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Apte V, Ghose A, Linares CA, Adeleke S, Papadopoulos V, Rassy E, Boussios S. Paediatric Anatomical Models in Radiotherapy Applications. Clin Oncol (R Coll Radiol) 2024; 36:562-575. [PMID: 39013657 DOI: 10.1016/j.clon.2024.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/18/2024]
Abstract
Anatomical models have key applications in radiotherapy, notably to help understand the relationship between radiation dose and risk of developing side effects. This review analyses whether age-specific computational phantoms, developed from healthy subjects and paediatric cancer patient data, are adequate to model a paediatric population. The phantoms used in the study were International Commission on Radiological Protection (ICRP), 4D extended cardiac torso (XCAT) and Radiotherapy Paediatric Atlas (RT-PAL), which were also compared to literature data. Organ volume data for 19 organs was collected for all phantoms and literature. ICRP was treated as the reference for comparison, and percentage difference (P.D) for the other phantoms were calculated relative to ICRP. Overall comparisons were made for each age category (1, 5, 10, 15) and each organ. Statistical analysis was performed using Microsoft Excel (version 16.59). The smallest P.D to ICRP was for Literature (-17.4%), closely followed by XCAT (26.6%). The largest was for RT-PAL (88.1%). The rectum had the largest average P.D (1,049.2%) and the large bowel had the smallest (2.0%). The P.D was 122.6% at age 1 but this decreased to 43.5% by age 15. Linear regression analysis showed a correlation between organ volume and age to be the strongest for ICRP (R2 = 0.943) and weakest for XCAT (R2 = 0.676). The phantoms are similar enough to ICRP for potential use in modelling paediatric populations. ICRP and XCAT could be used to model a healthy population, whereas RT-PAL could be used for a population undergoing/after radiotherapy.
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Affiliation(s)
- V Apte
- Medical School, University College London, London WC1E 6BT, UK
| | - A Ghose
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK; Department of Medical Oncology, Barts Cancer Centre, St Bartholomew's Hospital, Barts Heath NHS Trust, London EC1A 7BE, UK; Department of Medical Oncology, Mount Vernon Cancer Centre, East and North Hertfordshire Trust, London HA6 2RN, UK; Health Systems and Treatment Optimisation Network, European Cancer Organisation, Brussels 1040, Belgium; Oncology Council, Royal Society of Medicine, London W1G 0AE, UK
| | - C A Linares
- Guy's Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - S Adeleke
- Guy's Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK; School of Cancer & Pharmaceutical Sciences, King's College London, Strand, London WC2R 2LS, UK
| | - V Papadopoulos
- Department of Urology, Kent and Canterbury Hospital, Canterbury CT1 3NG, UK
| | - E Rassy
- Department of Medical Oncology, Gustave Roussy Institut, Villejuif 94805, France
| | - S Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK; School of Cancer & Pharmaceutical Sciences, King's College London, Strand, London WC2R 2LS, UK; Kent Medway Medical School, University of Kent, Canterbury CT2 7LX, UK; Canterbury Christ Church University, Canterbury CT2 7PB, UK; AELIA Organization, 9th Km Thessaloniki - Thermi, Thessaloniki 57001, Greece.
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2
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Cazzato F, Grassi S, Brugada R, Oliva A. Letter to the editor regarding the article "Heart weight must not be measured before dissection during autopsies". Int J Legal Med 2024; 138:1663-1665. [PMID: 38374289 DOI: 10.1007/s00414-024-03189-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/09/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Francesca Cazzato
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Simone Grassi
- Department of Health Sciences, Section of Forensic Medical Sciences, University of Florence, largo Brambilla 3, 50134, Florence, Italy
| | - Ramon Brugada
- Cardiovascular Genetics Centre, University of Girona-IDIBGI, Salt, 17190, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029, Madrid, Spain
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
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3
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Kump DS. Mechanisms Underlying the Rarity of Skeletal Muscle Cancers. Int J Mol Sci 2024; 25:6480. [PMID: 38928185 PMCID: PMC11204341 DOI: 10.3390/ijms25126480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Skeletal muscle (SKM), despite comprising ~40% of body mass, rarely manifests cancer. This review explores the mechanisms that help to explain this rarity, including unique SKM architecture and function, which prohibits the development of new cancer as well as negates potential metastasis to SKM. SKM also presents a unique immune environment that may magnify the anti-tumorigenic effect. Moreover, the SKM microenvironment manifests characteristics such as decreased extracellular matrix stiffness and altered lactic acid, pH, and oxygen levels that may interfere with tumor development. SKM also secretes anti-tumorigenic myokines and other molecules. Collectively, these mechanisms help account for the rarity of SKM cancer.
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Affiliation(s)
- David S Kump
- Department of Biological Sciences, Winston-Salem State University, 601 Martin Luther King Jr. Dr., Winston-Salem, NC 27110, USA
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4
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Palmer JA, Rosenthal N, Teichmann SA, Litvinukova M. Revisiting Cardiac Biology in the Era of Single Cell and Spatial Omics. Circ Res 2024; 134:1681-1702. [PMID: 38843288 PMCID: PMC11149945 DOI: 10.1161/circresaha.124.323672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/16/2024] [Accepted: 04/24/2024] [Indexed: 06/09/2024]
Abstract
Throughout our lifetime, each beat of the heart requires the coordinated action of multiple cardiac cell types. Understanding cardiac cell biology, its intricate microenvironments, and the mechanisms that govern their function in health and disease are crucial to designing novel therapeutical and behavioral interventions. Recent advances in single-cell and spatial omics technologies have significantly propelled this understanding, offering novel insights into the cellular diversity and function and the complex interactions of cardiac tissue. This review provides a comprehensive overview of the cellular landscape of the heart, bridging the gap between suspension-based and emerging in situ approaches, focusing on the experimental and computational challenges, comparative analyses of mouse and human cardiac systems, and the rising contextualization of cardiac cells within their niches. As we explore the heart at this unprecedented resolution, integrating insights from both mouse and human studies will pave the way for novel diagnostic tools and therapeutic interventions, ultimately improving outcomes for patients with cardiovascular diseases.
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Affiliation(s)
- Jack A. Palmer
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, United Kingdom (J.A.P., S.A.T.)
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus (J.A.P., S.A.T.), University of Cambridge, United Kingdom
| | - Nadia Rosenthal
- The Jackson Laboratory for Mammalian Genetics, Bar Harbor, ME (N.R.)
- National Heart and Lung Institute, Imperial College London, United Kingdom (N.R.)
| | - Sarah A. Teichmann
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, United Kingdom (J.A.P., S.A.T.)
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus (J.A.P., S.A.T.), University of Cambridge, United Kingdom
- Theory of Condensed Matter Group, Department of Physics, Cavendish Laboratory (S.A.T.), University of Cambridge, United Kingdom
| | - Monika Litvinukova
- University Hospital Würzburg, Germany (M.L.)
- Würzburg Institute of Systems Immunology, Max Planck Research Group at the Julius-Maximilians-Universität Würzburg, Germany (M.L.)
- Helmholtz Pioneer Campus, Helmholtz Munich, Germany (M.L.)
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5
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Bridges J, Ramirez-Guerrero JA, Rosa-Garrido M. Gender-specific genetic and epigenetic signatures in cardiovascular disease. Front Cardiovasc Med 2024; 11:1355980. [PMID: 38529333 PMCID: PMC10962446 DOI: 10.3389/fcvm.2024.1355980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/13/2024] [Indexed: 03/27/2024] Open
Abstract
Cardiac sex differences represent a pertinent focus in pursuit of the long-awaited goal of personalized medicine. Despite evident disparities in the onset and progression of cardiac pathology between sexes, historical oversight has led to the neglect of gender-specific considerations in the treatment of patients. This oversight is attributed to a predominant focus on male samples and a lack of sex-based segregation in patient studies. Recognizing these sex differences is not only relevant to the treatment of cisgender individuals; it also holds paramount importance in addressing the healthcare needs of transgender patients, a demographic that is increasingly prominent in contemporary society. In response to these challenges, various agencies, including the National Institutes of Health, have actively directed their efforts toward advancing our comprehension of this phenomenon. Epigenetics has proven to play a crucial role in understanding sex differences in both healthy and disease states within the heart. This review presents a comprehensive overview of the physiological distinctions between males and females during the development of various cardiac pathologies, specifically focusing on unraveling the genetic and epigenetic mechanisms at play. Current findings related to distinct sex-chromosome compositions, the emergence of gender-biased genetic variations, and variations in hormonal profiles between sexes are highlighted. Additionally, the roles of DNA methylation, histone marks, and chromatin structure in mediating pathological sex differences are explored. To inspire further investigation into this crucial subject, we have conducted global analyses of various epigenetic features, leveraging data previously generated by the ENCODE project.
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Affiliation(s)
| | | | - Manuel Rosa-Garrido
- Department of Biomedical Engineering, School of Medicine, School of Engineering, University of Alabama at Birmingham, Birmingham, AL, United States
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Lange A, Medugorac I, Ali A, Kessler B, Kurome M, Zakhartchenko V, Hammer SE, Hauser A, Denner J, Dobenecker B, Wess G, Tan PLJ, Garkavenko O, Reichart B, Wolf E, Kemter E. Genetic diversity, growth and heart function of Auckland Island pigs, a potential source for organ xenotransplantation. Xenotransplantation 2024; 31:e12858. [PMID: 38646921 DOI: 10.1111/xen.12858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/23/2024] [Accepted: 03/28/2024] [Indexed: 04/23/2024]
Abstract
One of the prerequisites for successful organ xenotransplantation is a reasonable size match between the porcine organ and the recipient's organ to be replaced. Therefore, the selection of a suitable genetic background of source pigs is important. In this study, we investigated body and organ growth, cardiac function, and genetic diversity of a colony of Auckland Island pigs established at the Center for Innovative Medical Models (CiMM), LMU Munich. Male and female Auckland Island pig kidney cells (selected to be free of porcine endogenous retrovirus C) were imported from New Zealand, and founder animals were established by somatic cell nuclear transfer (SCNT). Morphologically, Auckland Island pigs have smaller body stature compared to many domestic pig breeds, rendering their organ dimensions well-suited for human transplantation. Furthermore, echocardiography assessments of Auckland Island pig hearts indicated normal structure and functioning across various age groups throughout the study. Single nucleotide polymorphism (SNP) analysis revealed higher runs of homozygosity (ROH) in Auckland Island pigs compared to other domestic pig breeds and demonstrated that the entire locus coding the swine leukocyte antigens (SLAs) was homozygous. Based on these findings, Auckland Island pigs represent a promising genetic background for organ xenotransplantation.
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Affiliation(s)
- Andreas Lange
- Chair for Molecular Animal Breeding and Biotechnology, Gene Center and Department of Veterinary Sciences, LMU Munich, Munich, Germany
- Center for Innovative Medical Models (CiMM), LMU Munich, Munich, Germany
| | - Ivica Medugorac
- Population Genomics Group, Department of Veterinary Sciences, LMU Munich, Munich, Germany
| | - Asghar Ali
- Chair for Molecular Animal Breeding and Biotechnology, Gene Center and Department of Veterinary Sciences, LMU Munich, Munich, Germany
- Center for Innovative Medical Models (CiMM), LMU Munich, Munich, Germany
| | - Barbara Kessler
- Chair for Molecular Animal Breeding and Biotechnology, Gene Center and Department of Veterinary Sciences, LMU Munich, Munich, Germany
- Center for Innovative Medical Models (CiMM), LMU Munich, Munich, Germany
| | - Mayuko Kurome
- Chair for Molecular Animal Breeding and Biotechnology, Gene Center and Department of Veterinary Sciences, LMU Munich, Munich, Germany
- Center for Innovative Medical Models (CiMM), LMU Munich, Munich, Germany
| | - Valeri Zakhartchenko
- Chair for Molecular Animal Breeding and Biotechnology, Gene Center and Department of Veterinary Sciences, LMU Munich, Munich, Germany
- Center for Innovative Medical Models (CiMM), LMU Munich, Munich, Germany
| | - Sabine E Hammer
- Institute of Immunology, Department of Pathobiology, University of Veterinary Medicine, Vienna, Austria
| | - Andreas Hauser
- Chair for Molecular Animal Breeding and Biotechnology, Gene Center and Department of Veterinary Sciences, LMU Munich, Munich, Germany
| | - Joachim Denner
- Institute of Virology, Free University of Berlin, Berlin, Germany
| | - Britta Dobenecker
- Chair for Animal Nutrition, Department of Veterinary Sciences, LMU Munich, Munich, Germany
| | - Gerhard Wess
- Clinic of Small Animal Medicine, Center for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | | | | | - Bruno Reichart
- Walter-Brendel-Center for Experimental Medicine, LMU Munich, Munich, Germany
| | - Eckhard Wolf
- Chair for Molecular Animal Breeding and Biotechnology, Gene Center and Department of Veterinary Sciences, LMU Munich, Munich, Germany
- Center for Innovative Medical Models (CiMM), LMU Munich, Munich, Germany
- Laboratory for Functional Genome Analysis (LAFUGA), Gene Center, LMU Munich, Munich, Germany
| | - Elisabeth Kemter
- Chair for Molecular Animal Breeding and Biotechnology, Gene Center and Department of Veterinary Sciences, LMU Munich, Munich, Germany
- Center for Innovative Medical Models (CiMM), LMU Munich, Munich, Germany
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7
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Luong S, Winston D. Sarcoid Involving the Heart and Frontal Bone With Minimal Pulmonary Involvement. Am J Forensic Med Pathol 2024; 45:e5-e7. [PMID: 37490577 DOI: 10.1097/paf.0000000000000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
- Susanna Luong
- From the Burrell College of Osteopathic Medicine, Las Cruces, NM
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8
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Furst B, González-Alonso J. The heart, a secondary organ in the control of blood circulation. Exp Physiol 2023. [PMID: 38126953 DOI: 10.1113/ep091387] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
Circulation of the blood is a fundamental physiological function traditionally ascribed to the pressure-generating function of the heart. However, over the past century the 'cardiocentric' view has been challenged by August Krogh, Ernst Starling, Arthur Guyton and others, based on haemodynamic data obtained from isolated heart preparations and organ perfusion. Their research brought forth experimental evidence and phenomenological observations supporting the concept that cardiac output occurs primarily in response to the metabolic demands of the tissues. The basic tenets of Guyton's venous return model are presented and juxtaposed with their critiques. Developmental biology of the cardiovascular system shows that the blood circulates before the heart has achieved functional integrity and that its movement is intricately connected with the metabolic demands of the tissues. Long discovered, but as yet overlooked, negative interstitial pressure may play a role in assisting the flow returning to the heart. Based on these phenomena, an alternative circulation model has been proposed in which the heart functions like a hydraulic ram and maintains a dynamic equilibrium between the arterial (centrifugal) and venous (centripetal) forces which define the blood's circular movement. In this focused review we introduce some of the salient arguments in support of the proposed circulation model. Finally, we present evidence that exercising muscle blood flow is subject to local metabolic control which upholds optimal perfusion in the face of a substantive rise in muscle vascular conductance, thus lending further support to the permissive role of the heart in the overall control of blood circulation.
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Affiliation(s)
- Branko Furst
- Department of Anesthesiology, Albany Medical Center, Albany, New York, USA
| | - José González-Alonso
- Sport, Health and Exercise Sciences, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
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Gadsby Z, Garland J, Thompson M, Ondruschka B, Da Broi U, Tse R. Binucleated Myocytes and Heart Weight: A Preliminary Study Linking Cardiac Hypertrophy and Myocyte Hypertrophy. Am J Forensic Med Pathol 2023; 44:273-277. [PMID: 37527350 DOI: 10.1097/paf.0000000000000869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
ABSTRACT Hypertrophy of the heart is assessed by heart weight (and dimensions) and myocyte hypertrophy. Establishing an association between the two may be useful in assessing hypertrophy in cases where there are limitations in assessing the heart weight. This preliminary study explored the association between the number of binucleated myocytes (a feature of myocyte hypertrophy) in a randomly chosen single high-power field of the left ventricular free wall and heart weight in an adult White population. It also compared the number of binucleated myocytes between cases with increased heart weight (>400 g in female and >500 g in male) and cases with normal heart weight. Heart weight and number of binucleated myocytes correlated significantly in male only. Increased heart weight had a significantly higher number of binucleated myocytes, with 8.5 binucleated myocytes being able to segregate cases with increased heart weight (74% sensitivity and 79% specificity). The results of this study showed the number of binucleated myocytes may have a complementary role in assessing hypertrophy of the heart.
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Affiliation(s)
- Zeena Gadsby
- From the Griffith University School of Medicine, Southport, Queensland, Australia
| | - Jack Garland
- Queensland Public Health and Scientific Services, Coopers Plains, Queensland, Australia
| | | | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ugo Da Broi
- Department of Medicine, Section of Forensic Medicine, University of Udine, Udine, Italy
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Garland J, Thompson M, Thompson I, Olumbe A, Tse R. Significant difference in cardiac ventricular dimensions when measured using two different standard methods. Forensic Sci Med Pathol 2023; 19:479-483. [PMID: 36705885 PMCID: PMC10752913 DOI: 10.1007/s12024-023-00579-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/28/2023]
Abstract
Cardiac ventricular dimensions measured at postmortem examination are used to assess whether there is hypertrophy of the heart chambers. However, there is no clear consensus on where these measurements should be taken. Some have proposed this should be measured at the mid-ventricular level, but others advocate it should be measured at a set distance (e.g. 20 mm) from the base of the heart. Twenty consecutive adult hearts were examined and showed the ventricular dimensions were significantly higher (mean: 5-15 mm, p < 0.01) when measured at a level 20 mm from the base of the heart compared to the mid-ventricular level. Of clinical significance is that in slightly less than half the cases, normal ventricular dimensions at mid ventricle level fell within the criteria considered pathological (> 40 mm) when measured at 20 mm from the base of the heart. In terms of actual ventricular dimensions, only the left ventricle diameter measured at 20 mm from the base of the heart correlated significantly (albeit moderately) with heart weight, suggesting it can be a predictor for cardiac hypertrophy.
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Affiliation(s)
- Jack Garland
- Forensic and Scientific Services, Health Support Queensland, Gold Coast University Hospital, Southport, QLD, Australia
| | - Melissa Thompson
- Forensic and Scientific Services, Health Support Queensland, Gold Coast University Hospital, Southport, QLD, Australia
- Griffith University School of Medicine, Southport, QLD, Australia
| | - Isabella Thompson
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Alex Olumbe
- Forensic and Scientific Services, Health Support Queensland, Gold Coast University Hospital, Southport, QLD, Australia
- Griffith University School of Medicine, Southport, QLD, Australia
| | - Rexson Tse
- Forensic and Scientific Services, Health Support Queensland, Gold Coast University Hospital, Southport, QLD, Australia.
- Griffith University School of Medicine, Southport, QLD, Australia.
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand.
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11
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Lohner L, Sinning C, Suling AI, Tse R, Garland J, Ondruschka B. Heart weight must not be measured before dissection during autopsies. Int J Legal Med 2023; 137:1751-1755. [PMID: 37723344 PMCID: PMC10567818 DOI: 10.1007/s00414-023-03089-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023]
Abstract
During autopsies, weighing the heart is a standard procedure. In addition to myocardial pathologies, heart size, and ventricular wall thickness, heart weight is a common parameter to describe cardiac pathology and should be recorded as accurately as possible. To date, there exists no standard for recording heart weight at autopsy, although some authors recommend weighing the heart after dissection and removal of blood and blood clots. In the study presented, the hearts of 58 decedents were weighed after being dissected out of the pericardial sac (a), after dissection using the short-axis or inflow-outflow method with manual removal of blood and blood clots (b), and after rinsing and drying (c). Depending on the dissection method, the heart weight was 7.8% lower for the inflow-outflow method and 11.6% lower for the short-axis method after dissection compared to before and correspondingly 2.9% to 5% lower again after rinsing and drying respectively. Accordingly, the heart should be dissected, blood and blood clots removed, rinsed with water, and dried with a surgical towel after dissection, before weighing.
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Affiliation(s)
- Larissa Lohner
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Christoph Sinning
- University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Isabella Suling
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rexson Tse
- Griffith University School of Medicine, Southport, QLD, Australia
- Queensland Public Health and Scientific Services, Coopers Plains, QLD, Australia
| | - Jack Garland
- Queensland Public Health and Scientific Services, Coopers Plains, QLD, Australia
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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12
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Notley SR, Mitchell D, Taylor NAS. A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 1: Foundational principles and theories of regulation. Eur J Appl Physiol 2023; 123:2379-2459. [PMID: 37702789 DOI: 10.1007/s00421-023-05272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/30/2023] [Indexed: 09/14/2023]
Abstract
This contribution is the first of a four-part, historical series encompassing foundational principles, mechanistic hypotheses and supported facts concerning human thermoregulation during athletic and occupational pursuits, as understood 100 years ago and now. Herein, the emphasis is upon the physical and physiological principles underlying thermoregulation, the goal of which is thermal homeostasis (homeothermy). As one of many homeostatic processes affected by exercise, thermoregulation shares, and competes for, physiological resources. The impact of that sharing is revealed through the physiological measurements that we take (Part 2), in the physiological responses to the thermal stresses to which we are exposed (Part 3) and in the adaptations that increase our tolerance to those stresses (Part 4). Exercising muscles impose our most-powerful heat stress, and the physiological avenues for redistributing heat, and for balancing heat exchange with the environment, must adhere to the laws of physics. The first principles of internal and external heat exchange were established before 1900, yet their full significance is not always recognised. Those physiological processes are governed by a thermoregulatory centre, which employs feedback and feedforward control, and which functions as far more than a thermostat with a set-point, as once was thought. The hypothalamus, today established firmly as the neural seat of thermoregulation, does not regulate deep-body temperature alone, but an integrated temperature to which thermoreceptors from all over the body contribute, including the skin and probably the muscles. No work factor needs to be invoked to explain how body temperature is stabilised during exercise.
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Affiliation(s)
- Sean R Notley
- Defence Science and Technology Group, Department of Defence, Melbourne, Australia
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Duncan Mitchell
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Sciences, University of Western Australia, Crawley, Australia
| | - Nigel A S Taylor
- Research Institute of Human Ecology, College of Human Ecology, Seoul National University, Seoul, Republic of Korea.
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13
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Sangita M, Yadav J, Chaurasia JK, Arora A, Jahan A, Patnaik M. Hypoplastic coronary artery disease, as a cause of sudden death. Autops Case Rep 2023; 13:e2023440. [PMID: 37635733 PMCID: PMC10449246 DOI: 10.4322/acr.2023.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/20/2023] [Indexed: 08/29/2023]
Abstract
Hypoplastic coronary artery disease (HCAD) is a rare coronary artery anomaly that may be the cause of sudden death. It can involve a single or all coronary arteries. This anomaly may cause circulatory insufficiency leading to myocardial infarction. HCAD has no symptoms or may exhibit cardiovascular signs like syncope, dyspnea, chest discomfort, or dizziness. It is often diagnosed at autopsy, and early diagnosis is made with a coronary angiogram. We report HCAD as the cause of the sudden death of a 25-year-old female with a history of loss of consciousness following exertion. On autopsy, all the coronary arteries' lumen was narrowed with thin vessel walls. Histopathological examination shows an underdeveloped and missing muscular layer of the left anterior descending and circumflex coronary arteries' vascular wall. Many cases of HCAD diagnosed by radiographic imaging in living patients have been reported in the literature, but a structural anomaly of coronaries leading to HCAD has not been reported. We report a case of HCAD describing the histopathological examination findings of the vascular wall of coronary vessels illustrating the structural difference.
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Affiliation(s)
- Moirangthem Sangita
- All India Institute Medical Sciences, Bhopal, Forensic Medicine and Toxicology, Bhopal, India
| | - Jayanthi Yadav
- All India Institute Medical Sciences, Bhopal, Forensic Medicine and Toxicology, Bhopal, India
| | - Jai Kumar Chaurasia
- All India Institute Medical Sciences, Bhopal, Pathology and Lab Medicine, Bhopal, India
| | - Arneet Arora
- All India Institute Medical Sciences, Bhopal, Forensic Medicine and Toxicology, Bhopal, India
| | - Afsar Jahan
- All India Institute Medical Sciences, Bhopal, Forensic Medicine and Toxicology, Bhopal, India
| | - Mrinal Patnaik
- All India Institute Medical Sciences, Bhopal, Forensic Medicine and Toxicology, Bhopal, India
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Burrowes KS, Ruppage M, Lowry A, Zhao D. Sex matters: the frequently overlooked importance of considering sex in computational models. Front Physiol 2023; 14:1186646. [PMID: 37520817 PMCID: PMC10374267 DOI: 10.3389/fphys.2023.1186646] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Personalised medicine and the development of a virtual human or a digital twin comprises visions of the future of medicine. To realise these innovations, an understanding of the biology and physiology of all people are required if we wish to apply these technologies at a population level. Sex differences in health and biology is one aspect that has frequently been overlooked, with young white males being seen as the "average" human being. This has not been helped by the lack of inclusion of female cells and animals in biomedical research and preclinical studies or the historic exclusion, and still low in proportion, of women in clinical trials. However, there are many known differences in health between the sexes across all scales of biology which can manifest in differences in susceptibility to diseases, symptoms in a given disease, and outcomes to a given treatment. Neglecting these important differences in the development of any health technologies could lead to adverse outcomes for both males and females. Here we highlight just some of the sex differences in the cardio-respiratory systems with the goal of raising awareness that these differences exist. We discuss modelling studies that have considered sex differences and touch on how and when to create sex-specific models. Scientific studies should ensure sex differences are included right from the study planning phase and results reported using sex as a biological variable. Computational models must have sex-specific versions to ensure a movement towards personalised medicine is realised.
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Affiliation(s)
- K. S. Burrowes
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - M. Ruppage
- Department of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - A. Lowry
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - D. Zhao
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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15
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Oualha D, Ben Abderrahim S, Ben Abdeljelil N, BelHadj M, Ben Jomâa S, Saadi S, Zakhama A, Haj Salem N. Cardiac rupture during acute myocardial infarction : Autopsy study (2004-2020). Ann Cardiol Angeiol (Paris) 2023; 72:101601. [PMID: 37060875 DOI: 10.1016/j.ancard.2023.101601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/17/2023] [Accepted: 03/28/2023] [Indexed: 04/17/2023]
Abstract
INTRODUCTION Cardiac rupture is a rare but critical complication of myocardial infarction with an incidence of 1 to 3% of cases. We aimed in this autopsy study to analyze the anatomical, epidemiological, cardiac, and coronary profiles of cardiac rupture in the Monastir region. METHODS We conducted a descriptive study with retrospective data collection of all cases of myocardial infarction complicated by a cardiac rupture over seventeen years (2004-2020). RESULTS Thirty-one cases were included in this study. The mean age of the cases was 67 years with a male predominance. Sixteen cases (57%) had cardiovascular risk factors. The most common symptomatology reported before death was acute chest pain in 57% of cases. Fourteen cases (45%) corresponded to the definition of sudden cardiac death. At autopsy, the heart had a mean weight of 452.78 grams. A large hemopericardium was associated in 90% of cases. Myocardial rupture involved the posterior wall of the left ventricle in 50% of cases. The myocardial rupture occurred at a site of acute myocardial infarction in 86% of cases and on a myocardial scar in 14% of cases. The coronary study showed double or triple vessel atherosclerotic coronary artery disease in 57% of cases with fresh thrombi at the infarct-related coronary in 11% of cases. CONCLUSIONS Our analysis found that cardiac rupture mostly involved elderly subjects with underlying cardiovascular risk factors. Our findings sustain that age is a determining prognostic factor after acute coronary syndrome with the need for further education and awareness-raising efforts to speed up access to care for these patients.
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Affiliation(s)
- Dorra Oualha
- Department of Forensic Medicine, Fattouma Bourguiba University Hospital, June 1st 1995 Street, 5000, Monastir, Tunisia
| | - Sarra Ben Abderrahim
- Department of Forensic Medicine, Ibn El Jazzar University Hospital, Kairouan, Tunisia.
| | - Nouha Ben Abdeljelil
- Department of Pathological Anatomy and Cytology, Fattouma Bourguiba University Hospital, June 1st 1995 Street, 5000, Monastir, Tunisia
| | - Meriem BelHadj
- Department of Forensic Medicine, Fattouma Bourguiba University Hospital, June 1st 1995 Street, 5000, Monastir, Tunisia
| | - Sami Ben Jomâa
- Department of Forensic Medicine, Fattouma Bourguiba University Hospital, June 1st 1995 Street, 5000, Monastir, Tunisia
| | - Said Saadi
- Department of Forensic Medicine, Fattouma Bourguiba University Hospital, June 1st 1995 Street, 5000, Monastir, Tunisia
| | - Abdelfateh Zakhama
- Department of Pathological Anatomy and Cytology, Fattouma Bourguiba University Hospital, June 1st 1995 Street, 5000, Monastir, Tunisia
| | - Nidhal Haj Salem
- Department of Forensic Medicine, Fattouma Bourguiba University Hospital, June 1st 1995 Street, 5000, Monastir, Tunisia
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16
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Kelly KL, Lin PT, Basso C, Bois M, Buja LM, Cohle SD, d'Amati G, Duncanson E, Fallon JT, Firchau D, Fishbein G, Giordano C, Leduc C, Litovsky SH, Mackey-Bojack S, Maleszewski JJ, Michaud K, Padera RF, Papadodima SA, Parsons S, Radio SJ, Rizzo S, Roe SJ, Romero M, Sheppard MN, Stone JR, Tan CD, Thiene G, van der Wal AC, Veinot JP. Sudden cardiac death in the young: A consensus statement on recommended practices for cardiac examination by pathologists from the Society for Cardiovascular Pathology. Cardiovasc Pathol 2023; 63:107497. [PMID: 36375720 DOI: 10.1016/j.carpath.2022.107497] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022] Open
Abstract
Sudden cardiac death is, by definition, an unexpected, untimely death caused by a cardiac condition in a person with known or unknown heart disease. This major international public health problem accounts for approximately 15-20% of all deaths. Typically more common in older adults with acquired heart disease, SCD also can occur in the young where the cause is more likely to be a genetically transmitted process. As these inherited disease processes can affect multiple family members, it is critical that these deaths are appropriately and thoroughly investigated. Across the United States, SCD cases in those less than 40 years of age will often fall under medical examiner/coroner jurisdiction resulting in scene investigation, review of available medical records and a complete autopsy including toxicological and histological studies. To date, there have not been consistent or uniform guidelines for cardiac examination in these cases. In addition, many medical examiner/coroner offices are understaffed and/or underfunded, both of which may hamper specialized examinations or studies (e.g., molecular testing). Use of such guidelines by pathologists in cases of SCD in decedents aged 1-39 years of age could result in life-saving medical intervention for other family members. These recommendations also may provide support for underfunded offices to argue for the significance of this specialized testing. As cardiac examinations in the setting of SCD in the young fall under ME/C jurisdiction, this consensus paper has been developed with members of the Society of Cardiovascular Pathology working with cardiovascular pathology-trained, practicing forensic pathologists.
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Affiliation(s)
| | | | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health - University of Padua, Padua, Italy
| | | | | | | | | | - Emily Duncanson
- Jesse E. Edwards Registry of Cardiovascular Disease, St. Paul, MN, USA
| | | | | | | | | | | | | | | | | | - Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Switzerland
| | | | | | - Sarah Parsons
- Victorian Institute of Forensic Medicine, Melbourne, Australia
| | | | - Stefania Rizzo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health - University of Padua, Padua, Italy
| | | | | | - Mary N Sheppard
- St. George's Medical School, University of London, London, United Kingdom
| | | | | | - Gaetano Thiene
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health - University of Padua, Padua, Italy
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17
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Pulakat L. A role for misaligned gene expression of fetal gene program in the loss of female-specific cardiovascular protection in young obese and diabetic females. Front Endocrinol (Lausanne) 2023; 14:1108449. [PMID: 36909327 PMCID: PMC9995961 DOI: 10.3389/fendo.2023.1108449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Healthy, premenopausal women have the advantage of female-specific cardiovascular protection compared to age-matched healthy men. However, pathologies such as obesity and Type 2 diabetes mellitus (T2DM) cause losing of this female-specific cardiovascular protection in young, obese and diabetic females. Molecular mechanisms underlying this loss of female-specific cardiovascular protection in young, obese and diabetic females are not clearly elucidated. This review takes a close look at the latest advances in our understanding of sex differences in adult cardiac gene expression patterns in health and disease. Based on the emerging data, this review proposes that female biased gene expression patterns in healthy adult hearts of human and pre-clinical models support the existence of active fetal gene program in healthy, premenopausal female heart compared to age-matched healthy male heart. However, the misalignment of gene expression pattern in this female-specific active cardiac fetal gene program caused by pathologies such as obesity and T2DM may contribute to the loss of female-specific cardiovascular protection in young, obese and diabetic females.
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Affiliation(s)
- Lakshmi Pulakat
- Molecular Cardiology Research Institute, Tufts Medical Center, and Department of Medicine, Tufts University School of Medicine, Boston, MA, United States
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18
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Liu WJ, Dhuromsingh M, He XW, Xie Y, Liu XL, Wang HJ, Zeng HS. Relationship between Coronary Artery Tortuosity and Cardiorespiratory Fitness in Patients without Obstructed Coronaries. Curr Med Sci 2022; 42:941-948. [PMID: 36245033 DOI: 10.1007/s11596-022-2656-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to analyze the relationship between cardiorespiratory fitness (CRF) and the increasing severity of coronary artery tortuosity (CAT) in patients with non-stenosed coronaries. METHODS A total of 396 patients who underwent coronary angiography and cardiopulmonary exercise testing (CPET) between August 2020 and July 2021 were included in this single-center retrospective study after excluding patients with significant coronary artery disease (≥50% stenosis). Patients were divided into two groups: no or mild coronary artery tortuosity (N/M-CAT) and moderate to severe coronary artery tortuosity (M/S-CAT) and laboratory electrocardiographic, echocardiographic, and CPET parameters were compared between two groups. RESULTS M/S-CAT was found in 46.9% of the study participants, with 66.7% being women. M/S-CAT was significantly associated with advanced age (P=0.014) and females (P=0.001). Diastolic dysfunction parameters, E velocity (P=0.011), and E/A ratio (P=0.004) also revealed significant differences between the M/S-CAT group and N/M-CAT group. VO2@peak (1.22±0.39 vs. 1.07±0.39, P<0.01) and VO2@AT (0.77±0.22 vs. 0.71±0.21, P=0.017) were significantly lower in the M/S-CAT group than in the N/M-CAT group. Multivariate logistic regression analysis identified females (OR=0.448; 95% CI, 0.296-0.676; P=0.000) and E/A ratio (OR=0.307; 95% CI, 0.139-0.680; P=0.004) to be independent risk factors of M/S-CAT and showed no association of CPET parameters to M/S-CAT. CONCLUSION The results indicate that increasing severity of CAT is strongly associated with female gender and E/A ratio and is not directly correlated with decreasing CRF. Further research with a larger patient population and a longer follow-up time is required to fully comprehend the impact of CAT on CRF.
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Affiliation(s)
- Wan-Jun Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Menaka Dhuromsingh
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xing-Wei He
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yang Xie
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao-Lei Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hong-Jie Wang
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - He-Song Zeng
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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19
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Ali H, Naik U, McDonald M, Almosa M, Horn K, Staines A, Buja LM. Complexities and complications of extreme obesity. AUTOPSY AND CASE REPORTS 2022; 12:e2021402. [PMID: 36245943 PMCID: PMC9545056 DOI: 10.4322/acr.2021.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
Obesity is a common chronic disorder and has detrimental long-term consequences if left untreated. Herein, we report a case of a young lady who suffered from morbid obesity and many of its consequences, and we present a literature review of these complications. While the cause of obesity is multifactorial, the genetic component is particularly important in the pathophysiology of marked obesity. Resistance to Leptin is considered one of the main causes of obesity. There is a unique relationship between polycystic ovary syndrome and obesity, as observed in our case. Obesity is associated with cardiovascular and lung diseases such as heart failure, thromboembolic disease, sleep apnea, and pulmonary hypertension. Our patient had cardiomegaly (730 gm) with eccentric hypertrophy of left and right ventricles. The coronary arteries and aorta were free of atherosclerosis, which is a surprising finding that relates to the mysterious phenomenon of obesity paradox. The terminal event in our young woman was multiple segmental and subsegmental pulmonary arterial thrombi/thromboemboli superimposed on chronic cardiopulmonary stress due to massive obesity.
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Affiliation(s)
- Haval Ali
- University of Texas Health Science Center at Houston (UTHealth Houston), McGovern Medical School, Department of Pathology and Laboratory Medicine, Houston, TX, USA
| | - Udit Naik
- University of Texas Health Science Center at Houston (UTHealth Houston), McGovern Medical School, Department of Pathology and Laboratory Medicine, Houston, TX, USA
| | - Michelle McDonald
- University of Texas Health Science Center at Houston (UTHealth Houston), McGovern Medical School, Department of Pathology and Laboratory Medicine, Houston, TX, USA
| | - Mohammad Almosa
- University of Texas Health Science Center at Houston (UTHealth Houston), McGovern Medical School, Department of Pathology and Laboratory Medicine, Houston, TX, USA
| | - Karen Horn
- University of Texas Health Science Center at Houston (UTHealth Houston), McGovern Medical School, Department of Pathology and Laboratory Medicine, Houston, TX, USA
| | - Alexis Staines
- University of Texas Health Science Center at Houston (UTHealth Houston), McGovern Medical School, Department of Pathology and Laboratory Medicine, Houston, TX, USA
| | - Louis Maximilian Buja
- University of Texas Health Science Center at Houston (UTHealth Houston), McGovern Medical School, Department of Pathology and Laboratory Medicine, Houston, TX, USA
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20
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Shah A, Goerlich CE, Pasrija C, Hirsch J, Fisher S, Odonkor P, Strauss E, Ayares D, Mohiuddin MM, Griffith BP. Anatomical Differences Between Human and Pig Hearts and Their Relevance for Cardiac Xenotransplantation Surgical Technique. JACC Case Rep 2022; 4:1049-1052. [PMID: 36062051 PMCID: PMC9434648 DOI: 10.1016/j.jaccas.2022.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
Cardiac xenotransplantation has been proposed to bridge the gap between supply and demand for patients with end-stage heart failure requiring transplantation. However, differences in pig anatomy compared with human anatomy require modification of the surgical approach. In addition, careful consideration should be given to size matching before transplantation. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Aakash Shah
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Corbin E. Goerlich
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Chetan Pasrija
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jeffrey Hirsch
- Department of Radiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Stacy Fisher
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Patrick Odonkor
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Erik Strauss
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Muhammad M. Mohiuddin
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bartley P. Griffith
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Address for correspondence: Dr. Bartley P. Griffith, Program in Cardiac Xenotransplantation, 110 S. Paca Street, 7th Floor, Baltimore, Maryland 21201, USA.
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21
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Lin YM, Paolino L, Lou L, Herrera A, Pierre E, Agarwal A, Ramaswamy S. Directional dependence on concomitant pressure and volume increases during left ventricular filling. J Biomech 2022; 138:111129. [DOI: 10.1016/j.jbiomech.2022.111129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/26/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
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22
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Abstract
RNA-based gene therapy requires therapeutic RNA to function inside target cells without eliciting unwanted immune responses. RNA can be ferried into cells using non-viral drug delivery systems, which circumvent the limitations of viral delivery vectors. Here, we review the growing number of RNA therapeutic classes, their molecular mechanisms of action, and the design considerations for their respective delivery platforms. We describe polymer-based, lipid-based, and conjugate-based drug delivery systems, differentiating between those that passively and those that actively target specific cell types. Finally, we describe the path from preclinical drug delivery research to clinical approval, highlighting opportunities to improve the efficiency with which new drug delivery systems are discovered.
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Affiliation(s)
- Kalina Paunovska
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA, USA
| | - David Loughrey
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA, USA
| | - James E Dahlman
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA, USA.
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23
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Amato R, Gardin JF, Tooze JA, Cline JM. Organ Weights in Relation to Age and Sex in Cynomolgus Monkeys ( Macaca fascicularis). Toxicol Pathol 2022; 50:574-590. [PMID: 35383510 DOI: 10.1177/01926233221088283] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Laboratory animal research is an important contributor to both human and animal medicine. Currently, there is extensive use of cynomolgus monkeys (Macaca fascicularis) in pathology and toxicology research. The purpose of this study was to define reference values for absolute and percentage organ weights in M fascicularis of different ages and sex. Organ weights were obtained from necropsies of 1022 cynomolgus monkeys at the Wake Forest School of Medicine from 1997 to 2018. Distributions of absolute and percentage weights for each organ were described; sex and age groups were compared using analysis of variance. Age effects on percentage of body weights for each organ were analyzed within each sex. Diet effects were also analyzed. This evaluation showed that male body weights and absolute organ weights were greater for all age groups; however, female organ to body weight percentages were greater for most organs. Percentage of organ weight to body weight declined for the adrenals, brain, lung, thyroid and thymus during maturation, whereas percentage weight of pancreas, prostate, testes, and uterus increased. Animals consuming a high-fat, Western-type diet had a lower body weight than animals consuming a carbohydrate-rich chow diet. This information will be useful for further toxicology and pathology studies concerning cynomolgus monkeys.
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Affiliation(s)
| | - Jean F Gardin
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Janet A Tooze
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - J Mark Cline
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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24
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Bech AB, Clausen T, Waal H, Delaveris GJM, Skeie I. Organ pathologies detected post-mortem in patients receiving opioid agonist treatment for opioid use disorder: a nation-wide 2-year cross-sectional study. Addiction 2022; 117:977-985. [PMID: 34648218 DOI: 10.1111/add.15705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/01/2021] [Indexed: 11/26/2022]
Abstract
AIMS To document organ pathologies detected post-mortem in patients receiving opioid agonist treatment for opioid use disorder and estimate the extent to which individual characteristics are associated with pulmonary, cardiovascular, hepatic or renal pathologies. DESIGN Two-year cross-sectional nation-wide study. SETTING Norway. PARTICIPANTS Among all 200 patients who died during opioid agonist treatment between 1 January 2014 and 31 December 2015, 125 patients (63%) were autopsied. Among these, 122 patients (75% men) had available autopsy reports and were included. The mean age at the time of death was 48 years. MEASUREMENTS Information on pulmonary, cardiovascular, hepatic and renal pathologies were retrieved from forensic or medical autopsy reports, with no (0) and yes (1) as outcome variables and age, sex and body mass index as covariates in logistic regression analyses. FINDINGS Pathologies in several organs were common. Two-thirds (65%) of the decedents had more than two organ system diseases. The most common organ pathologies were chronic liver disease (84%), cardiovascular disease (68%) and pulmonary emphysema (41%). In bivariate analyses, only older age was associated with any pulmonary pathology [odds ratio (OR) = 1.06; 95% confidence interval (CI) = 1.01-1.10], cardiovascular pathology (OR = 1.11; 95% CI = 1.05-1.17) and renal pathology (OR = 1.05; 95% CI = 1.00-1.11). Older age remained independently associated with cardiovascular pathology (OR = 1.10; 95% CI = 1.04-1.16) and renal pathology (OR = 1.06; 95% CI = 1.01-1.12) adjusted for body mass index and sex. CONCLUSIONS Among autopsied Norwegians who died during opioid agonist treatment in 2014 and 2015, two-thirds had more than two organ system diseases, despite their mean age of 48 years at the time of death. Older age was independently associated with at least one cardiovascular or renal pathology after adjusting for sex and body mass index.
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Affiliation(s)
- Anne Berit Bech
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Department of Mental Health, Brumunddal, Norway
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | - Helge Waal
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway
- National Advisory Unit on Substance Use Disorder Treatment, Oslo University Hospital, Oslo, Norway
| | | | - Ivar Skeie
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Department of Mental Health, Brumunddal, Norway
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway
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25
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St. Pierre SR, Peirlinck M, Kuhl E. Sex Matters: A Comprehensive Comparison of Female and Male Hearts. Front Physiol 2022; 13:831179. [PMID: 35392369 PMCID: PMC8980481 DOI: 10.3389/fphys.2022.831179] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/02/2022] [Indexed: 12/27/2022] Open
Abstract
Cardiovascular disease in women remains under-diagnosed and under-treated. Recent studies suggest that this is caused, at least in part, by the lack of sex-specific diagnostic criteria. While it is widely recognized that the female heart is smaller than the male heart, it has long been ignored that it also has a different microstructural architecture. This has severe implications on a multitude of cardiac parameters. Here, we systematically review and compare geometric, functional, and structural parameters of female and male hearts, both in the healthy population and in athletes. Our study finds that, compared to the male heart, the female heart has a larger ejection fraction and beats at a faster rate but generates a smaller cardiac output. It has a lower blood pressure but produces universally larger contractile strains. Critically, allometric scaling, e.g., by lean body mass, reduces but does not completely eliminate the sex differences between female and male hearts. Our results suggest that the sex differences in cardiac form and function are too complex to be ignored: the female heart is not just a small version of the male heart. When using similar diagnostic criteria for female and male hearts, cardiac disease in women is frequently overlooked by routine exams, and it is diagnosed later and with more severe symptoms than in men. Clearly, there is an urgent need to better understand the female heart and design sex-specific diagnostic criteria that will allow us to diagnose cardiac disease in women equally as early, robustly, and reliably as in men. Systematic Review Registration https://livingmatter.stanford.edu/.
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Affiliation(s)
- Sarah R. St. Pierre
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
| | - Mathias Peirlinck
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
| | - Ellen Kuhl
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
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26
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Garland J, Kesha K, Glenn C, Stables S, Ondruschka B, Lohner L, Tse R. Heart Weight Is an Independent Factor Associated With, But Is a Poor Predictor for, Sudden Cardiac Death. Am J Forensic Med Pathol 2022; 43:18-22. [PMID: 34483235 DOI: 10.1097/paf.0000000000000711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT An enlarged heart can cause electrical instability and impaired contractility, leading to fatal arrhythmia and acute heart failure, and is associated with sudden cardiac death. However, there is limited postmortem evidence on whether heart weight is an independent factor associated with sudden cardiac death. This 18-month retrospective study examined 108 adult heart weights in which all the hearts were weighed after dissection, blood and blood clots removed, rinsed in water, and pat dried. The multivariate logistic regression analysis showed heart weight was an independent factor associated with sudden cardiac death. However, after normalization, the heart weight was a poor predictor of sudden cardiac death with an area under the curve less than 0.7 in the plotted receiver operating characteristic curve.
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Affiliation(s)
- Jack Garland
- From the Forensic and Analytical Science Service, NSW Health Pathology, New South Wales, Australia
| | - Kilak Kesha
- Northern Forensic Pathology Service of New Zealand, Auckland, New Zealand
| | - Charley Glenn
- Northern Forensic Pathology Service of New Zealand, Auckland, New Zealand
| | - Simon Stables
- Northern Forensic Pathology Service of New Zealand, Auckland, New Zealand
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Larissa Lohner
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kedzierski N, Hernandez M. Blackout Brownie: A Final Dessert Case Study. J Anal Toxicol 2022; 46:e105-e109. [PMID: 35137122 DOI: 10.1093/jat/bkac008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/27/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Cannabis products have been becoming more widely accepted as a recreational drug and for medicinal purposes to aid in various ailments. This paper reports a death after acute ingestion of an edible cannabis brownie. The 65-year-old female decedent with a history of chronic pain ingested an edible cannabis brownie after other alternative edibles and prescribed medication produced no desired effects. After consuming the cannabis product with her husband, both began feeling high and nauseated. The decedent was last seen alive by her husband stopped part way up the stairs prior to him going to sleep. She was found expired at the base of the stairs the following morning with no apparent trauma. The autopsy concluded the decedent was obese with severe ischemic cardiovascular disease. The toxicology report detected delta-9-tetrahydrocannabinol present at greater than 5000 ng/mL in the decedent's central blood at the time of sample collection. The final cause of death was ruled as natural due to cardiovascular disease with cannabis present in her system.
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Affiliation(s)
- Nancy Kedzierski
- Toxicology Department, Orange County Crime Laboratory, 320 N. Flower St., Santa Ana, CA 92703 USA
| | - Melanie Hernandez
- Toxicology Department, Orange County Crime Laboratory, 320 N. Flower St., Santa Ana, CA 92703 USA
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28
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Aitken-Buck HM, Moore M, Whalley GA, Lohner L, Ondruschka B, Coffey S, Tse RD, Lamberts RR. Estimating heart mass from heart volume as measured from post-mortem computed tomography. Forensic Sci Med Pathol 2022; 18:333-342. [PMID: 35478080 PMCID: PMC9587075 DOI: 10.1007/s12024-022-00478-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 12/14/2022]
Abstract
Heart mass can be predicted from heart volume as measured from post-mortem computed tomography (PMCT), but with limited accuracy. Although related to heart mass, age, sex, and body dimensions have not been included in previous studies using heart volume to estimate heart mass. This study aimed to determine whether heart mass estimation can be improved when age, sex, and body dimensions are used as well as heart volume. Eighty-seven (24 female) adult post-mortem cases were investigated. Univariable predictors of heart mass were determined by Spearman correlation and simple linear regression. Stepwise linear regression was used to generate heart mass prediction equations. Heart mass estimate performance was tested using median mass comparison, linear regression, and Bland-Altman plots. Median heart mass (P = 0.0008) and heart volume (P = 0.008) were significantly greater in male relative to female cases. Alongside female sex and body surface area (BSA), heart mass was univariably associated with heart volume in all cases (R2 = 0.72) and in male (R2 = 0.70) and female cases (R2 = 0.64) when segregated. In multivariable regression, heart mass was independently associated with age and BSA (R2 adjusted = 0.46-0.54). Addition of heart volume improved multivariable heart mass prediction in the total cohort (R2 adjusted = 0.78), and in male (R2 adjusted = 0.74) and female (R2 adjusted = 0.74) cases. Heart mass estimated from multivariable models incorporating heart volume, age, sex, and BSA was more predictive of actual heart mass (R2 = 0.75-0.79) than models incorporating either age, sex, and BSA only (R2 = 0.48-0.57) or heart volume only (R2 = 0.64-0.73). Heart mass can be more accurately predicted from heart volume measured from PMCT when combined with the classical predictors, age, sex, and BSA.
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Affiliation(s)
- Hamish M Aitken-Buck
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, 9054, New Zealand.
| | - Matthew Moore
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gillian A Whalley
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Larissa Lohner
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sean Coffey
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rexson D Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Regis R Lamberts
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, 9054, New Zealand
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Buja LM, Zhao B, Segura A, Lelenwa L, McDonald M, Michaud K. Cardiovascular pathology: guide to practice and training. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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30
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Chahal CAA, Tester DJ, Fayyaz AU, Jaliparthy K, Khan NA, Lu D, Khan M, Sahoo A, Rajendran A, Knight JA, Simpson MA, Behr ER, So EL, St. Louis EK, Reichard RR, Edwards WD, Ackerman MJ, Somers VK. Confirmation of Cause of Death Via Comprehensive Autopsy and Whole Exome Molecular Sequencing in People With Epilepsy and Sudden Unexpected Death. J Am Heart Assoc 2021; 10:e021170. [PMID: 34816733 PMCID: PMC9075361 DOI: 10.1161/jaha.121.021170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Sudden cardiac arrest is the leading mode of death in the United States. Epilepsy affects 1% of Americans; yet epidemiological data show a prevalence of 4% in cases of sudden cardiac arrest. Sudden unexpected death in epilepsy (SUDEP) may share features with sudden cardiac arrest. The objective of this study was to report autopsy and genomic findings in a large cohort of SUDEP cases. Methods and Results Mayo Clinic Sudden Death Registry containing cases (ages 0–90 years) of sudden unexpected and unexplained deaths 1960 to present was queried. Exome sequencing performed on decedent cases. From 13 687 cases of sudden death, 656 (4.8%) had a history of seizures, including 368 confirmed by electroencephalography, 96 classified as SUDEP, 58 as non‐SUDEP, and 214 as unknown (insufficient records). Mean age of death in SUDEP was 37 (±19.7) years; 56 (58.3%) were male; 65% of deaths occurred at night; 54% were found in bed; and 80.6% were prone. Autopsies were obtained in 83 cases; bystander coronary artery disease was frequently reported as cause of death; nonspecific fibrosis was seen in 32.6% of cases, in structurally normal hearts. There were 4 cases of Dravet syndrome with pathogenic variants in SCN1A gene. Using whole exome sequencing in 11 cases, 18 ultrarare nonsynonymous variants were identified in 6 cases including CACNB2, RYR2, CLNB, CACNA1H, and CLCN2. Conclusions This study examined one of the largest single‐center US series of SUDEP cases. Several cases were reclassified as SUDEP, 15% had an ECG when alive, and 11 (11.4%) had blood for whole exome sequencing analysis. The most frequent antemortem genetic finding was pathogenic variants in SCN1A; postmortem whole exome sequencing identified 18 ultrarare variants.
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Affiliation(s)
- C. Anwar A. Chahal
- Mayo Clinic Graduate School of Biomedical SciencesMayo ClinicRochesterMN
- WellSpan Center for Inherited Cardiovascular DiseasesWellSpan HealthPA
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Division of CardiologyDepartment of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| | - David J. Tester
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Department of Molecular Pharmacology & Experimental TherapeuticsWindland Smith Rice Sudden Death Genomic LaboratoryMayo ClinicRochesterMN
| | - Ahmed U. Fayyaz
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Department of Laboratory Medicine & PathologyMayo ClinicRochesterMN
| | - Keerthi Jaliparthy
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Department of MedicineMayo ClinicRochesterMN
- Mayo Clinic College of MedicineMayo ClinicRochesterMN
| | | | - Dongmei Lu
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Mayo Clinic College of MedicineMayo ClinicRochesterMN
| | - Mariha Khan
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | | | | | | | | | - Elijah R. Behr
- Cardiology Section and Cardiovascular Clinical Academic GroupSt George’s, University of LondonLondonUnited Kingdom
- St George’s University Hospitals’ NHS Foundation TrustLondonUnited Kingdom
| | - Elson L. So
- Department of NeurologyMayo ClinicRochesterMN
| | - Erik K. St. Louis
- Mayo Clinic College of MedicineMayo ClinicRochesterMN
- Department of NeurologyMayo ClinicRochesterMN
- Mayo Center for Sleep MedicineMayo ClinicRochesterMN
| | - R. Ross Reichard
- Department of Laboratory Medicine & PathologyMayo ClinicRochesterMN
| | | | | | - Virend K. Somers
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Mayo Clinic College of MedicineMayo ClinicRochesterMN
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Müller LO, Fossan FE, Bråten AT, Jørgensen A, Wiseth R, Hellevik LR. Impact of baseline coronary flow and its distribution on fractional flow reserve prediction. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3246. [PMID: 31397083 DOI: 10.1002/cnm.3246] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/27/2019] [Accepted: 07/25/2019] [Indexed: 06/10/2023]
Abstract
Model-based prediction of fractional flow reserve (FFR) in the context of stable coronary artery disease (CAD) diagnosis requires a number of modelling assumptions. One of these assumptions is the definition of a baseline coronary flow, ie, total coronary flow at rest prior to the administration of drugs needed to perform invasive measurements. Here we explore the impact of several methods available in the literature to estimate and distribute baseline coronary flow on FFR predictions obtained with a reduced-order model. We consider 63 patients with suspected stable CAD, for a total of 105 invasive FFR measurements. First, we improve a reduced-order model with respect to previous results and validate its performance versus results obtained with a 3D model. Next, we assess the impact of a wide range of methods to impose and distribute baseline coronary flow on FFR prediction, which proved to have a significant impact on diagnostic performance. However, none of the proposed methods resulted in a significant improvement of prediction error standard deviation. Finally, we show that intrinsic uncertainties related to stenosis geometry and the effect of hyperemic inducing drugs have to be addressed in order to improve FFR prediction accuracy.
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Affiliation(s)
- Lucas O Müller
- Department of Structural Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| | - Fredrik E Fossan
- Department of Structural Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anders T Bråten
- Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arve Jørgensen
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rune Wiseth
- Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Leif R Hellevik
- Department of Structural Engineering, Norwegian University of Science and Technology, Trondheim, Norway
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Garland J, Kesha K, Glenn C, Morrow P, Stables S, Ondruschka B, Lohner L, Tse R. The effects of drying the rinsed dissected heart on postmortem heart weight. J Forensic Sci 2021; 67:251-256. [PMID: 34382207 DOI: 10.1111/1556-4029.14858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/26/2022]
Abstract
Blood and blood clots should be removed from the heart chambers before being weighed. The actual method in removing blood and blood clots may vary and can include manual removal with subsequent rinsing the heart in water. It is unclear whether drying the rinsed heart affects the heart weight. The objective of this article was to investigate the effects drying the rinsed dissected heart (residual rinsing water) on postmortem heart weight. The prospective study compared 44 dissected heart weights after being rinsed and after being pat dried. An average 18-20 g of residual rinsing water (4% of heart weight) was present in the dissected heart. The amount of residual rinsing water correlates positively with heart weight. The effects of drying the rinsed dissected heart were considered clinically insignificant. Although being clinically insignificant, this study highlights the lack of standardized approach in weighing the heart and the potential implications in interpreting heart weights.
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Affiliation(s)
- Jack Garland
- Forensic and Analytical Science Service, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Kilak Kesha
- Northern Forensic Pathology Service of New Zealand, Auckland, New Zealand
| | - Charley Glenn
- Northern Forensic Pathology Service of New Zealand, Auckland, New Zealand
| | - Paul Morrow
- Northern Forensic Pathology Service of New Zealand, Auckland, New Zealand
| | - Simon Stables
- Northern Forensic Pathology Service of New Zealand, Auckland, New Zealand
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Larissa Lohner
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rexson Tse
- Northern Forensic Pathology Service of New Zealand, Auckland, New Zealand.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Eslami V, Kimberley Molina D, Ákos Szabó C. Definite SUDEP population in Bexar County, Texas: A 36-year data registry. Epilepsy Behav 2021; 121:108005. [PMID: 34052632 DOI: 10.1016/j.yebeh.2021.108005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Sudden unexplained death in epilepsy (SUDEP) is one of the leading causes of mortality in epilepsy. In this study, cases of definite SUDEP are reported for Bexar County from a 36-year period. METHODS Death reports by Bexar County Medical Examiner (BCME) from 1983 to 2018 were reviewed to identify cases with definite SUDEP. The findings were based upon investigators' reports, which included medical history, medication list, sleep position, time of death, and pathology reports. In addition to these potential risk factors, body mass indices (BMI), as well as heart, lung, and brain weights were compared between SUDEP victims with therapeutic vs subtherapeutic anti-seizure medication (ASM) levels. RESULTS Definite SUDEP was identified in 286 cases. The incidence of definite SUDEP was 0.51 ± 0.26/1000 person-years among PWE and 0.56 ± 0.29 per 100,000 person-years among the general population in Bexar County. The median age was 37 years old (interquartile range 27-48), and the majority were male (65%). While 171 (60%) people were prescribed at least one ASM, ASM levels were subtherapeutic in 239 cases (83.6%). Risk factors for SUDEP did not differ between SUDEP victims with therapeutic vs subtherapeutic ASM levels. While BMIs were only slightly increased in adherent vs nonadherent SUDEP victims, they were significantly associated with subtherapeutic ASM levels. Abnormal lung, heart, and brain weights were reported in 48 (16.8%), 67 (23.4%), and 43 (15.0%) SUDEP cases, respectively. SIGNIFICANCE This study is one of the largest autopsy-based registries of definite SUDEP. Subtherapeutic ASM levels measured in post-mortem blood samples suggest that nonadherence to ASM therapy was a leading risk factor for SUDEP. As BMI was elevated in this cohort, and obesity was significantly associated with subtherapeutic ASM levels, it may also be a risk factor for SUDEP. Case-controlled studies are needed to validate the specific role of obesity and related comorbidities in this population.
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Affiliation(s)
- Vahid Eslami
- Department of Neurology, University of Health Science Center at San Antonio, TX, United States
| | - D Kimberley Molina
- Bexar County's Medical Examiner's Office, San Antonio, TX, United States
| | - Charles Ákos Szabó
- Department of Neurology, University of Health Science Center at San Antonio, TX, United States; South Texas Comprehensive Epilepsy Center, San Antonio, TX, United States.
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Retrospective Analysis of Sudden Cardiac Deaths in a 10-Year Autopsy Series in the City of Isparta in Turkey. Am J Forensic Med Pathol 2021; 41:263-268. [PMID: 32740105 DOI: 10.1097/paf.0000000000000593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sudden cardiac death (SCD) is an important public health problem that accounts for approximately 15% to 20% of global deaths. Our retrospective study aimed to analyze etiological distribution and epidemiological data of 128 cases with SCD as death cause based on autopsies between 2010 and 2019. The mean age of SCD cases was 57.09, with the highest incidence in older than 60 years (43.8%). Male/female ratio was 4.5:1, peaking with 9.2:1 in the 41- to 60-year age group. Deaths occurred mostly at home (41.4%). Coronary atherosclerotic heart disease (CAD) was main SCD cause (65.6%) with cardiac tamponade (10.9%), unexplained SCD (8.6%), and hypertrophic cardiomyopathy (7.8%) after it. A total of 71.2% of CAD cases had coronary artery stenosis of greater than 75% and 92.9% had atherosclerotic degeneration in the left anterior descending artery. Based on the body mass index-based normal heart weights table, 91.7% of CAD cases had cardiomegaly. This study showed CAD, cardiomegaly, and high body mass index concurrence as a very important SCD risk. Because SCD incidence increases in older than 40 years, determining risk groups through regular medical examinations and inspections, older than 30 years would provide implementation of preventive measures. Some cardiac diseases causing sudden death are undetectable despite detailed autopsy and histopathological examinations. Including postmortem cardiogenetic analysis among routine techniques in sudden deaths would lower sudden unexplained death diagnosis rates.
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Ventricular Weight Increases Proportionally With Total Heart Weight in Postmortem Population. Am J Forensic Med Pathol 2021; 41:259-262. [PMID: 32501818 DOI: 10.1097/paf.0000000000000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Heart weight is routinely measured at postmortem examination and is critical to determine whether the heart is enlarged (ie, cardiomegaly). Cardiomegaly has the potential to cause sudden death by being electrically unstable, resulting in fatal arrhythmias. The majority of fatal cardiac arrhythmias is ventricular in origin and is assumed that ventricular size is disproportionately larger in cardiomegaly. This prospective study compared ventricular weight (VW) and total heart weight (THW) in 40 consecutive cases. The results, unexpectedly, showed that VW increases proportionally and linearly with THW in normal and enlarged hearts (THW, >500 g) and did not increase disproportionally with increased THW. The ratio of VW/THW did not have any significant correlation or difference with sex, height, weight, and cardiac causes of death but did have a negative correlation with age. Further studies are indicated to document the morphological changes when the heart enlarges, which may aid in understanding the pathophysiology of sudden death from cardiomegaly.
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Basso C, Michaud K, d'Amati G, Banner J, Lucena J, Cunningham K, Leone O, Vink A, van der Wal AC, Sheppard MN. Cardiac hypertrophy at autopsy. Virchows Arch 2021; 479:79-94. [PMID: 33740097 PMCID: PMC8298245 DOI: 10.1007/s00428-021-03038-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 12/31/2022]
Abstract
Since cardiac hypertrophy may be considered a cause of death at autopsy, its assessment requires a uniform approach. Common terminology and methodology to measure the heart weight, size, and thickness as well as a systematic use of cut off values for normality by age, gender, and body weight and height are needed. For these reasons, recommendations have been written on behalf of the Association for European Cardiovascular Pathology. The diagnostic work up implies the search for pressure and volume overload conditions, compensatory hypertrophy, storage and infiltrative disorders, and cardiomyopathies. Although some gross morphologic features can point to a specific diagnosis, systematic histologic analysis, followed by possible immunostaining and transmission electron microscopy, is essential for a final diagnosis. If the autopsy is carried out in a general or forensic pathology service without expertise in cardiovascular pathology, the entire heart (or pictures) together with mapped histologic slides should be sent for a second opinion to a pathologist with such an expertise. Indication for postmortem genetic testing should be integrated into the multidisciplinary management of sudden cardiac death.
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Affiliation(s)
- Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giulia d'Amati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Jytte Banner
- Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Joaquin Lucena
- Forensic Pathology Service, Institute of Legal Medicine and Forensic Sciences, Seville, Spain
| | - Kristopher Cunningham
- Department of Laboratory Medicine and Pathobiology, Ontario Forensic Pathology Service, University of Toronto, Toronto, Canada
| | - Ornella Leone
- Cardiovascular and Cardiac Transplant Pathology Unit, Department of Pathology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Aryan Vink
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Mary N Sheppard
- Department of Cardiovascular Pathology, Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's Medical School, London, UK
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Wach A, Faßbender C, Ackermann H, Parzeller M. [A retrospective mortality analysis of natural deaths of the 65+ generation based on postmortem autopsies performed at the Institute of Legal Medicine in Frankfurt am Main during two periods]. Rechtsmedizin (Berl) 2021; 31:509-519. [PMID: 33716407 PMCID: PMC7938877 DOI: 10.1007/s00194-021-00469-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY In Germany, a constant demographic change is taking place, which leads to an increasing aging of the society. The present study aimed to analyze natural deaths occurring at an age of ≥ 65 years, since health vulnerability in this age group is gaining importance. MATERIAL AND METHODS Autopsy reports of the Institute of Forensic Medicine, University Hospital of the Goethe University Frankfurt/Main, Germany, were retrospectively evaluated regarding natural death cases of ≥ 65-year-olds in a time comparison (period I: 2000-2002; period II: 2013-2015). RESULTS During both periods, a total of 1206 autopsies concerning this age group were performed. Among these, 404 cases (33.5%) of unnatural death and 39 cases (3.2%) of a combination of natural and unnatural death were recorded; in 94 cases (7.8%), the manner of death could not be elucidated. The majority (n = 669; 55.5%) included cases of natural death. In the largest group of these (n = 350; 52.3%), cardiac causes of death were predominant, followed by 132 (19.7%) respiratory and 47 (7.0%) abdominal causes of death. In addition, 37 (5.5%) cases of malignant neoplasms, 33 (4.9%) of ruptures of large vessels, 33 (4.9%) of cerebral, and 37 (5.5%) other cases of natural death were noted. A significant decrease of cardiac causes of death was observed in the comparison of periods I and II. In particular, there was a significant decrease in high-grade occlusive coronary sclerosis. Moreover, there were significant differences between both sexes. Men had significantly more bypasses, stents and heart scars and suffered a myocardial infarction about 10 years earlier than women. CONCLUSION The results of the present study are largely consistent with the literature. The decrease in numbers of cardiac deaths may be attributed to increasingly better medical care and to a significantly higher rate of stent implantation. Especially in times of pandemics, the role of forensic gerontology will become more important.
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Affiliation(s)
- A. Wach
- Institut für Rechtsmedizin, Universitätsklinikum, Goethe-Universität Frankfurt a.M., Kennedyallee 104, 60596 Frankfurt am Main, Deutschland
| | - C. Faßbender
- Institut für Rechtsmedizin, Universitätsklinikum, Goethe-Universität Frankfurt a.M., Kennedyallee 104, 60596 Frankfurt am Main, Deutschland
| | - H. Ackermann
- Institut für Biostatistik und Mathematische Modellierung, Zentrum der Gesundheitswissenschaften, Klinikum und Fachbereich Medizin, Goethe-Universität Frankfurt a.M., Frankfurt am Main, Deutschland
| | - M. Parzeller
- Institut für Rechtsmedizin, Universitätsklinikum, Goethe-Universität Frankfurt a.M., Kennedyallee 104, 60596 Frankfurt am Main, Deutschland
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Establishment of Reference Ranges for Normal Organ Weights in Malaysian Adults at Autopsy. Am J Forensic Med Pathol 2020; 41:110-114. [PMID: 32205487 DOI: 10.1097/paf.0000000000000539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Organ weights are routinely measured during autopsies as a crude screening tool to detect possible organ pathology. In several centers, inclusion of major organ weights indicates whether an autopsy report has achieved its standard of practice, which in turn should be subjected to an audit. Previous studies show statistical variation in organ weights across different populations. Malaysian pathologists have relied on Western data and crude subjective determination in the interpretation of normal organ weights. Hence, the need for a reference range as a guide for pathologists is acute. Organ weights from traumatic deaths between 2004 and 2017 were analyzed in the UKM Medical Centre. Statistical analysis was performed to form reference ranges for normal weights of the brain, heart, lung, liver, spleen, and kidneys. In addition, the data were compared between sexes, races, and body mass index values to determine whether organ weights were affected by these parameters. In this study, reference ranges for organ weights are presented for Malaysian adult men and women.
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Ghormade PS, Soni JP, Sarma B, Dash SK. Autopsy findings in death due to Eisenmenger syndrome: A medico-legal case of road traffic accident. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2020. [DOI: 10.1016/j.fsir.2019.100040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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40
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Javanshiri K, Haglund M, Englund E. Cardiovascular Disease, Diabetes Mellitus, and Hypertension in Lewy Body Disease: A Comparison with Other Dementia Disorders. J Alzheimers Dis 2020; 71:851-859. [PMID: 31450500 PMCID: PMC6839595 DOI: 10.3233/jad-190485] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Research concerning the potential roles of cardiovascular disease (CaVD) and diabetes mellitus (DM) as risk factors for Lewy body disease (LBD) is limited. These disorders are, however, established risk factors for vascular dementia (VaD) and have been proposed as risk factors for Alzheimer’s disease (AD). Objective: The aim of this study was to investigate the prevalence of CaVD and DM in LBD and compare the results with previous findings in cases with AD, VaD, and mixed AD-VaD (MD). Methods: Autopsy reports at the Clinical Department of Pathology in Lund from 2001–2018 were analyzed. All cases with a complete neuropathological diagnosis of LBD were selected, not distinguishing between subjects with clinical Parkinson disease dementia and dementia with Lewy bodies, on the condition of a clinical diagnosis of dementia. Clinical data were retrieved through the patients’ medical records and the Swedish National Diabetes Register (NDR) and compared with those of the AD, VaD, and MD cases. Results: In LBD, there was less CaVD, significantly less DM (p = 0.002) and likewise significantly less hypertension (p < 0.001) than in VaD. The results of the LBD group were consistent with the results of the AD group. Conclusion: Our findings of a low prevalence of CaVD and CaVD risk factors in LBD and in AD argue against the association between these risk factors and their contribution to the development of neurodegenerative diseases.
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Affiliation(s)
- Keivan Javanshiri
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Sweden; Department of Clinical Pathology, Lab Medicine, Region Skane, Sweden
| | - Mattias Haglund
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Sweden; Department of Clinical Pathology, Lab Medicine, Region Skane, Sweden
| | - Elisabet Englund
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Sweden; Department of Clinical Pathology, Lab Medicine, Region Skane, Sweden
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Schoppen ZJ, Balmert LC, White S, Olson R, Arunkumar P, Dellefave‐Castillo LM, Puckelwartz MJ, George AL, McNally EM, Webster G. Prevalence of Abnormal Heart Weight After Sudden Death in People Younger than 40 Years of Age. J Am Heart Assoc 2020; 9:e015699. [PMID: 32885733 PMCID: PMC7726998 DOI: 10.1161/jaha.120.015699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background After sudden cardiac death in people aged <40 years, heart weight is a surrogate for cardiomegaly and a marker for cardiomyopathy. However, thresholds for cardiomegaly based on heart weight have not been validated in a cohort of cases of sudden cardiac death in young people. Methods and Results We surveyed medical examiner offices to determine which tools were used to assess heart weight norms. The survey determined that there was no gold standard for cardiomegaly (52 centers reported 22 different methods). We used a collection of heart weight data from sudden deaths in the Northwestern Sudden Death Collaboration (NSDC) to test the 22 methods. We found that the methods reported in our survey had little consistency: they classified between 18% and 81% of NSDC hearts with cardiomegaly. Therefore, we obtained biometric and postmortem data from a reference population of 3398 decedents aged <40 years. The reference population was ethnically diverse and had no known cardiac pathology on autopsy or histology. We derived and validated a multivariable regression model to predict normal heart weights and a threshold for cardiomegaly (upper 95% CI limit) in the young reference population (the Chicago model). Using the new model, the prevalence of cardiomegaly in hearts from the NSDC was 19%. Conclusions Medical examiner offices use a variety of tools to classify cardiomegaly. These approaches produce inconsistent results, and many overinterpret cardiomegaly. We recommend the model proposed to classify postmortem cardiomegaly in cases of sudden cardiac death in young people.
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Affiliation(s)
- Zachary J. Schoppen
- Division of CardiologyAnn & Robert H. Lurie Children’s Hospital of ChicagoNorthwestern University Feinberg School of MedicineChicagoIL
| | - Lauren C. Balmert
- Department of Preventive Medicine (Biostatistics)Northwestern University Feinberg School of MedicineChicagoIL
| | | | - Rachael Olson
- Division of CardiologyAnn & Robert H. Lurie Children’s Hospital of ChicagoNorthwestern University Feinberg School of MedicineChicagoIL
| | | | - Lisa M. Dellefave‐Castillo
- Center for Genetic Medicine and Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Megan J. Puckelwartz
- Department of PharmacologyNorthwestern University Feinberg School of MedicineChicagoIL
- Center for Genetic Medicine and Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Alfred L. George
- Department of PharmacologyNorthwestern University Feinberg School of MedicineChicagoIL
| | - Elizabeth M. McNally
- Center for Genetic Medicine and Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Gregory Webster
- Division of CardiologyAnn & Robert H. Lurie Children’s Hospital of ChicagoNorthwestern University Feinberg School of MedicineChicagoIL
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42
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Kitulwatte IDG, Edirisinghe PAS. Study on existence of inflammation in the myocardium in unequivocal acute traumatic deaths. J Forensic Leg Med 2020; 75:102055. [PMID: 32949899 DOI: 10.1016/j.jflm.2020.102055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/02/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Over-diagnosis of myocarditis is possible, where presence of scant/negligible inflammatory foci are interpreted as active myocarditis in autopsy cases. A Prospective descriptive study on 100 young healthy individuals who died of known sudden traumatic causes was performed to study the existence, frequency and severity of inflammatory foci in myocardium of a normal population who died suddenly of acute trauma, in order to develop an autopsy diagnostic criteria. RESULTS Out of 100 hearts, 48 had scant inflammatory foci. Thirteen had mild inflammation and three with moderate inflammation. Presence of scant inflammation was significantly associated with the age of the individual (P = 0.0182). However, the presence or severity of inflammation did not show any significant association with the clinical symptoms (P = 0.4924), gross pathology (P = 0.3954) or weight of the heart (P = 0.3109). CONCLUSIONS Presence of scant inflammation in the myocardium is a common occurrence and it may be an age related change, which cannot account for the cause of death. Much severe forms of myocarditis with no clinically apparent picture could exist among young individuals. Thus, in the absence of other causes of death, conclusion of myocarditis as a cause of death in these cases needs a careful evaluation of other positive signs.
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Affiliation(s)
- I D G Kitulwatte
- Department of Forensic Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
| | - P A S Edirisinghe
- Department of Forensic Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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43
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Stader F, Siccardi M, Battegay M, Kinvig H, Penny MA, Marzolini C. Repository Describing an Aging Population to Inform Physiologically Based Pharmacokinetic Models Considering Anatomical, Physiological, and Biological Age-Dependent Changes. Clin Pharmacokinet 2020; 58:483-501. [PMID: 30128967 DOI: 10.1007/s40262-018-0709-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Aging is characterized by anatomical, physiological, and biological changes that can impact drug kinetics. The elderly are often excluded from clinical trials and knowledge about drug kinetics and drug-drug interaction magnitudes is sparse. Physiologically based pharmacokinetic modeling can overcome this clinical limitation but detailed descriptions of the population characteristics are essential to adequately inform models. OBJECTIVE The objective of this study was to develop and verify a population database for aging Caucasians considering anatomical, physiological, and biological system parameters required to inform a physiologically based pharmacokinetic model that included population variability. METHODS A structured literature search was performed to analyze age-dependent changes of system parameters. All collated data were carefully analyzed, and descriptive mathematical equations were derived. RESULTS A total of 362 studies were found of which 318 studies were included in the analysis as they reported rich data for anthropometric parameters and specific organs (e.g., liver). Continuous functions could be derived for most system parameters describing a Caucasian population from 20 to 99 years of age with variability. Areas with sparse data were identified such as tissue composition, but knowledge gaps were filled with plausible qualified assumptions. The developed population was implemented in Matlab® and estimated system parameters from 1000 virtual individuals were in accordance with independent observed data showing the robustness of the developed population. CONCLUSIONS The developed repository for aging subjects provides a singular specific source for key system parameters needed for physiologically based pharmacokinetic modeling and can in turn be used to investigate drug kinetics and drug-drug interaction magnitudes in the elderly.
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Affiliation(s)
- Felix Stader
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland. .,Infectious Disease Modelling Unit, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Marco Siccardi
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Hannah Kinvig
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Melissa A Penny
- Infectious Disease Modelling Unit, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Eberhardt N, Sanmarco LM, Bergero G, Favaloro RR, Vigliano C, Aoki MP. HIF-1α and CD73 expression in cardiac leukocytes correlates with the severity of myocarditis in end-stage Chagas disease patients. J Leukoc Biol 2020; 109:233-244. [PMID: 32450615 DOI: 10.1002/jlb.4ma0420-125r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/25/2020] [Accepted: 04/30/2020] [Indexed: 12/13/2022] Open
Abstract
Chronic Chagas cardiomyopathy is the main infectious myocarditis worldwide. Almost 30% of Trypanosoma cruzi infected individuals develop slow and progressive myocarditis that leads to ventricular dilation and heart failure. Heart transplantation is an established, valuable therapeutic option for end-stage Chagas disease patients. Although the pathophysiology of Chagas disease has been addressed for decades by numerous groups, the cardiac immunologic mechanisms involved in the progression of clinical manifestation are still unknown. Growing evidence demonstrates that hypoxia-inducible factor (HIF)-1α plays indispensable roles in driving immune response by triggering the expression of CD73 purinergic ecto-enzyme. Purinergic system controls the duration and magnitude of purine signals directed to modulate immune cells through the conversion of extracellular ATP (microbicide/proinflammatory) to the immunoregulatory metabolite adenosine. In the present work, we described that infiltrating leukocytes within cardiac explants from patients with end-stage Chagas cardiomyopathy up-regulated HIF-1α and CD73 expression. Moreover, the number of HIF-1α+ and CD73+ leukocytes positively correlated with the myocarditis severity and the local parasite load. Furthermore, we demonstrated a direct relationship between tissue parasite persistence and the influx of immune cells to the infected hearts, which ultimately determine the severity of the myocarditis. These findings provide evidence that CD73-dependent regulatory pathways are locally triggered in the myocardium of patients with end-stage Chagas disease.
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Affiliation(s)
- Natalia Eberhardt
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Córdoba, Argentina.,Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Liliana Maria Sanmarco
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Córdoba, Argentina.,Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina.,Brigham and Women's Hospital, Department of Neurology, Harvard Institute of Medicine, Boston, Massachusetts, USA
| | - Gastón Bergero
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Córdoba, Argentina.,Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Roberto René Favaloro
- Departamento de Cirugía cardiovascular, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Carlos Vigliano
- Hospital Universitario Fundación Favaloro, Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
| | - Maria Pilar Aoki
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Córdoba, Argentina.,Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
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45
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Loper N, Garland J, Ondruschka B, Glenn C, Kesha K, Stables S, Tse R. Significant Differences in PostMortem Heart Weight Before and After Dissection Using the Short-Axis Dissecting Method. J Forensic Sci 2020; 65:1563-1567. [PMID: 32396225 DOI: 10.1111/1556-4029.14451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/09/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
Correctly assessing heart weight can be critical at postmortem examination. The current international guidelines advocate using the short-axis method in dissecting the heart and the heart weighed when the blood is emptied. However, it did not specify at what point the heart should be weighed or how the blood should be emptied. This study compared heart weights at three different time points during the heart examination (immediately after dissecting out of the pericardial sac with blood still in chambers, blood washed/removed from heart chambers without the heart opened, and the heart completely opened, blood emptied, and pad dried). This was to illustrate the variation in measurement and potential errors when the heart is weighed at different time of dissection. The results show that there were statistical and clinical significant differences between the heart weights at each weighing points. We recommend the heart to be completely dissected with any blood and residual washing/rinsing water emptied before being weighed. Although performed in this study, the effect of pad drying the heart on heart weight was not explored and was a limitation in this study.
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Affiliation(s)
- Nicole Loper
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland, 1023, New Zealand
| | - Jack Garland
- Forensic and Analytical Science Service, NSW Health Pathology, 480 Weeroona Road, Lidcombe, NSW, 2124, Australia
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University of Leipzig, Augustusplatz 10, Leipzig, 04109, Germany
| | - Charley Glenn
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, 2 Park Road, Auckland, 1023, New Zealand
| | - Kilak Kesha
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, 2 Park Road, Auckland, 1023, New Zealand
| | - Simon Stables
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, 2 Park Road, Auckland, 1023, New Zealand
| | - Rexson Tse
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland, 1023, New Zealand.,Department of Forensic Pathology, LabPLUS, Auckland City Hospital, 2 Park Road, Auckland, 1023, New Zealand
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46
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Aktuelle Normwerte der Organgewichte und -indizes für die rechtsmedizinische Praxis, Teil 1. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-019-00370-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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47
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Gross and Histopathological Findings in the First Reported Vaping-Induced Lung Injury Death in the United States. Am J Forensic Med Pathol 2020; 41:1-4. [PMID: 31977349 DOI: 10.1097/paf.0000000000000533] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The popularity of e-cigarettes (vaping) has been on the rise in recent years, but the adverse effects of vaping have been greatly unknown. In 2019, the use of vaping products has been linked to an outbreak of severe lung disease, some cases of which have progressed to death. One death attributed to vaping is presented with emphasis on the gross and histopathological findings from the autopsy. These findings were correlated with the patient's clinical course and medicolegal investigation to determine the cause of death. To our knowledge, this is the first confirmed death in the United States that was directly attributed to the use of vaping.
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48
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Noll C, Montastier É, Amrani M, Kunach M, Frisch F, Fortin M, Bouffard L, Dubreuil S, Phoenix S, Cunnane SC, Guérin B, Turcotte EE, Laville M, Carpentier AC. Seven-day overfeeding enhances adipose tissue dietary fatty acid storage and decreases myocardial and skeletal muscle dietary fatty acid partitioning in healthy subjects. Am J Physiol Endocrinol Metab 2020; 318:E286-E296. [PMID: 31891539 DOI: 10.1152/ajpendo.00474.2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Increased myocardial partitioning of dietary fatty acids (DFA) and decreased left ventricular (LV) function is associated with insulin resistance in prediabetes. We hypothesized that enhanced myocardial DFA partitioning and reduced LV function might be induced concomitantly with reduced insulin sensitivity upon a 7-day hypercaloric (+50% in caloric intake), high-saturated fat (~11%energy), and simple carbohydrates (~54%energy) diet (HIGHCAL) versus an isocaloric diet (ISOCAL) with a moderate amount of saturated fat (~8%energy) and carbohydrates (~50%energy). Thirteen healthy subjects (7 men/6 women) underwent HIGHCAL versus ISOCAL in a randomized crossover design, with organ-specific DFA partitioning and LV function measured using the oral 14(R,S)-[18F]fluoro-6-thia-heptadecanoic acid and [11C]acetate positron emission tomography methods at the end of both interventions. HIGHCAL induced a decrease in insulin sensitivity indexes with no significant change in body composition. HIGHCAL led to increased subcutaneous abdominal (+4.2 ± 1.6%, P < 0.04) and thigh (+2.4 ± 1.2%, P < 0.08) adipose tissue storage and reduced cardiac (-0.31 ± 0.11 mean standard uptake value [(SUV), P < 0.03] and skeletal muscle (-0.17 ± 0.08 SUV, P < 0.05) DFA partitioning without change in LV function. We conclude that early increase in adipose tissue DFA storage protects the heart and skeletal muscles from potential deleterious effects of DFA.
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Affiliation(s)
- Christophe Noll
- Division of Endocrinology, Department of Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Émilie Montastier
- Division of Endocrinology, Department of Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mehdi Amrani
- Division of Endocrinology, Department of Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Margaret Kunach
- Division of Endocrinology, Department of Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Frédérique Frisch
- Division of Endocrinology, Department of Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mélanie Fortin
- Division of Endocrinology, Department of Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Lucie Bouffard
- Division of Endocrinology, Department of Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Stéphanie Dubreuil
- Division of Endocrinology, Department of Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Serge Phoenix
- Department of Nuclear Medicine and Radiobiology, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Stephen C Cunnane
- Research Center on Aging, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Brigitte Guérin
- Department of Nuclear Medicine and Radiobiology, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Eric E Turcotte
- Department of Nuclear Medicine and Radiobiology, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Martine Laville
- Department of Endocrinology, Diabetology and Nutrition, Groupement Hospitalier Lyon Sud, Fédération Hospitalo-Universitaire DO-IT, Hospices Civils de Lyon, Pierre Bénite, France
| | - André C Carpentier
- Division of Endocrinology, Department of Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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49
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Conway K, Rayes O, Brown T, Webb M. Atherosclerotic and Hypertensive Cardiovascular Disease are Associated with Death at Sublethal Carboxyhemoglobin Levels: A Postmortem Study. J Forensic Sci 2019; 65:855-859. [PMID: 31856351 DOI: 10.1111/1556-4029.14261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/26/2019] [Accepted: 12/02/2019] [Indexed: 11/28/2022]
Abstract
Residential fires are a significant cause for morbidity and mortality in the United States. Death is often the result of soot and smoke inhalation causing carbon monoxide (CO) toxicity. The approximate lethal level of carboxyhemoglobin (COHb) in healthy adults has been well described. However, a significant number of medical examiner cases involve infirmed decedents, often elderly, with complex cardiovascular disease burdens. It is well known that death in these cases will occur at sublethal levels of COHb; however, increased lethality has been largely documented via anecdotal experience and lacks quantification. Fifty-five cases were identified where death resulted from smoke and soot inhalation suffered in a residential fire. The control group, with no cardiovascular disease, had an age-adjusted mean COHb level of 61.6% at the time of death. Presence of hypertensive cardiovascular disease showed a 30% reduction in COHb (age-adjusted mean 43.2%), atherosclerotic disease showed a 33% reduction (age-adjusted mean 41.5%), and combined disease presentation accounted for 41% reduction (age-adjusted mean 36.3%). When controlling for age, atherosclerotic and hypertensive cardiovascular diseases were each associated with statistically significant decreases in COHb (p < 0.01). Increasing age was associated with decreased COHb levels at 2.8% per 10 years of life (p < 0.01), even when modeled with hypertensive and atherosclerotic disease. These findings carry important public health significance, as well as practical significance for the medical examiner when interpreting COHb levels in cases of suspected deaths due to smoke and soot inhalation.
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Affiliation(s)
- Kyle Conway
- Department of Pathology, Michigan Medicine/University of Michigan, 2800 Plymouth Road 35-1411, Ann Arbor, MI, 48109
| | - Omar Rayes
- Wayne County Medical Examiner's Office, Michigan Medicine/University of Michigan, 1300 East Warren Avenue, Detroit, MI, 48207
| | - Theodore Brown
- Western Michigan University Homer Stryker M.D. School of Medicine, 300 Portage Street, Kalamazoo, MI, 49007
| | - Milad Webb
- Wayne County Medical Examiner's Office, Michigan Medicine/University of Michigan, 1300 East Warren Avenue, Detroit, MI, 48207
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50
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Molina DK, Vance K, Coleman ML, Hargrove VM. Testing an Age‐old Adage: Can Autopsy Findings be of Assistance in Differentiating Opioid Versus Cardiac Deaths? J Forensic Sci 2019; 65:112-116. [DOI: 10.1111/1556-4029.14174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/26/2019] [Accepted: 08/05/2019] [Indexed: 02/04/2023]
Affiliation(s)
- D. Kimberley Molina
- Bexar County Medical Examiner's Office 7337 Louis Pasteur Drive San Antonio TX78227
| | - Kathryn Vance
- Baylor University 1301 S University Parks Drive Waco TX76706
| | - Maci L. Coleman
- Baylor University 1301 S University Parks Drive Waco TX76706
| | - Veronica M. Hargrove
- Bexar County Medical Examiner's Office 7337 Louis Pasteur Drive San Antonio TX78227
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