCPR than after mCPR, sternum fractures being twice as common and rib fractures being markedly more numerous after aCPR. These findings should be considered in the light of emerging survival data.