Domestic and Community Violence in Greece After the First COVID-19 Quarantine: A Clinical Forensic Approach

Many scientists expressed their concerns regarding the impact of COVID-19-related quarantine measures on interpersonal violence, mainly concerning children and intimate partners, as well as other negative psychological effects. During early 2020, free circulation in Greece was prohibited for 42 days, up until May 4th. The aim of our study was to investigate characteristics of bodily harm allegation cases referred to the Department of Forensic Medicine and Toxicology of the Medical School of the National and Kapodistrian University of Athens, Greece, during the first month succeeding free circulation re-establishment in the broader Attica region. We also aimed to detect any possible differences regarding bodily harm allegations by comparing the corresponding time period of 2019. A decrease in community violence (CV) allegations, especially youth violence incidents, was observed in 2020. Females' victimization, as well as allegations against strangers, were also decreased. No differences were observed concerning the injury mechanism. Victims of 2020 filed the allegations faster and, thus, were examined almost one day earlier than their 2019 counterparts. During lockdown, domestic violence (DV) hotline reporting was significantly increased, but paradoxically DV cases referred to our Department were decreased. In Greece, the legislators did not foresee any specific exemption from circulation restriction for DV victims attempting to escape abuse. Our results revealed a small, but notable, impact on non-fatal interpersonal violence.

Non-Fatal Attacks by Dogs: Characteristics of Victims and Attacking Dogs, From the Forensic Perspective: A Series of 106 Cases From Athens, Greece, and Brief Review of the Literature

Introduction: The close association of dogs with humans may explain the fact that dog bites are possibly the most common animal bites recorded. The relevant data concerning Greece is scarce. We aimed to study this phenomenon by describing its characteristics.

Methods: We performed a retrospective analysis of cases concerning dog attack victims, examined our Department, between 2011 and 2019. Recorded variables included sex, age, nationality, occupation, marital status, medical history, ownership status of the dog, injury anatomic location, incident time, the timing of clinical forensic examination, incapacitation time, and medical care provided.

Statistical analysis was performed using Stata/MP 13 (Stata Corp., College Station, TX) and IBM SPSS Statistics Version 20 (IBM, Armonk, NY). Statistical significance was defined as a two-sided p value of <0.05.

Results: Most incidents involved male victims (54.2%). The victim’s mean age was 44.9 years. The dog involved was unowned in 19.8% of cases. The most frequent anatomical site of injury was the legs (48.1%). Older victims suffered injuries in more sensitive areas of the body (head and neck), when compared to younger adults. Only 1.9% of victims required hospitalization. The mean incapacitation time was estimated at 5.39 days.

Conclusions: Per our results, males tend more often to be victims of dog attacks. Typically, victims are of increased age and are attacked by a dog already known to them. Most incidents take place during late winter and spring, more specifically during February and during May. The most frequently affected anatomical sites were the legs. Older people suffered injuries in more sensitive areas of the body.

Biological rhythms of fatal myocardial infarction in Greece: an autopsy study

BACKGROUND

Biological rhythms, acting as an endogenous clock, prepare and assist the organism to function optimally during predictable seasonal and daily cycles. Many elements of the cardiovascular system exhibit specific rhythmical patterns. Besides genetic mechanisms, external stimuli may alter biological rhythms.

METHODS

The aim of this study was to investigate the patterns of biological rhythms in patients who suffered a fatal myocardial Infarction (MI), ascertained by macroscopical or histopathological examination. Cases of fatal MI examined during the time 2010-2017 were included in our study sample (827 cases in total). Medical History was also obtained for each case. The assessment of seasonal variation of fatal MI was accomplished by employing three different methods, Rayleigh Uniformity Test, X² Goodness-of-fit test and Edward's Seasonality Test. Statistical significance was defined as a 2-sided p value of <0.05.

RESULTS

Regarding the distribution of total cases, fatal MIs onset occurs more often during winter, with higher incidence in December and January. The weekly distribution of cases seems uniform. The circadian pattern presents higher frequencies of fatal MIs between 08:00 and 12:00 with the acrophase between 11:00 and 12:00. Further analysis was conducted separately, depending on the method of time-of-death reporting.

CONCLUSIONS

Taking under consideration the variation of the occurrence of MI related deaths, in accordance with the respective biological rhythms, public health policies more suitable to the individual requirements of every country's population may be adopted.

A fluorine turns a medicinal benzodiazepine into NPS: the case of flualprazolam

Purpose

The purpose of this review is to summarize the existing knowledge on flualprazolam, a novel ‘designer’ benzodiazepine that derives from the fluorination of the phenyl moiety in the ortho-position of alprazolam.

Methods

An extensive literature search was carried out in PubMed, Google Scholar and World Wide Web using relevant keywords. All articles found were gathered, and the available information is presented.

Results

This article reviews the existing knowledge on chemistry, pharmacology, toxicology, prevalence and current legal status of flualprazolam. Moreover, forensic and clinical cases where flualprazolam was involved worldwide, as well as flualprazolam seizures, along with the methods for its determination in biological samples are presented.

Conclusions

The recent flualprazolam-related cases have raised concerns to regulatory authorities and international stakeholders suggesting that flualprazolam should be under international control. The urgent international control of flualprazolam, despite the limited information on clinical effects and pharmacologic characteristics available, is an important measure for the prevention of its increasing abuse worldwide.

Study of the distribution of antidepressant drugs in vitreous humor using a validated GC/MS method

Vitreous humor has become in recent years an important alternative biological fluid in forensic toxicological analysis especially for the investigation of cases where alcohol and drugs of abuse are involved but there is limited scientific information regarding the distribution of antidepressant drugs in this material. This work aimed to study the distribution of antidepressant drugs in vitreous humor and to estimate the blood/vitreous humor concentration ratios of these drugs. For this purpose, a GC/MS method for the simultaneous determination of 9 antidepressant drugs, namely amitriptyline, nortriptyline, citalopram, clomipramine, fluoxetine, maprotiline, mirtazapine, sertraline and venlafaxine, and 4 of their metabolites, namely desmethylmaprotiline, desmethylmirtazapine, desmethylsertraline, O-desmethylvenlafaxine, was developed and validated. The developed method includes solid-phase extraction followed by derivatization with Heptafluorobutyric Anhydride. For all analytes, LOD and LOQ were 1.50 and 5.00ng/mL, respectively, and the calibration curves were linear within the dynamic range of 5.00-500.0ng/mL (R²≥0.990). The absolute recovery was found to be ≥86.3 % for all analytes. The accuracy (%Er) was found to range between -6.58 and 6.18 %, whereas the precision (%RSD) was less than 10.9 % for all analytes. The developed method was successfully applied to vitreous humor samples from 43 blood positive cases for antidepressant drugs. Whenever antidepressant drugs were detected in blood, they were also detected in the respective vitreous humor samples. The vitreous humor/blood concentration ratios were also calculated and were found to range from 0.04-7.07. Citalopram, mirtazapine, and its metabolite desmethylmirtazapine as well as venlafaxine and its metabolite O-desmethylvenlafaxine were the most identified substances in these samples (n≥4) and their results were better statistically evaluated. Our results suggest that vitreous humor could be an appropriate matrix for the determination of antidepressants in postmortem toxicology.

Impact of Covid-19 lockdown on characteristics of autopsy cases in Greece. Comparison between 2019 and 2020

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Frequency of fatal MI seems to remain unaffected by the COVID-19 pandemic.

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Deaths resulting from road traffic accidents exhibit a significant decrease.

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Homicides and suicides remain unaffected by the COVID-19 outbreak.

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Emergency measures prevented overwhelming of the Greek healthcare system.

In order to reduce transmission of COVID-19, social distancing measures were proposed, including spatial distancing (2 m distance), or even generalized lockdown. Main concern was to prevent overwhelming of the healthcare systems, mainly of the intensive care units (ICUs) by decreasing the spreading of the disease. In Greece, the Government, after consulting with experts in the fields of infectious disease and epidemiology, implemented a rather aggressive stance with an early lockdown.

Aim of our study, is to identify and compare the characteristics of cases referred for autopsy during the first month of the lockdown period for the COVID-19 outbreak, versus the cases referred during the same period in 2019.

231 autopsy cases were included in our study, 125 in 2019 and 106 in 2020. Regarding gender, age and nationality, no significant differences were detected between the two time periods. Age subgroup analysis demonstrated increased number of cases within the age group 70–79 years, in 2020.

As to the place of death, the increase in the percentage of out-of-hospital deaths was not confirmed as statistically significant. Regarding type of death (violent, sudden/unexpected), the drop of violent deaths in the 2020 examined period, was not confirmed as statistically significant; however, further subgroup analysis showed a significant drop of fatal injuries resulting from road traffic accidents in the 2020 period. The slight increase of sudden/unexpected deaths, especially myocardial infarction cases, did not reach statistical significance.

One month after lockdown, we cannot detect significant differences in the two time periods examined. Further study should be conducted soon when more data will become available. Frequency of fatal myocardial infarction seems to remain unaffected by the COVID-19 pandemic while deaths resulting from road traffic accidents exhibit a significant decrease. Homicides and suicides remain at low levels, in our jurisdiction area, seemingly unaffected by the COVID-19 outbreak and the subsequent lockdown.

It appears that since sudden/unexpected deaths, statistically remain unaffected, the preventive measures taken by the Greek authorities prevented overwhelming of the healthcare system, which could function properly.

Recent aspects of the effects of zinc on human health

Zinc (Zn) is one of the most important essential nutrients of great public health significance. It is involved in numerous biological functions and it is considered as a multipurpose trace element, due to its capacity to bind to more than 300 enzymes and more than 2000 transcriptional factors. Its role in biochemical pathways and cellular functions, such as the response to oxidative stress, homeostasis, immune responses, DNA replication, DNA damage repair, cell cycle progression, apoptosis and aging is significant. Zn is required for the synthesis of protein and collagen, thus contributing to wound healing and a healthy skin. Metallothioneins are metal-binding proteins and they are potent scavengers of heavy metals, including Zn, and protect the organism against stress. Zn deficiency is observed almost in 17% of the global population and affects many organ systems, leading to dysfunction of both humoral and cell-mediated immunity, thus increasing the susceptibility to infection. This review gives a thorough insight into the most recent evidence on the association between Zn biochemistry and human pathologies, epigenetic processes, gut microbial composition, drug targets and nanomedicine.

Traumatic complete outer ear amputation by human bite, a forensic case report and review of the literature

We present a case of a complete external ear amputation, caused by a human bite, that took place during a quarrel in a local farmers' market. The male victim was transferred to the Hospital. After surgical reattachment of the auricle, a forensic clinical examination was performed, as per legal obligation. During examination, the victim was found to have sustained: contusions of the orbital regions (lower eyelids), bilaterally, soft tissue oedema of the forehead (to the left of the middle line), and contusion of the right neck area. He also sustained multiple soft tissue injuries (contusions, abrasions) on the torso and on both upper and lower extremities. Clinical forensic examination of human bite injuries requires thorough description of the wound, proper photography and possibly collection of swabs for DNA identification (in case of unknown perpetrator). Nevertheless, the Forensic Pathologist is often required to perform clinical examination, only after medical care has been provided. Therefore, clinicians should be aware of the need of proper documentation and act accordingly.

Unusual Elevator-Related Deaths: A Report of Two Cases

We present two cases of elevator-related deaths that occurred in two different elevators, and deaths were caused by a similar, but unusual, mechanism. An elevator is a platform or compartment housed in a shaft for raising and lowering people or things to different levels. Elevator-related deaths and injuries are rarely reported in the literature. In most of these cases, cause of death was attributed to falls. It seems that most of the elevator accidents may be attributed to factors related to device maintenance inadequacies or even to device malfunctioning. In our cases, both elevator cars were not equipped with full-length inner doors, thus allowing both accidents to occur. Since 2014, the European Union adopted a relative directive, which imposes the need to equip all elevators with such full-length doors. The enforcement of the above-mentioned EU Directive is crucial, in order to prevent similar accidents in the future.

Incidence of fatalities of road traffic accidents associated with alcohol consumption and the use of psychoactive drugs: A 7-year survey (2011-2017)

Driving under the influence of alcohol and/or psychoactive substances increases the risk of severe, even fatal motor vehicle accidents. The aim of this descriptive study was to present the impact of alcohol and/or psychoactive substances on fatal road traffic accidents (RTAs) during the period 2011-2017. For this purpose, the toxicological investigation reports from the Department of Forensic Medicine and Toxicology of the University of Athens were used. In total, 1,841 (32.2%) of the autopsies conducted by the Department of Forensic Medicine and Toxicology of the National and Kapodistrian University of Athens over a 7-year period (2011-2017) were victims of fatal RTAs. Blood and urine samples were collected and analyzed for the presence of alcohol and psychoactive substances. The results were classified according to sex, age, victim (car driver, motorcyclist, pedestrian, or passenger) and the date the accident occurred (day, month and year). In total, 40.7% of the RTA-related fatalities were associated with alcohol consumption, among which 20.3% were car drivers. Of these, 87.3% were male victims. A higher frequency of RTA-related fatalities associated with a blood alcohol concentration (BAC) >110 mg/dl was encountered in younger compared with older age groups. Psychoactive substances were detected in 348 (18.9%) of the victims (cannabis in 46.6% of these, benzodiazepines in 25.9%, opiates in 16.4% and cocaine in 11.1% of these). The percentage of the RTA-related victims that had consumed alcohol in combination with other psychoactive substances was 4.5%. On the whole, the findings of this study suggest that alcohol and psychoactive substances are probably risk factors for RTA-related fatalities.

Microrna expression signatures predict patient progression and disease outcome in pediatric embryonal central nervous system neoplasms

Background

Although, substantial experimental evidence related to diagnosis and treatment of pediatric central nervous system (CNS) neoplasms have been demonstrated, the understanding of the etiology and pathogenesis of the disease remains scarce. Recent microRNA (miRNA)-based research reveals the involvement of miRNAs in various aspects of CNS development and proposes that they might compose key molecules underlying oncogenesis. The current study evaluated miRNA differential expression detected between pediatric embryonal brain tumors and normal controls to characterize candidate biomarkers related to diagnosis, prognosis and therapy.

Methods

Overall, 19 embryonal brain tumors; 15 Medulloblastomas (MBs) and 4 Atypical Teratoid/Rabdoid Tumors (AT/RTs) were studied. As controls, 13 samples were used; The First-Choice Human Brain Reference RNA and 12 samples from deceased children who underwent autopsy and were not present with any brain malignancy. RNA extraction was carried out using the Trizol method, whilst miRNA extraction was performed with the mirVANA miRNA isolation kit. The experimental approach included miRNA microarrays covering 1211 miRNAs. Quantitative Real-Time Polymerase Chain Reaction was performed to validate the expression profiles of miR-34a and miR-601 in all 32 samples initially screened with miRNA microarrays and in an additional independent cohort of 30 patients (21MBs and 9 AT/RTs). Moreover, meta-analyses was performed in total 27 embryonal tumor samples; 19 MBs, 8 ATRTs and 121 control samples. Twelve germinomas were also used as an independent validation cohort. All deregulated miRNAs were correlated to patients’ clinical characteristics and pathological measures.

Results

In several cases, there was a positive correlation between individual miRNA expression levels and laboratory or clinical characteristics. Based on that, miR-601 could serve as a putative tumor suppressor gene, whilst miR-34a as an oncogene. In general, miR-34a demonstrated oncogenic roles in all pediatric embryonal CNS neoplasms studied.

Conclusions

Deeper understanding of the aberrant miRNA expression in pediatric embryonal brain tumors might aid in the development of tumor-specific miRNA signatures, which could potentially afford promising biomarkers related to diagnosis, prognosis and patient targeted therapy.

Electronic supplementary material

The online version of this article (doi:10.1186/s13045-014-0096-y) contains supplementary material, which is available to authorized users.

Does history of childhood maltreatment make a difference in prison? A hierarchical approach on early family events and personality traits

This study attempts to assess childhood maltreatment in prison through a hierarchical approach. The hierarchical approach principally aims to disentangle the independent effects of childhood maltreatment upon psychiatric morbidity/personality traits, if any, from the burden that the adverse family conditions have already imposed to the mental health of the maltreated individual-prisoner. To this direction, a conceptual framework with five hierarchical levels was constructed, namely: immutable demographic factors; family conditions; childhood maltreatment (physical abuse, neglect and sexual abuse); personality traits, habits and psychiatric morbidity; prison-related variables. A self-administered, anonymous set (battery) of questionnaires was administered to 173 male prisoners in the Chalkida prison, Greece; 26% of prisoners disclosed childhood maltreatment. Psychiatric condition in the family, parental alcoholism and parental divorce correlated with childhood maltreatment. After adjustment for immutable demographic factors and family conditions, childhood maltreatment was associated with aggression (both in terms of Lifetime History of Aggression and Buss–Perry Aggression Questionnaire scores), illicit substance use, personal history of psychiatric condition, current smoking, impulsivity and alcohol abuse. In conclusion, childhood maltreatment represents a pivotal, determining factor in the life course of male prisoners. Delinquents seem to suffer from long-term consequences of childhood maltreatment in terms of numerous mental health aspects.

Forensic investigation of suicide cases in major Greek correctional facilities

INTRODUCTION

According to Greek legislation the medico-legal investigation of deaths occurring in prisons is mandatory. Furthermore, in cases of suicide or of suspected suicide the contribution of medico-legal investigation is of grave importance. The current paper addresses the medico-legal investigation of suicide cases in Greek correctional facilities and aims to describe the current situation.

MATERIALS & METHODS

Our study consists of the meticulous research in the data records of major Greek correctional facilities, for the time period 1999-2010. Official permission was obtained by the Hellenic Ministry of Justice, which provided us the access to the records. Data was also collected from the Piraeus Forensic Service, from the Department of Pathological Anatomy of the University of Athens and finally from our own records. Measures were taken to respect the anonymity of the cases. Data was collected for the social, penal, medical history as well as for the medico-legal investigation.

RESULTS-CONCLUSIONS

It appears that 85.7% of suicide cases were transferred to the Prisoner's Hospital (p < 0.0001), the forensic pathologist who conducted the PME did not perform scene investigation in none of the 70 suicide cases. In a total of 70 cases, histopathological examination, was requested only in 30 cases (42.9%). Hanging was the preferred method for those who committed suicide, followed by the poisoning due to psychoactive substances. Understanding the mistakes made during the forensic investigation of suicide cases inside correctional facilities is necessary, in order to prevent them from occurring again in the future, by implementing appropriate new policies and guidelines.

The social profile of victims of suicide in major Greek correctional facilities

INTRODUCTION

Suicide rates in correctional institutions have been increasing during the last decades. The reasons for this increase remain unclear, yet a lot of contradictory explanations were stated: the increase might be due to mass incarceration and overcrowding of small cells resulting in high psychosocial stress, changes in psychiatric health policy which might have transferred the care for patients from mental hospitals to custodial institutions, or legislation changes that might have led to a selection of offenders at higher risk (e.g. offenders who committed high violent offences or suffered from mental disorders without being referred to psychiatric hospitals). In Greece the situation is not described in details, at least during the last few years. By law, every death of prisoner is subject to medicolegal investigation.

MATERIALS & METHODS

Our study consists of the meticulous research of the data records of major Greek correctional facilities, for the time period 1999-2010. An official permission was obtained from the Hellenic Ministry of Justice, which gave us access to these restricted records. Data was also collected from the Piraeus Forensic Service, from the Department of Pathological Anatomy of the University of Athens and finally from our own records. Measures were taken to respect the anonymity of the cases. Data was collected for the social, penal, medical history as well as for the medicolegal investigation.

RESULTS - CONCLUSIONS

A total of 339 cases were collected, only 259 of which had available full data records, due to weaknesses in the prison records. From the 259 cases, 70 incidents of suicide were collected. Victims of suicide in major Greek correctional facilities, appear to fulfill the expected profile, as in the general population.

Current aspects of penal surgical liability in Greece

The surgeon may face in every day practice issues that may render him liable. The legal liability usually emerges due to the negligence exhibited during the preoperative, the operative and the postoperative stage. The surgeon, as any doctor, isn't liable for the result, but he is responsible for the correct diagnosis and therapeutic treatment, always according to the principles of the Medical science and to the possibilities available to him in every specific case (facilities and time). The continuous education about the issues of his speciality, the adaptation of scientifically approved techniques, the correct monitoring of the patient, both preoperatively and postoperatively, and finally the good communication with the patient are necessary for the proper practice of Medicine; but also constitute the "shield" of the surgeon against any possible legal conflict.

Toxicogenomic evaluation of chemically induced chromosomal imbalance using DNA image analysis

The study of carcinogenic potential of a variety of chemical agents such as food additives and drugs of abuse via the application of various in vitro methodologies constitutes the first step for the evaluation of their toxicogenomic profile. Considering the chromosomal theories of carcinogenesis, where it is stated that aneuploidy and chromosomal imbalance (instability) are among the main causes of carcinogenesis, chemicals capable to induce such changes in the cells could be considered as potential carcinogens. Chromosomal imbalance and aneuploidy directly affect the overall DNA content of the exposed cell as well as other cellular morpho- and densitometric features. These features can be measured by means of computerized DNA image analysis technologies and include DNA content (DNA Index), Proliferation Index, Ploidy Balance, Degree of Aneuploidy, Skewness and Kurtosis. Considering the enormous number of untested chemicals and drugs of abuse that follow non-genotoxic mechanisms of carcinogenesis, the establishment of a reliable technology for the estimation of chemically induced chromosomal imbalance is of particular importance in toxicogenomic studies. In the present article and based on our previously published work, we highlight the advantages of the applications of DNA image analysis technology in an easy-to-use experimental model for the evaluation of the potential risk of various chemicals. The use of this technology for the detection of chemically induced chromosomal instability will contribute to the development of safer regulatory directives concerning the use of chemicals in food and pharmaceutical industry, as well as in the clarification of mechanisms of action of drugs of abuse.

DNA content alterations in Tetrahymena pyriformis macronucleus after exposure to food preservatives sodium nitrate and sodium benzoate

The toxicity, in terms of changes in the DNA content, of two food preservatives, sodium nitrate and sodium benzoate was studied on the protozoan Tetrahymena pyriformis using DNA image analysis technology. For this purpose, selected doses of both food additives were administered for 2 h to protozoa cultures and DNA image analysis of T. pyriformis nuclei was performed. The analysis was based on the measurement of the Mean Optical Density which represents the cellular DNA content. The results have shown that after exposure of the protozoan cultures to doses equivalent to ADI, a statistically significant increase in the macronuclear DNA content compared to the unexposed control samples was observed. The observed increase in the macronuclear DNA content is indicative of the stimulation of the mitotic process and the observed increase in MOD, accompanied by a stimulation of the protozoan proliferation activity is in consistence with this assumption. Since alterations at the DNA level such as DNA content and uncontrolled mitogenic stimulation have been linked with chemical carcinogenesis, the results of the present study add information on the toxicogenomic profile of the selected chemicals and may potentially lead to reconsideration of the excessive use of nitrates aiming to protect public health.

Relationship between alcohol consumption and control of hypertension among elderly Greeks. The Nemea primary care study

BACKGROUND

The aim of this study was to evaluate the significance of alcohol intake in relation to blood pressure control in treated subjects and to determine if there is a causative link between alcohol and inadequate control of hypertension.

METHODS

Our study population comprised 637 elderly individuals who reside in Nemea and in four other villages located in Corinthia, Peloponnesus, of which 615 were included in the analysis. The average age was 73.5±6.15 years. A special epidemiological questionnaire was completed by each participant and the blood pressure (BP) was measured according to a predefined protocol. Odds ratios were calculated and adjusted for potential confounders.

RESULTS

The overall prevalence of hypertension was 69.1%, 70.7% in men and 67.0% in women. In total, 11% of the hypertensives were not aware of having hypertension. Of those who were aware of having hypertension 91.0% were being treated. Among treated hypertensives 49.1% had systolic BP<140 mmHg and diastolic BP<90 mmHg. Only heavy drinking (>300 g/week) was found to be related with hypertension control.

CONCLUSIONS

Our study showed that the level of control among the elderly, in a Greek population, is positively associated with alcohol intake only for heavy drinking. The role of alcohol consumption in hypertension in the elderly needs further investigation.

Zinc and human health: an update

The importance of micronutrients in health and nutrition is undisputable, and among them, zinc is an essential element whose significance to health is increasingly appreciated and whose deficiency may play an important role in the appearance of diseases. Zinc is one of the most important trace elements in the organism, with three major biological roles, as catalyst, structural, and regulatory ion. Zinc-binding motifs are found in many proteins encoded by the human genome physiologically, and free zinc is mainly regulated at the single-cell level. Zinc has critical effect in homeostasis, in immune function, in oxidative stress, in apoptosis, and in aging, and significant disorders of great public health interest are associated with zinc deficiency. In many chronic diseases, including atherosclerosis, several malignancies, neurological disorders, autoimmune diseases, aging, age-related degenerative diseases, and Wilson's disease, the concurrent zinc deficiency may complicate the clinical features, affect adversely immunological status, increase oxidative stress, and lead to the generation of inflammatory cytokines. In these diseases, oxidative stress and chronic inflammation may play important causative roles. It is therefore important that status of zinc is assessed in any case and zinc deficiency is corrected, since the unique properties of zinc may have significant therapeutic benefits in these diseases. In the present paper, we review the zinc as a multipurpose trace element, its biological role in homeostasis, proliferation and apoptosis and its role in immunity and in chronic diseases, such as cancer, diabetes, depression, Wilson's disease, Alzheimer's disease, and other age-related diseases.

Immunotoxicity of cocaine and crack

The toxicity of cocaine and crack was studied on the protozoan Tetrahymena pyriformis, using several endpoints, such as the DNA content of the macronuclei and the phagocytic ability. Both forms induced an increase in the DNA content of the protozoan, which indicates the stimulation of the mitotic process. In contrast, the phagocytic activity, of the protozoan was decreased after the administration of cocaine, an effect that was more extensive after the administration of crack. These results, derived from previous experiments, suggest a possible relationship between the observed immunosuppression in cocaine abusers and the immunosuppression found in the protozoan. This suppression subsequently may play a role in the development of other opportunistic infections in drug abusers. This paper, based on in vivo experiments with the protozoan Tetrahymena, suggests the compromised immune response in cocaine addicts and assures the reported effects of cocaine on immune cell function.

Serum selenium levels do not differ in type 2 diabetic subjects with and without coronary artery disease

BACKGROUND

The aim of the present study was to investigate whether selenium levels differ between type 2 diabetic subjects with and without coronary artery disease (CAD).

METHODS

A total of 200 subjects with type 2 diabetes (100 with CAD and 100 without CAD), consecutively selected from the diabetes outpatient clinic of our hospital were enrolled into the study. A detailed medical history and a physical examination were obtained by all the participants.

RESULTS

Serum selenium levels did not differ between diabetic subjects with and without CAD (102.40 ± 31.10 vs. 108.86 ± 33.88 microg/L, p = 0.16). In diabetic subjects with CAD multivariate linear regression analysis demonstrated significant independent associations between selenium and sex (beta = 0.21, p = 0.03) and glucose levels (beta = 0.25, p = 0.008). In diabetic subjects without CAD multivariate linear regression analysis demonstrated significant independent associations between selenium and peripheral artery disease (beta = 0.16, p = 0.05) and glucose levels (beta = -0.09, p = 0.05).

CONCLUSION

Serum selenium levels did not differ between diabetic subjects with and without CAD. In diabetic subjects with CAD, the only determinants of serum selenium levels were sex and glucose levels. In diabetic subjects without CAD the only determinants of serum selenium levels were peripheral artery disease and glucose levels.

Students' physical and psychological reactions to forensic dissection: Are there risk factors?

The reactions of students to forensic dissection encompass psychologico-emotional and physical components. This exploratory study aimed to determine risk factors for students' adverse physical and psychological reactions to forensic dissection. All sixth-year medical students (n = 304) attending the compulsory practical course in forensic medicine in the 2005-2006 academic year were asked to complete a questionnaire at the conclusion of the five-day course. The questionnaire surveyed physical and psychological reactions (outcomes) and 47 student traits, beliefs, and behaviors (risk factors) that might predispose to adverse reactions. Multivariate ordinal logistic regression yielded five independent risk factors for negative psychological reactions: female gender, stereotypic beliefs about forensic pathologists, a less cognitive and more emotional frame of mind relative to forensic dissection, more passive coping strategies, and greater fear of death. The sole independent risk factor for physical symptoms was a less cognitive/more emotional approach to dissection. Students' reactions to forensic dissection integrate a host of inherent and dissection-related risk factors, and future interventions to improve this aspect of medical education will need to take into account the complexities underlying students' experiences with dissection.

Forensic investigation of submersion deaths

CONTEXT

The diagnosis of the cause and the establishment of the manner of death in submersion cases are routine challenge for forensic pathologists as it presents considerable diagnostic difficulties.

OBJECTIVE

To concisely review the main questions during a submersion death investigation and to give the respective documented answers.

DATA SOURCES

The search strategy included a literature search of PubMed, Medline and Google Scholar databases, as well as a review of the cited references by the identified studies and a hand search of relevant textbooks and reference works.

CONCLUSIONS

A complete autopsy, histopathological examination and full toxicological screening are important to determine whether death indeed followed submersion in the water, or to see whether any natural disease or substance use have contributed or caused death. In ambiguous situations, the co-estimation of circumstantial evidence may be of invaluable importance toward the conclusion concerning the cause and the manner of death. The thorough forensic investigation of the submersion deaths not only serves the justice administration, but it also presents considerable benefits for the public health.

Health care provision in prisons: a review on European and international guidelines

Health care provision in prisons is an area of increasing international concern. The spectrum of health problems which prisoners may bring to prison is wide and in many cases prevalence is greater than in the general population.The profound knowledge of delicate issues such as medical confidentiality and informed consent of the patient, with special refer to infectious disease, hunger strike and prison research is necessary in the prison working environment. In the following paragraphs the European and International conventions and guidelines on the matter are discussed.

Atypical kawasaki disease presenting with symptoms from the genitourinary system: an autopsy report

Symptoms from the genitourinary system are unusual in Kawasaki disease (KD). Renal involvement is even rarer and it is confirmed by biopsy when the person is alive. We describe the case of an 11-year-old boy admitted to the hospital complaining about prolonged fever (5 days) and hematuria. His urinalysis showed also pyuria, proteinuria and urinary renal tubular epithelial cells concentrations. During the next days, the patient presented limb edema. After almost 2 weeks of hospitalization the patient was transferred to the intensive care unit because of melena and intense abdominal pain. Upon admission, the patient collapsed and died. The diagnosis of KD was established during autopsy. The macroscopical and histopathological examination of the heart showed increased dimensions and weight and multiple thrombi in the coronary arteries with intramural dense polymorphonuclear inflammatory infiltration and necrosis. Histological examination of the kidneys revealed normal glomerulus, mild expansion of mesangial matrix, interstitial infiltration with lymphocytes, plasmatocytes and eosinophiles, normal vessels and normal immunofluorescence.

Forensic investigation of child victim with sexual abuse

Sexual abuse includes any activity with a child, before the age of legal consent, that is for the sexual gratification of an adult or a significantly older child. Sexual mistreatment of children by family members (incest) and nonrelatives known to the child is the most common type of sexual abuse. Intrafamiliar sexual abuse is difficult to document and manage, because the child must be protected from additional abuse and coercion not to reveal or to deny the abuse, while attempts are made to preserve the family unit. The role of a comprehensive forensic medical examination is of major importance in the full investigation of such cases and the building of an effective prosecution in the court. The protection of the sexually abused child from any additional emotional trauma during the physical examination is of great importance. A brief assessment of the developmental, behavioral, mental and emotional status should also be obtained. The physical examination includes inspection of the whole body with special attention to the mouth, breasts, genitals, perineal region, buttocks and anus. The next concern for the doctor is the collection of biologic evidence, provided that the alleged sexual abuse has occurred within the last 72 hours. Cultures and serologic tests for sexually transmitted diseases are decided by the doctor according to the special circumstances of each case. Pregnancy test should also be performed in each case of a girl in reproductive age.

Students who wish to specialize in forensic medicine vs. their fellow students: motivations, attitudes and reactions during autopsy practice

PURPOSE

To investigate the particular features of students who express the desire to follow a forensic career.

METHODS AND MATERIALS

Three hundred and four 6th-year students attending the compulsory practice in forensic medicine in the academic year 2005-2006 were asked to fill in a self-administered questionnaire at the end of the course.

RESULTS

The predominant motivation for following forensics was the scientific interest (39.7%). Gender, marital status, religion, place of residence, number of siblings, father/mother being a health professional, being a religious individual were not associated with forensics. Higher grades were a negative predictor for the forensic specialty. A trend linking rejection of an afterlife and orientation towards forensic medicine was found. The fear of death was more intense in students rejecting forensics. Feelings of fear, aversion and grief during the last day of autopsy seemed to be important negative predictors. Stereotypes about forensic doctors (such as "forensic doctors have a peculiar character") significantly modified the decision of students, but the beliefs about the role of the autopsy practice (cause of anxiety for death, stimulus to live every moment in life) did not.

CONCLUSION

Medical students who want to follow forensics present only small differences concerning their inherent features, beliefs, reactions, emotions and attitudes, compared with the rest of their fellow students.

Medical confidentiality: legal and ethical aspects in Greece

Respect for confidentiality is firmly established in codes of ethics and law. Medical care and the patients' trust depend on the ability of the doctors to maintain confidentiality. Without a guarantee of confidentiality, many patients would want to avoid seeking medical assistance The principle of confidentiality, however, is not absolute and may be overridden by public interests. On some occasions (birth, death, infectious disease) there is a legal obligation on the part of the doctor to disclose but only to the appropriate authorities. Permissible disclosure can be granted by the patients' consent, for example, for the purpose of insurance they may wish to take out. Moreover, there are some ambivalent situations (such as criminal acts, or notification of sexual partner in case of a patient with AIDS) for which Greek law does not include relevant provisions, and the Codes of Medical Ethics do not offer clear guidelines. Therefore, the Greek doctor is called to estimate the situation and assume full responsibility for his decision. Finally, new considerations have arisen in the context of the recent advances in the field of telemedicine and electronic archiving. The paper discusses the current situation and legislation in Greece.

Driving under the influence in Greece: A 7-year survey (1998–2004)

Alcohol is one of the main causes of traffic accidents worldwide. Its use decreases significantly the driving ability of an individual increasing in this way the possibilities of their involvement in motor-vehicle accidents. The above possibilities are increased when a psychoactive substance has been taken in combination with alcohol due to their synergistic effect. The Laboratory of Forensic Medicine and Toxicology of the University of Athens is authorized to perform the toxicological investigation of traffic accidents that happen in the southern part of Greece. The objective of the present study was to identify the prevalence of alcohol and other psychoactive substances among drivers involved in road traffic accidents in Greece during the period 1998-2004. Alcohol was detected in the blood of about 37% of the drivers involved in traffic accident during the years 1998-2000. The detection of alcohol was lower (29%) in the years 2001-2004. Cannabis, benzodiazepines, opiates, and cocaine were found in 4%, 4%, 4% and 1% of the total number of cases, respectively. The above values were compared with those of a previous study concerning the period 1995-1997 and the reasons for the reduction of the number of alcohol-related traffic accidents during the last years are discussed.

Cardiovascular disease and drowning: autopsy and laboratory findings

INTRODUCTION

The purpose of this report is to describe the main autopsy and laboratory findings from a large number of drowning victims in Greece.

METHODS

A retrospective analysis was carried out of the consecutive cases of drowning victims autopsied in our department during the period 1997-2004.

RESULTS

A total of 197 submersion cases were referred to the Department. In 168 cases drowning was considered as the cause of death. In 82 cases (49%) significant histopathological findings from the cardiovascular system were present. Alcohol was found in 21 cases (13%) and psychoactive substances in 4 cases (2%). Food was found in the stomach of 45 drowning victims (27%). Men (65%) and elderly people (60 years and older, 74%) made up the majority of drowning victims. In 29 submersion cases the cause of death was other than drowning; in 25 of these cases death was attributed to cardiovascular disease (complication of coronary artery disease, 23 cases; dissecting aortic aneurysm, 1 case; cerebral stroke, 1 case).

CONCLUSIONS

The great majority of drowning victims are the elderly and men. Moreover, in a considerable number of submersion cases cardiovascular disease was related to the death, either as a contributing factor, or as the cause of death.

Simultaneous evaluation of maspin and CXCR4 in patients with breast cancer

AIM

To study simultaneously the actions of maspin and CXCR4, which share several similar pathways in cancer, including apoptosis and angiogenesis.

METHODS

Our material consisted of 151 invasive breast carcinomas arranged in a tissue microarray setting. Maspin and CXCR4 expression was evaluated by immunohistochemistry. Microvessel density was assessed by CD34 immunodetection and apoptosis by the Tdt-mediated dUTP nick end labelling assay.

RESULTS

Maspin expression was related to CXCR4 expression, apoptosis, patient age and the Nottingham prognostic index. The expression of both maspin and CXCR4 progressively increased in high-grade tumours. In patients with lymph node negative breast cancer, maspin overexpression was associated with increased risk of death. High CXCR4 expression was associated with prolonged survival of patients with high maspin expression.

CONCLUSIONS

Our results show that maspin overexpression could prove to be a potentially useful marker, especially for the clinically important group of patients with lymph node negative breast cancer. The expression of CXCR4 is of less significance in our study, but may be informative for specific patient subsets or in a longer time frame.

Tumor histology and stage but not p53, Her2-neu or cathepsin-D expression are independent prognostic factors in breast cancer patients

BACKGROUND

Several factors are currently employed for prognosis assessment and treatment determination in breast cancer. An array of molecular parameters, such as p53, Her2-neu (c-erbB 2) and Cathepsin-D, are also examined to improve clinical patient management. We have conducted a statistically powerful study of the prognostic value of conventional factors and of the investigational factors p53, Her2-neu and Cathepsin-D in patients with invasive breast carcinoma, in order to compare their significance. Our analysis was extended to determine the associations of p53 and Her2-neu with risk of death and relapse among patients with and without lymph node metastases.

MATERIALS AND METHODS

In a set of 125 primary breast tumors, p53 and Her2-neu expression were immunohistochemically evaluated. Cathepsin-D, estrogen and progesterone receptor concentrations were determined in cytosols by a standard immunoradiometric assay.

RESULTS

Over a mean of 62 months, 49 patients (39%) had a relapse and 29 patients (23%) died. Overexpression of p53, Her2-neu and Cathepsin-D was observed in 31%, 46% and 88% of cases, respectively. Overall survival was associated with histology (hazard ratio 0.04, 95% confidence interval: 0.01, 0.49 for lobular tumors) and stage (hazard ratio 5.94, 95% confidence interval: 1.30, 27.15 for stage III samples). Disease-free survival was also related to histology (hazard ratio 0.23, 95% confidence interval: 0.08, 0.73 for lobular tumors) and stage (hazard ratio 4.27, 95% confidence interval: 1.36, 13.36 for stage III tumors). Patients with both negative nodal status and Her2-neu overexpression tended to display an elevated risk of death.

CONCLUSION

Our results support the prognostic power of tumor histology and stage and emphasize the need for further studies on the prognostic impact of p53. Her2-neu and Cathepsin-D in breast cancer. Additionally, our analysis indicates that deregulation of Her2-neu might characterize a subgroup of node-negative patients with poor prognosis who could benefit from an aggressive adjuvant therapy.

Structural properties of the axis studied in cadaveric specimens

Peripheral quantitative computed tomography scans of the axis in 20 fresh cadaveric specimens obtained at autopsy were studied to investigate the internal structural properties of the axis. In all specimens, serial scans were done in three planes. The area of the dens consisted of dense cortical and trabecular bone (Region 1, above the base of the dens) and showed statistically significantly greater peripheral quantitative computed tomography values when compared with the anterior part of the body of the axis (Region 2, below the base of the dens). An age-related progressive decrease of peripheral quantitative computed tomography values was observed, with specimens from subjects younger than 40 years showing statistically significantly greater peripheral quantitative computed tomography values when compared with those from subjects older than 40 years. A small area of trabecular bone with decreased density was found close to the anteroinferior edge of the body of the axis in the specimens from younger subjects. In contrast, a large area of trabecular bone with decreased density extending anteroinferiorly to superoposteriorly to the base of the dens was found in the specimens from older subjects. Based on these findings, we think that dens fracture classification systems and fixation techniques should be reconsidered.

The biceps femoris short head muscle flap: an experimental anatomical study

The vascular communication between the heads of the biceps femoris muscle has been established after 25 cadaveric dissections. Perfusions of dye through the long or the short head consistently showed 1-2 anastomotic bundles. Outflow of dye opposite to the site of the perfused head was remarkable in most cases. Intramuscular dissections disclosed broad and well structured vascular networks in all short heads, but this was not true for all long heads. Our observations suggest that the anastomotic vessels alone might support the short head which, when released from its profunda femoris vessels, is adequate to cover lateral knee defects. Depending on the level of the anastomotic vessels, the proximal or the distal part of the short head should be used. A pedicled flap may be used as well, whereas transsection of the biceps tendon offers additional mobility.

Induction of metallothionein in the liver of carbon tetrachloride intoxicated rats: an immunohistochemical study

Metallothioneins (MTs), are low molecular weight proteins, mainly implicated in metal ion detoxification. In the present study, we investigated the expression of hepatic MT in a rat model of injury and regeneration, induced by carbon tetrachloride (CCl(4)) administration. A single intraperitoneal injection of 1 ml CCl(4)/kg body weight was performed in male Wistar rats, killed at different time points post-administration. The enzymatic activities of aspartate and alanine aminotransferases in serum were determined, in addition to the liver histological findings, to estimate hepatotoxicity. The rate of tritiated thymidine incorporation into hepatic DNA, the enzymatic activity of thymidine kinase in liver tissue and the assessment of the mitotic index in hepatocytes, were used as indices of regeneration. MT was detected immunohistochemically in liver tissue sections. CCl(4) administration caused severe hepatic injury, followed by regeneration. MT expression became prominent as early as 12 h after the administration of CCl(4), in the nuclei of hepatocytes, while at 24 and 36 h intense cytoplasmic staining for MT appeared in the hepatocytes in the vicinity of necrotic areas. The peak of hepatocyte proliferative capacity, occurring at 48 h post-CCl(4) administration coincides with the maximum nuclear and cytoplasmic MT expression. At further time points MT expression presented a decreasing trend. Induction of MT expression was observed in the liver after a single administration of CCl(4), being more prominent at the time of maximum hepatocellular proliferation, participating actively in the replication of hepatocytes.

The inferiorly based gastrocnemius muscle flap: anatomic aspects

The arterial communication between the gastrocnemius muscle heads through their lowest anastomotic arteriole bundle alone was examined in specimens from 14 fresh cadavers. In 3 specimens, the larger vessels in close vicinity to the lowest vessels were preserved as well. Distinct communication between the arterial networks of the heads was demonstrated in all cases after injecting dyes through both sural arteries or into the lateral sural artery and the lowest anastomotic arteriole in 11 and 3 specimens, respectively. Therefore, it seems that one head can be adequately supplied from the contralateral one through their lowest anastomotic arteriole(s); nevertheless, the location of this vessel varies significantly and cannot be detected preoperatively. Measurements demonstrated that although this vessel is not found at a constant level, it is invariably detected in the lower third of the medial gastrocnemius head's length and, in 93 percent of cases, in the lower fourth. Thus, rough preoperative planning becomes feasible. Given that the venous communication between the heads has been documented as well, the authors think that an inferiorly based flap of the medial gastrocnemius head for defects of the middle third of the tibia might be both reliable and applicable; however, for reasons of safety, the muscle heads should remain attached along their lower third.

Metallothionein and heat shock protein expression during acute liver injury and regeneration in rats

Metallothioneins (MT) are cytosolic proteins rich in cysteine which play a physiological role in metal ion homeostasis. Heat shock proteins (HSPs) are expressed in various organs in response to different stress stimuli. The purpose of the present study was to examine the intrahepatic distribution of MT and HSP-27, -70 and -90 in two different experimental models of acute liver injury and regeneration, induced by either thioacetamide, or carbon tetrachloride administration in male Wistar rats. Toxicological endpoints and markers of hepatocellular regeneration were assessed at various time points following toxin administration. The enzymatic activities of aspartate and alanine aminotransferases in serum, and histological findings in the liver were used to estimate toxin-induced injury. Tritiated thymidine incorporation into hepatic DNA, liver thymidine kinase activity and hepatocyte mitotic index were used to estimate liver regeneration. MT and HSPs were detected immunohistochemically. At the time of maximum liver injury, moderate MT and intense HSPs expression was prominent in hepatocytes in the vicinity of necrotic areas. At the time of maximum hepatocellular proliferation, intense MT and HSP-90 staining was evident in all hepatocytes, while at the same time, mild HSP-27 and HSP-70 immunoreactivity was noted. Our findings indicate that the differential distribution of MT and HSPs in the liver after toxin-induced injury, in common with the observed pattern of staining, reflect liver proliferating capacity.

Liver metallothionein expression in thioacetamide-intoxicated rats

Metallothioneins (MT), a group of ubiquitous low molecular weight proteins, implicated primarily in metal ion detoxification, are known to be expressed during hepatocellular proliferation after partial hepatectomy in rats. In the present study, we investigated the expression of MT in a rat model of liver injury and regeneration, induced by intraperitoneal administration of thioacetamide (TAA). The animals were killed at 0, 12, 24, 36, 48, 60, 72, 84, 96, 108 and 120 hours after TAA administration. The rate of tritiated thymidine incorporation into hepatic DNA, the enzymatic activity of thymidine kinase, and the assessment of the mitotic index in hepatocytes were used as indices of liver regeneration. Liver MTs were detected immunohistochemically. TAA administration caused severe hepatic injury, followed by regeneration. MT expression became prominent in hepatocytes as early as 12 hours post-TAA administration. At 24 and 36 hours post-TAA administration intense nuclear and cytoplasmic staining of hepatocytes was found in the vicinity of necrotic areas. The maximal nuclear and cytoplasmic MT expression coincides with the peak of hepatocyte proliferative capacity, occurring at 48 and 60 hours post-TAA administration. MT expression correlated positively with the Zn content of liver tissue, but negatively with serum one, at the time of maximum hepatocyte proliferative capacity. This study suggests that MT participates in hepatocyte replication after toxin-induced liver injury.

The venous communication between the gastrocnemius muscle heads

This investigation establishes the venous communication between the gastrocnemius muscle heads. Fourteen fresh (with the exception of one) cadaveric specimens were examined. Anastomotic veins were dissected along the raphe after perfusion of each muscle with 0.1 % methylene blue solution. A distally based musculocutaneous perforating vein of the medial head was the site of perfusion in 13 specimens, whereas one specimen received injection through the accompanying vein of the medial sural cutaneous nerve. Additional perfusion of dye from different sites was required in two specimens. Communicating veins were dissected in all 14 muscles. Direct anastomotic veins were detected in eight specimens; whereas in six the accompanying vein of the medial sural cutaneous nerve that had been included proved to be the intermediate pathway of venous communication between the muscle heads. Obstructive valves were encountered in most cases; nevertheless anastomotic veins were always recognized. The role of valves and the clinical implications are discussed.

The arterial communication between the gastrocnemius muscle heads: a fresh cadaveric study and clinical implications

The purpose of this investigation was to describe the anatomy of the communicating (anastomotic) vessels between the gastrocnemius muscle heads and to record the extent of their supply potential. Ensuing clinical implications are discussed. Fourteen fresh cadaveric gastrocnemius muscles were examined. Detailed dissections of the communicating vessels were facilitated after injections of methylene blue or cadaveric blood solutions through the medial, lateral, or both sural arteries. The extent of the arterial cross-supply between the muscles' heads through these vessels was determined in-eight specimens after methylene blue perfusions through the lateral sural arteries, while one specimen was examined after injection of methylene blue and yellow ink through the lateral and medial sural arteries, respectively. Communicating vessels were detected in all 14 specimens. A mean number of 5.8 vascular bundles and single vessels was found. The bundles consisted of arterioles and, as all indications suggested, of concomitant venules as well. Regarding arterial cross-supply, it was clearly evident that each head could be vascularized solely from the contralateral one, mostly through these bundles. However, even if only a part of the bundles was preserved intact, vasculature was not affected.

Hepatic stimulator substance activity in the liver of thioacetamide-intoxicated rats

AIMS/BACKGROUND

Hepatic stimulator substance (HSS) is a known hepatic growth factor which appears to be organ-specific but species non-specific. We have recently shown that the administration of HSS enhanced hepatocyte proliferation occurring due to thioacetamide (TAA)-induced liver injury in rats (Theocharis SE, et al., Scand J Gastroenterol 1998; 33: 656-63). In the present study, we examined the activity of the endogenously produced HSS in the liver of TAA administered rats during injury and regeneration.

METHODS

TAA at a dose of 300 mg/kg of body weight was injected intraperitoneally in male Wistar rats. The animals were sacrificed at 0, 12, 24, 36, 48, 60 and 72 h after TAA administration. The rate of tritiated thymidine incorporation into hepatic DNA, the enzymatic activity of liver thymidine kinase and the assessment of mitotic index in hepatocytes were used to estimate liver regeneration. HSS extract was obtained from the livers of TAA-treated rats, sacrificed at the above mentioned time points. This HSS extract was injected in 34% partially hepatectomized rats, to assess its activity. The ability of the injected HSS extract to increase hepatocellular proliferation over that normally occurring 24 h following 34% partial hepatectomy was used to express the activity of HSS by determining the above mentioned indices of liver regeneration.

RESULTS

The administration of TAA caused severe hepatic injury recognized histopathologically as well as by the increased activities of serum hepatic enzymes aspartate and alanine aminotrasferases. The hepatic injury, which peaked at 24 and 36 h post-TAA treatment (p<0.001), was followed by hepatocyte proliferation, presenting peaks at 48 and 60 h (p<0.001). The activity of the endogenously produced HSS from livers of TAA-treated rats increased at 36 h after TAA administration as well as being highly expressed at 48 and 60 h thus coinciding with the peak of hepatocyte proliferation. At other time points, HSS activity was decreased.

CONCLUSIONS

The observed variations of HSS activity in rat liver suggest active participation of this growth factor in hepatocyte replication which follows toxin-induced liver injury as a repair mechanism process.