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Nature Microbiology Nov 2023The emergence of SARS-CoV-2 has resulted in millions of deaths as a result of COVID-19. Suitable models were missing at the beginning of the pandemic, and studies... (Review)
Review
The emergence of SARS-CoV-2 has resulted in millions of deaths as a result of COVID-19. Suitable models were missing at the beginning of the pandemic, and studies investigating disease pathogenesis relied on patients who had succumbed to COVID-19. Since then, autopsies of patients have substantially contributed to our understanding of the pathogenesis of COVID-19 and associated major organ complications. Here we summarize how autopsies have complemented experimental studies, mainly in animal models, and how they have facilitated critical knowledge of COVID-19 to improve daily clinical practice and develop therapeutic interventions. Employing advanced histopathologic and molecular genetic methods in post-mortem tissues, the COVID-19 pandemic has highlighted the importance of autopsies for virology research and clinical practice in current and emerging infectious diseases.
Topics: Animals; Humans; COVID-19; SARS-CoV-2; Autopsy; Pandemics; Models, Animal
PubMed: 37798476
DOI: 10.1038/s41564-023-01488-7 -
Clinical Radiology Nov 2023
Topics: Humans; Diagnostic Imaging; Autopsy
PubMed: 37827589
DOI: 10.1016/j.crad.2023.09.001 -
Clinical Radiology Nov 2023Post-mortem computed tomography (CT) can provide useful insights into coronial and forensic pathological investigation of the fire-damage victim. Understanding the... (Review)
Review
Post-mortem computed tomography (CT) can provide useful insights into coronial and forensic pathological investigation of the fire-damage victim. Understanding the pathological changes that can occur in fatalities caused by fire, particularly in relation to fire damage to the body, is paramount in attempting to distinguish ante-mortem and peri-mortem blunt traumatic injuries from fire-related damage to the body. Understanding the fire-damage features on post-mortem CT may also assist in determining cause of the fire and associated fire-damage. Although the requirements of radiological evaluation in post-mortem imaging are very different to those of day-to-day clinical ante-mortem imaging, foremost is a high-resolution CT protocol of the entire body in order to fulfil the requirements and expectations of such imaging and radiological interpretation.
Topics: Humans; Tomography, X-Ray Computed; Autopsy; Wounds, Nonpenetrating
PubMed: 37827591
DOI: 10.1016/j.crad.2023.03.005 -
Clinical Radiology Nov 2023Post-mortem computed tomography (PMCT) imaging is gaining popularity and acceptance for use alongside forensic autopsies of children, predominantly to aid in the... (Review)
Review
Post-mortem computed tomography (PMCT) imaging is gaining popularity and acceptance for use alongside forensic autopsies of children, predominantly to aid in the detection of traumatic injuries. Recent research on this topic has provided a breadth of new information regarding the appropriate usage, imaging guidance, and diagnostic accuracy for the identification of different paediatric pathologies. Additionally, advanced CT imaging techniques, such as PMCT angiography or ventilated PMCT, have been trialled, and post-mortem micro-CT is now being used in specialist centres for the assessment of subtle fractures in extracted bone specimens. Various image post-processing methods (e.g., three-dimensional printing from PMCT imaging data) are being used for the illustration of injuries in the medicolegal setting to a lay audience and provide another avenue for the future of forensic radiology research. In this review, the evidence-based principles and benefits of post-mortem imaging for forensic investigation in childhood deaths are presented, with a particular focus on PMCT and current practices. Variations in forensic imaging strategies around the world, published diagnostic accuracy rates, and expected normal post-mortem imaging findings are discussed, as well as potential future applications and research in this area.
Topics: Humans; Child; Autopsy; Forensic Pathology; Fractures, Bone; Image Processing, Computer-Assisted; X-Ray Microtomography
PubMed: 37827594
DOI: 10.1016/j.crad.2023.06.001 -
The British Journal of Radiology Jul 2023Post-mortem imaging for the investigation of perinatal deaths is an acceptable tool amongst parents and religious groups, enabling a less invasive autopsy examination.... (Review)
Review
Post-mortem imaging for the investigation of perinatal deaths is an acceptable tool amongst parents and religious groups, enabling a less invasive autopsy examination. Nevertheless, availability is scarce nationwide, and there is some debate amongst radiologists regarding the best practice and optimal protocols for performing such studies. Much of the published literature to date focusses on single centre experiences or interesting case reports. Diagnostic accuracy studies are available for a variety of individual imaging modalities ( post-mortem CT, MRI, ultrasound and micro-CT), however, assimilating this information is important when attempting to start a local service.In this article, we present a comprehensive review summarising the latest research, recently published international guidelines, and describe which imaging modalities are best suited for specific indications. When the antenatal clinical findings are not supported by the post-mortem imaging, we also suggest how and when an invasive autopsy may be considered. In general, a collaborative working relationship within a multidisciplinary team (consisting of radiologists, radiographers, the local pathology department, mortuary staff, foetal medicine specialists, obstetricians and bereavement midwives) is vital for a successful service.
Topics: Humans; Pregnancy; Female; Autopsy; Magnetic Resonance Imaging; Perinatal Death; Ultrasonography; Radiologists
PubMed: 35451852
DOI: 10.1259/bjr.20211078 -
Pathologica Oct 2023A brief overview on the management of autopsies during the SARS-CoV-19 epidemic is proposed. In particular, the point is made of the Italian laws on the subject, the... (Review)
Review
A brief overview on the management of autopsies during the SARS-CoV-19 epidemic is proposed. In particular, the point is made of the Italian laws on the subject, the characteristics required for the autopsy room and the sampling suggested for the histological examination.
Topics: Humans; Autopsy; Severe acute respiratory syndrome-related coronavirus
PubMed: 38054900
DOI: 10.32074/1591-951X-921 -
International Journal of Legal Medicine Sep 2023Hanging is a common type of death, and the role of the medical investigation of such deaths by a forensic pathologist not only requires the determination of the cause of... (Review)
Review
Hanging is a common type of death, and the role of the medical investigation of such deaths by a forensic pathologist not only requires the determination of the cause of death but providing information to assist in the determination of the manner of death. The forensic pathologist should be well versed in the spectrum of injuries known to be associated with neck compression, to document injuries known to be associated with hanging, but also to identify those that are inconsistent with self-inflicted hanging or that may suggest the involvement of a third party in the death. Comprehensive identification and correct interpretation of external and internal injury are crucial for the appropriate degree of police and coroner/medical examiner investigation. We present two cases of deaths believed to be caused by self-inflicted hanging that were observed to have unexpected unilateral dislocation of the temporomandibular joint identified on routine post-mortem computed tomography, without any evidence of involvement of a third party. This injury was unexplained and had not been previously observed at our Forensic Institute nor was it identified after a review of the published biomedical research literature. Issues regarding the cause of this abnormality, possible mechanisms, and the medicolegal significance of this finding will be discussed.
Topics: Humans; Autopsy; Forensic Medicine; Tomography, X-Ray Computed; Asphyxia; Cause of Death; Forensic Pathology
PubMed: 37462823
DOI: 10.1007/s00414-023-03059-1 -
Forensic Science, Medicine, and... Sep 2023The autopsy is considered the gold standard in death investigation. Performing an autopsy requires human and material resources that must be programmed in order to meet...
INTRODUCTION AND OBJECTIVES
The autopsy is considered the gold standard in death investigation. Performing an autopsy requires human and material resources that must be programmed in order to meet the demands of the judicial system. However, as far as we know, the cost of forensic autopsy in Spain has not been determined. Thus, the aim of this study was to estimate the cost of a standard autopsy in order to organise Forensic Pathology Services more efficiently.
MATERIAL AND METHODS
A micro-cost analysis was carried out. The nominal group technique was applied using a panel of 10 forensic experts in order to identify and quantify the resources associated with a forensic autopsy.
RESULTS
The results showed that analysis and studies are the most important item in the total cost (54.7%), followed by staff (20.5%), preservation of body (14%), single-use products (7%), equipment and stock (1.6%), cleaning and disinfection (1.5%), facilities maintenance (0.5%) and IT (0.2%).
CONCLUSIONS
The total cost of a standard autopsy was €1501.45, which is lower than the European average. This study is the first in Spain to calculate the unit price of a forensic autopsy by means of micro-cost analysis. This may help to address the way forensic pathology centres are organised at different levels of complexity.
Topics: Humans; Autopsy; Spain; Cause of Death; Forensic Medicine; Forensic Pathology
PubMed: 36342626
DOI: 10.1007/s12024-022-00534-w -
Acta Neuropathologica Dec 2023Plasma-to-autopsy studies are essential for validation of blood biomarkers and understanding their relation to Alzheimer's disease (AD) pathology. Few such studies have...
Plasma-to-autopsy studies are essential for validation of blood biomarkers and understanding their relation to Alzheimer's disease (AD) pathology. Few such studies have been done on phosphorylated tau (p-tau) and those that exist have made limited or no comparison of the different p-tau variants. This study is the first to use immunoprecipitation mass spectrometry (IP-MS) to compare the accuracy of eight different plasma tau species in predicting autopsy-confirmed AD. The sample included 123 participants (AD = 69, non-AD = 54) from the Boston University Alzheimer's disease Research Center who had an available ante-mortem plasma sample and donated their brain. Plasma samples proximate to death were analyzed by targeted IP-MS for six different tryptic phosphorylated (p-tau-181, 199, 202, 205, 217, 231), and two non-phosphorylated tau (195-205, 212-221) peptides. NIA-Reagan Institute criteria were used for the neuropathological diagnosis of AD. Binary logistic regressions tested the association between each plasma peptide and autopsy-confirmed AD status. Area under the receiver operating curve (AUC) statistics were generated using predicted probabilities from the logistic regression models. Odds Ratio (OR) was used to study associations between the different plasma tau species and CERAD and Braak classifications. All tau species were increased in AD compared to non-AD, but p-tau217, p-tau205 and p-tau231 showed the highest fold-changes. Plasma p-tau217 (AUC = 89.8), p-tau231 (AUC = 83.4), and p-tau205 (AUC = 81.3) all had excellent accuracy in discriminating AD from non-AD brain donors, even among those with CDR < 1). Furthermore, p-tau217, p-tau205 and p-tau231 showed the highest ORs with both CERAD (OR = 15.29, OR = 5.05 and OR = 3.86) and Braak staging (OR = 14.29, OR = 5.27 and OR = 4.02) but presented increased levels at different amyloid and tau stages determined by neuropathological examination. Our findings support plasma p-tau217 as the most promising p-tau species for detecting AD brain pathology. Plasma p-tau231 and p-tau205 may additionally function as markers for different stages of the disease.
Topics: Humans; Alzheimer Disease; Amyloid beta-Peptides; tau Proteins; Autopsy; Biomarkers
PubMed: 38159140
DOI: 10.1007/s00401-023-02660-3 -
MMW Fortschritte Der Medizin Nov 2023