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Schraven S, Brück R, Rosenhain S, Lemainque T, Heines D, Noormohammadian H, Pabst O, Lederle W, Gremse F, Kiessling F. CT- and MRI-Aided Fluorescence Tomography Reconstructions for Biodistribution Analysis. Invest Radiol 2023:00004424-990000000-00181. [PMID: 38038691 DOI: 10.1097/rli.0000000000001052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVES Optical fluorescence imaging can track the biodistribution of fluorophore-labeled drugs, nanoparticles, and antibodies longitudinally. In hybrid computed tomography-fluorescence tomography (CT-FLT), CT provides the anatomical information to generate scattering and absorption maps supporting a 3-dimensional reconstruction from the raw optical data. However, given the CT's limited soft tissue contrast, fluorescence reconstruction and quantification can be inaccurate and not sufficiently detailed. Magnetic resonance imaging (MRI) can overcome these limitations and extend the options for tissue characterization. Thus, we aimed to establish a hybrid CT-MRI-FLT approach for whole-body imaging and compared it with CT-FLT. MATERIALS AND METHODS The MRI-based hybrid imaging approaches were established first by scanning a water and coconut oil-filled phantom, second by quantifying Cy7 concentrations of inserts in dead mice, and finally by analyzing the biodistribution of AF750-labeled immunoglobulins (IgG, IgA) in living SKH1 mice. Magnetic resonance imaging, acquired with a fat-water-separated mDixon sequence, CT, and FLT were co-registered using markers in the mouse holder frame filled with white petrolatum, which was solid, stable, and visible in both modalities. RESULTS Computed tomography-MRI fusion was confirmed by comparing the segmentation agreement using Dice scores. Phantom segmentations showed good agreement, after correction for gradient linearity distortion and chemical shift. Organ segmentations in dead and living mice revealed adequate agreement for fusion. Marking the mouse holder frame and the successful CT-MRI fusion enabled MRI-FLT as well as CT-MRI-FLT reconstructions. Fluorescence tomography reconstructions supported by CT, MRI, or CT-MRI were comparable in dead mice with 60 pmol fluorescence inserts at different locations. Although standard CT-FLT reconstruction only considered general values for soft tissue, skin, lung, fat, and bone scattering, MRI's more versatile soft tissue contrast enabled the additional consideration of liver, kidneys, and brain. However, this did not change FLT reconstructions and quantifications significantly, whereas for extending scattering maps, it was important to accurately segment the organs and the entire mouse body. The various FLT reconstructions also provided comparable results for the in vivo biodistribution analyses with fluorescent immunoglobulins. However, MRI additionally enabled the visualization of gallbladder, thyroid, and brain. Furthermore, segmentations of liver, spleen, and kidney were more reliable due to better-defined contours than in CT. Therefore, the improved segmentations enabled better assignment of fluorescence signals and more differentiated conclusions with MRI-FLT. CONCLUSIONS Whole-body CT-MRI-FLT was implemented as a novel trimodal imaging approach, which allowed to more accurately assign fluorescence signals, thereby significantly improving pharmacokinetic analyses.
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Affiliation(s)
- Sarah Schraven
- From the Institute for Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany (S.S., R.B., S.R., T.L., D.H., W.L., F.G., F.K.); Institute of Molecular Medicine, RWTH Aachen University, Aachen, Germany (H.N., O.P.); Gremse-IT GmbH, Aachen, Germany (S.R., F.G.); Department for Diagnostic and Interventional Radiology, RWTH Aachen University, Aachen, Germany (T.L.); Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany (F.K.); and Fraunhofer MEVIS, Institute for Medical Image Computing, Aachen, Germany (F.K.)
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Biancari F, Jormalainen M, Raivio P, Mustonen C, Honkanen HP, Valo J, Vento A, Juvonen T. Cerebral Oximetry Monitoring in Patients Undergoing Surgery for Stanford Type A Aortic Dissection. J Cardiothorac Vasc Anesth 2020; 35:2019-2025. [PMID: 33144000 DOI: 10.1053/j.jvca.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the prognostic impact of cerebral regional oxygen saturation (crSO2) in patients undergoing surgery for Stanford type A aortic dissection (TAAD). DESIGN Observational, retrospective, institutional study. SETTING University hospital. PARTICIPANTS A total of 152 patients who underwent surgery for TAAD from June 2009 to December 2018 at the authors' institution. INTERVENTIONS Surgery for TAAD using continuous perioperative monitoring of crSO2 with near-infrared cerebral oximetry (INVOS, Medtronic, MN). MEASUREMENTS AND RESULTS The rates of postoperative stroke/global brain ischemia were 22.4% and of hospital mortality 14.5%. Age, hemoglobin, and cardiogenic shock were independent predictors of nadir crSO2 from both frontal areas at arrival to the operating room. Repeated measures test showed that changes in crSO2 between the first measurement at operating room arrival, at the start of surgery, and at the end of surgery were not significant when measured on the right frontal area (p = 0.632), left frontal area (p = 0.608), as a nadir value from both frontal areas (p = 0.690), and as a difference between frontal areas (p = 0.826) in patients with and without major neurologic complications. Patients who had a nadir crSO2 <40% anytime during the perioperative period, had a numerically higher rate of major neurologic complications (27.3% v 20.4%, p = 0.354), but this difference did not reach statistical significance. The incidence of nadir of crSO2 value <40% at operating room arrival (5.9%, p = 1.000), at the start of surgery (5.3%, p = 0.685), and at the end of surgery (1.3%, p = 1.000) was rather low and not associated with these adverse events. CONCLUSIONS Derangements in crSO2 detected by cerebral oximetry before and during surgery for TAAD did not predict postoperative stroke and/or global brain ischemia.
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Affiliation(s)
- Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland; Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland; Department of Surgery, University of Turku, Turku, Finland.
| | - Mikko Jormalainen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Peter Raivio
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Caius Mustonen
- Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland
| | - Hannu-Pekka Honkanen
- Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland
| | - Johanna Valo
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Antti Vento
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland; Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland
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Shaaban-Ali M, Momeni M, Denault A. Clinical and Technical Limitations of Cerebral and Somatic Near-Infrared Spectroscopy as an Oxygenation Monitor. J Cardiothorac Vasc Anesth 2020; 35:763-779. [PMID: 32709385 DOI: 10.1053/j.jvca.2020.04.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/12/2020] [Accepted: 04/29/2020] [Indexed: 12/11/2022]
Abstract
Cerebral and somatic near-infrared spectroscopy monitors are commonly used to detect tissue oxygenation in various circumstances. This form of monitoring is based on tissue infrared absorption and can be influenced by several physiological and non-physiological factors that can induce error in the interpretation. This narrative review explores those clinical and technical limitations and proposes solutions and alternatives in order to avoid some of those pitfalls.
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Affiliation(s)
- Mohamed Shaaban-Ali
- Department of Anesthesia, College of Medicine, Assiut University, Assiut, Egypt
| | - Mona Momeni
- Department of Acute Medicine, Section Cardiothoracic and Vascular Anesthesia, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium
| | - André Denault
- Department of Anesthesia and Critical Care Medicine, Montreal Heart Institute, Université de Montréal, and Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
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Ginn C, Ateh D, Martin J. The use of point-of-care testing to establish cause of death in the autopsy setting. J Forensic Leg Med 2020; 71:101933. [DOI: 10.1016/j.jflm.2020.101933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
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Thyroid-related hormones as potential markers of hypoxia/ischemia. Hum Cell 2020; 33:545-558. [PMID: 32146707 PMCID: PMC7324426 DOI: 10.1007/s13577-020-00341-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 02/25/2020] [Indexed: 11/03/2022]
Abstract
This study aimed to investigate the usefulness of the thyroid-related hormones as markers of acute systemic hypoxia/ischemia to identify deaths caused by asphyxiation due to neck compression in human autopsy cases. The following deaths from pathophysiological conditions were examined: mechanical asphyxia and acute/subacute blunt head injury; acute/subacute non-head blunt injury; sharp instrument injury as the hemorrhagic shock condition; drowning as alveolar injury; burn; and death due to cardiac dysfunction. Blood samples were collected from the left and right cardiac chambers and iliac veins, and serum triiodothyronine (T3), thyroxine (T4), thyroglobulin (Tg), and thyroid-stimulating hormone (TSH) levels were measured using electrochemiluminescence immunoassays. Two types of thyroid cell lines were used to confirm independent thyroid function under the condition of hypoxia (3% O2). The human thyroid carcinoma cell line (HOTHC) cell line derived from human anaplastic thyroid carcinoma and the UD-PTC (sample of the second resection papillary thyroid carcinoma) cell line derived from human thyroid papillary adenoma, which forms Tg retention follicles, were used to examine the secretion levels of T3, T4, and Tg hormones. The results showed a strong correlation between T3 and T4 levels in all blood sampling sites, while the TSH and Tg levels were not correlated with the other markers. Serum T3 and T4 levels were higher in cases of mechanical asphyxia and acute/subacute blunt head injury, representing hypoxic and ischemic conditions of the brain as compared to those in other causes of death. In the thyroid gland cell line, T4, T3, and Tg levels were stimulated after exposure to hypoxia for 10-30 min. These findings suggest that systemic advanced hypoxia/ischemia may cause a rapid and TSH-independent release of T3 and T4 thyroid hormones in autopsy cases. These findings demonstrate that increased thyroid-related hormone (T3 and T4) levels in the pathophysiological field may indicate systemic hypoxia/ischemia.
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Tani N, Ikeda T, Aoki Y, Shida A, Oritani S, Ishikawa T. Evaluation of screening for drug use using postmortem prolactin levels in serum and cerebrospinal fluid. Hum Exp Toxicol 2019; 38:1244-1253. [PMID: 31319705 DOI: 10.1177/0960327119864139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prolactin (PRL) levels can usually be controlled by PRL-inhibiting psychiatric drugs that include anti-dopamine agents. However, the use of dopamine (DA) antagonists may lead to hyperprolactinemia under certain clinical conditions. The aim of this study was to investigate postmortem PRL levels as potential markers of drug abuse, especially that of DA antagonists, in autopsy cases. We examined 121 autopsy cases, excluding cases involving acute hypoxia/ischemia, such as asphyxia, because PRL concentrations are reportedly increased under acute hypoxic conditions. Detected drugs were classified as either DA antagonists, stimulants, psychotropic drugs other than DA antagonists, or other non-psychotropic drugs, and many cases had no detected drugs. Samples comprised blood collected from the right heart chamber and cerebrospinal fluid (CSF). PRL protein level was measured by chemiluminescent immunoassay, and PRL gene expression in the anterior pituitary of autopsy cases was analyzed by reverse transcription-polymerase chain reaction. The PRL-positive cell ratio in the anterior pituitary gland was also measured by immunohistochemical analysis. The results indicated that PRL levels in the serum and CSF were higher in DA antagonist cases than in other cases. PRL levels in the serum and CSF also correlated with the PRL gene expression in cases with abuse of DA antagonists. However, no significant difference in the PRL-positive cell ratio in the anterior pituitary gland was evident between any of the classes of drug-detected and drug-undetected cases. These results suggest that postmortem measurements of PRL transcription levels may be useful for diagnosing cases of DA antagonist use.
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Affiliation(s)
- N Tani
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan.,Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
| | - T Ikeda
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan.,Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
| | - Y Aoki
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
| | - A Shida
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
| | - S Oritani
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
| | - T Ishikawa
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan.,Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
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Carfora A, Campobasso CP, Cassandro P, La Sala F, Maiellaro A, Perna A, Petrella R, Borriello R. Fatal inhalation of volcanic gases in three tourists of a geothermal area. Forensic Sci Int 2019; 297:e1-e7. [DOI: 10.1016/j.forsciint.2019.01.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 11/28/2022]
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Maillard J, Sologashvili T, Diaper J, Licker MJ, Keli Barcelos G. A Case of Persistence of Normal Tissue Oxygenation Monitored by Near-Infrared Spectroscopy (NIRS) Values Despite Prolonged Perioperative Cardiac Arrest. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:21-25. [PMID: 30610182 PMCID: PMC6330994 DOI: 10.12659/ajcr.911399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient: Male, 65 Final Diagnosis: Aortic dissection Symptoms: Hemiplegia • hypotension Medication:— Clinical Procedure: Emergent surgery Specialty: Surgery
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Affiliation(s)
- Julien Maillard
- Department of Anesthesiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Tornike Sologashvili
- Department of Surgery, Division Cardiovascular Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - John Diaper
- Department of Anesthesiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Marc-Joseph Licker
- Department of Anesthesiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Gleicy Keli Barcelos
- Department of Anesthesiology, University Hospitals of Geneva, Geneva, Switzerland
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Lewis C, Parulkar SD, Bebawy J, Sherwani S, Hogue CW. Cerebral Neuromonitoring During Cardiac Surgery: A Critical Appraisal With an Emphasis on Near-Infrared Spectroscopy. J Cardiothorac Vasc Anesth 2018; 32:2313-2322. [DOI: 10.1053/j.jvca.2018.03.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Indexed: 11/11/2022]
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Ikeda T, Miyamoto K, Tani N, Oritani S, Michiue T, Morioka F, Ishikawa T. Forensic evaluation of sex estimation via measurements of adult index and ring finger lengths using postmortem computed tomography. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2018. [DOI: 10.1186/s41935-018-0075-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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11
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Tani N, Ikeda T, Watanabe M, Toyomura J, Ohyama A, Ishikawa T. Prolactin selectively transported to cerebrospinal fluid from blood under hypoxic/ischemic conditions. PLoS One 2018; 13:e0198673. [PMID: 29949606 PMCID: PMC6021042 DOI: 10.1371/journal.pone.0198673] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/23/2018] [Indexed: 12/04/2022] Open
Abstract
Aim The aim of this study was to determine and to verify the correlation between the amount of prolactin (PRL) levels in the blood and in the cerebrospinal fluid (CSF) by various causes of death as an indicator for acute hypoxia in autopsy cases. It is to confirm the cause of the change in prolactin level in CSF by in vitro system. Materials and methods In autopsy materials, the PRL levels in blood from the right heart ventricle and in the CSF were measured by chemiluminescent enzyme immunoassay, and changes in the percentage of PRL-positive cells in the pituitary gland were examined using an immunohistochemical method. Furthermore, an inverted culture method was used as an in vitro model of the blood-CSF barrier using epithelial cells of the human choroid plexus (HIBCPP cell line) and SDR-P-1D5 or MSH-P3 (PRL-secreting cell line derived from miniature swine hypophysis) under normoxic or hypoxic (5% oxygen) conditions, and as an index of cell activity, we used Vascular Endothelial Growth Factor (VEGF). Results and discussion Serum PRL levels were not significantly different between hypoxia/ischemia cases and other causes of death. However, PRL levels in CSF were three times higher in cases of hypoxia/ischemia than in those of the other causes of death. In the cultured cell under the hypoxia condition, PRL and VEGF showed a high concentration at 10 min. We established a brain-CSF barrier model to clarify the mechanism of PRL transport to CSF from blood, the PRL concentrations from blood to CSF increased under hypoxic conditions from 5 min. These results suggested that PRL moves in CSF through choroidal epithelium from blood within a short time. PRL is hypothesized to protect the hypoxic/ischemic brain, and this may be because of the increased transportation of the choroid plexus epithelial cells.
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Affiliation(s)
- Naoto Tani
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
- Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, Osaka, Japan
- * E-mail:
| | - Tomoya Ikeda
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
- Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, Osaka, Japan
| | - Miho Watanabe
- Department of NDU Life Sciences, School of Life Dentistry at Tokyo, The Nippon Dental University, Tokyo, Japan
- Field of Oral and Maxillofacial Surgery and System Medicine, Course of Clinical Science, Nippon Dental University, Graduate School of Life Dentistry at Niigata, Niigata, Japan
| | - Junko Toyomura
- Department of NDU Life Sciences, School of Life Dentistry at Tokyo, The Nippon Dental University, Tokyo, Japan
| | - Akihiro Ohyama
- Department of NDU Life Sciences, School of Life Dentistry at Tokyo, The Nippon Dental University, Tokyo, Japan
| | - Takaki Ishikawa
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
- Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, Osaka, Japan
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Genbrugge C, Eertmans W, Jans F, Boer W, Dens J, De Deyne C. Regional cerebral saturation monitoring during withdrawal of life support until death. Resuscitation 2017; 121:147-150. [DOI: 10.1016/j.resuscitation.2017.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 07/16/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
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13
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Molecular pathology of cerebral TNF-α, IL-1β, iNOS and Nrf2 in forensic autopsy cases with special regard to deaths due to environmental hazards and intoxication. Forensic Sci Med Pathol 2017; 13:409-416. [DOI: 10.1007/s12024-017-9896-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2017] [Indexed: 02/07/2023]
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Edmonds HL, Ganzel BL, Austin EH. Cerebral Oximetry for Cardiac and Vascular Surgery. Semin Cardiothorac Vasc Anesth 2017; 8:147-66. [PMID: 15248000 DOI: 10.1177/108925320400800208] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The technology of transcranial near-infrared spectroscopy (NIRS) for the measurement of cerebral oxygen balance was introduced 25 years ago. Until very recently, there has been only occasional interest in its use during surgical monitoring. Now, however, substantial technologic advances and numerous clinical studies have, at least partly, succeeded in overcoming long-standing and widespread misunderstanding and skepticism regarding its value. Our goals are to clarify common misconceptions about near-infrared spectroscopy and acquaint the reader with the substantial literature that now supports cerebral oximetric monitoring in cardiac and major vascular surgery.
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Affiliation(s)
- Harvey L Edmonds
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, Kentucky 40202-3619, USA.
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Du Y, Jin HN, Zhao R, Zhao D, Xue Y, Zhu BL, Guan DW, Xie XL, Wang Q. Molecular Pathology of Pulmonary Edema in Forensic Autopsy Cases with Special Regard to Fatal Methamphetamine Intoxication. J Forensic Sci 2016; 61:1531-1537. [DOI: 10.1111/1556-4029.13199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 01/12/2016] [Accepted: 01/16/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Yu Du
- Department of Forensic Medicine; National Police University of China, No. 83, Tawan Street, Huangpu District, 110035; Shenyang China
| | - Hong-Nian Jin
- Forensic Science Centre of Guangdong Provincial Public Security Department; No. 3 Beijiaochang Cross Road Yuexiu District 510050 Guangzhou China
| | - Rui Zhao
- Department of Forensic Pathology; China Medical University; School of Forensic Medicine; No. 77 Puhe Road, Shenyang North New Area Shenyang Liaoning Province China
| | - Dong Zhao
- Collaborative Innovation Center of Judicial Civilization, China; Key Laboratory of Evidence Science (China University of Political Science and Law); Ministry of Education; No. 25 West Tucheng Road Haidian District Beijing 100088 China
| | - Ye Xue
- Department of Forensic Pathology; School of Forensic Medicine; Southern Medical University; No. 1838 510515 Guangzhou China
| | - Bao-Li Zhu
- Department of Forensic Pathology; China Medical University; School of Forensic Medicine; No. 77 Puhe Road, Shenyang North New Area Shenyang Liaoning Province China
| | - Da-Wei Guan
- Department of Forensic Pathology; China Medical University; School of Forensic Medicine; No. 77 Puhe Road, Shenyang North New Area Shenyang Liaoning Province China
| | - Xiao-Li Xie
- Department of Toxicology, School of Public Health; Southern Medical University, (Guangdong Provincial Key Laboratory of Tropical Disease Research); No. 1838 Guangzhou 510515 China
| | - Qi Wang
- Department of Forensic Pathology; School of Forensic Medicine; Southern Medical University; No. 1838 510515 Guangzhou China
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Yajima D, Asari M, Okuda K, Maseda C, Yamada H, Ichimaru C, Matsubara K, Shiono H, Iwase H, Makino Y, Shimizu K. An objective approach using three indexes for determining fatal hypothermia due to cold exposure; statistical analysis of oxyhemoglobin saturation data. Leg Med (Tokyo) 2015; 17:451-8. [DOI: 10.1016/j.legalmed.2015.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 12/13/2022]
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Chen JH, Michiue T, Inamori-Kawamoto O, Ikeda S, Ishikawa T, Maeda H. Comprehensive investigation of postmortem glucose levels in blood and body fluids with regard to the cause of death in forensic autopsy cases. Leg Med (Tokyo) 2015; 17:475-82. [PMID: 26593993 DOI: 10.1016/j.legalmed.2015.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/24/2015] [Accepted: 08/27/2015] [Indexed: 01/08/2023]
Abstract
The serum glucose level is regulated within a narrow range by multiple factors under physiological conditions, but is greatly modified in the death process and after death. The present study comprehensively investigated glucose levels in blood and body fluids, including pericardial fluid (PCF), cerebrospinal fluid (CSF) and vitreous humor, reviewing forensic autopsy cases (n=672). Right heart blood glucose level was often higher than at other sites, and the CSF glucose level was the lowest, showing greater dissociation in acute/subacute death cases. The glucose level was higher in the diabetic (high HbA1c) than in the non-diabetic (low HbA1c) group at each site (p<0.01-0.0001). Fatal diabetic ketoacidosis cases had evidently high glucose levels at each site; whereas in the non-diabetic group, blood glucose level was higher in fatal alcohol abuse, saltwater drowning, electrocution, cerebrovascular disease and sudden cardiac death due to ischemic heart disease. Fatal methamphetamine (MA) abuse, sepsis, malnutrition (starvation) and hypoglycemia due to antidiabetics showed markedly lower blood glucose levels. Ketones in bilateral cardiac blood and PCF were increased in diabetic ketoacidosis and fatal alcohol abuse as well as in most cases of hyperthermia (heatstroke), hypothermia (cold exposure) and malnutrition. These findings suggest that combined analysis of glucose, HbA1c and ketones in blood and body fluids is useful to investigate not only fatal diabetic metabolic disorders but also death processes due to other causes, including alcohol and MA abuse, as well as thermal disorders, sepsis and malnutrition.
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Affiliation(s)
- Jian-Hua Chen
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan.
| | - Tomomi Michiue
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
| | - Osamu Inamori-Kawamoto
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
| | - Sayuko Ikeda
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
| | - Takaki Ishikawa
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
| | - Hitoshi Maeda
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
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18
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Should Cerebral Near-infrared Spectroscopy be Standard of Care in Adult Cardiac Surgery? Heart Lung Circ 2015; 24:544-50. [DOI: 10.1016/j.hlc.2015.01.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/19/2015] [Indexed: 11/18/2022]
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19
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Grinspan ZM, Pon S, Greenfield JP, Malhotra S, Kosofsky BE. Multimodal monitoring in the pediatric intensive care unit: new modalities and informatics challenges. Semin Pediatr Neurol 2014; 21:291-8. [PMID: 25727511 DOI: 10.1016/j.spen.2014.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We review several newer modalities to monitor the brain in children with acute neurologic disease in the pediatric intensive care unit, such as partial brain tissue oxygen tension (PbtO2), jugular venous oxygen saturation (SjvO2), near infrared spectroscopy (NIRS), thermal diffusion measurement of cerebral blood flow, cerebral microdialysis, and EEG. We then discuss the informatics challenges to acquire, consolidate, analyze, and display the data. Acquisition includes multiple data types: discrete, waveform, and continuous. Consolidation requires device interoperability and time synchronization. Analysis could include pressure reactivity index and quantitative EEG. Displays should communicate the patient's current status, longitudinal and trend information, and critical alarms.
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Affiliation(s)
- Zachary M Grinspan
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY; Department of Pediatrics, Weill Cornell Medical College, New York, NY; Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York, NY; New York Presbyterian Hospital, New York, NY.
| | - Steven Pon
- Department of Pediatrics, Weill Cornell Medical College, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Jeffrey P Greenfield
- New York Presbyterian Hospital, New York, NY; Department of Neurologic Surgery, Weill Cornell Medical College, New York, NY
| | - Sameer Malhotra
- Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York, NY; New York Presbyterian Hospital, New York, NY; Physician Organization, Weill Cornell Medical College, New York, NY
| | - Barry E Kosofsky
- Department of Pediatrics, Weill Cornell Medical College, New York, NY; New York Presbyterian Hospital, New York, NY
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20
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Ishikawa T, Inamori-Kawamoto O, Quan L, Michiue T, Chen JH, Wang Q, Zhu BL, Maeda H. Postmortem urinary catecholamine levels with regard to the cause of death. Leg Med (Tokyo) 2014; 16:344-9. [DOI: 10.1016/j.legalmed.2014.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/25/2014] [Accepted: 07/21/2014] [Indexed: 01/15/2023]
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21
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Kanto-Nishimaki Y, Saito H, Watanabe-Aoyagi M, Toda R, Iwadate K. Investigation of oxyhemoglobin and carboxyhemoglobin ratios in right and left cardiac blood for diagnosis of fatal hypothermia and death by fire. Leg Med (Tokyo) 2014; 16:321-5. [DOI: 10.1016/j.legalmed.2014.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/19/2014] [Accepted: 06/30/2014] [Indexed: 02/04/2023]
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22
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Wang Q, Ishikawa T, Michiue T, Zhu BL, Guan DW, Maeda H. Molecular pathology of brain matrix metalloproteases, claudin5, and aquaporins in forensic autopsy cases with special regard to methamphetamine intoxication. Int J Legal Med 2014; 128:469-74. [DOI: 10.1007/s00414-014-0972-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 01/21/2014] [Indexed: 01/27/2023]
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23
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Calderon-Arnulphi M, Alaraj A, Slavin KV. Near infrared technology in neuroscience: past, present and future. Neurol Res 2013; 31:605-14. [DOI: 10.1179/174313209x383286] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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24
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Skhirtladze-Dworschak K, Dworschak M. Cerebral oximetry and cardiac arrest. Semin Cardiothorac Vasc Anesth 2013; 17:269-75. [PMID: 23782549 DOI: 10.1177/1089253213492861] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cerebral oximetry is a Food and Drug Administration-approved technology that allows monitoring of brain oxygen saturation in accessible superficial brain cortex regions, which are amongst the most vulnerable in regard to ischemic or hypoxic injury. Since most oxygen in the area of interest is located in the venous compartment, the determined regional brain oxygen saturation approximately reflects the local balance between oxygen delivery and oxygen consumption. Major systemic alterations in blood oxygen content and oxygen delivery will be accompanied by corresponding changes in regional brain saturation. This systematic review, which is based on a Medline search, focuses on the characteristic changes in regional cerebral oxygen saturation that occur, when global oxygen supply to the brain ceases. It further highlights the potential application of cerebral oximetry in the management of cardiac arrest victims, the predictability of clinical outcome after global cerebral ischemia, and it also indicates possible potentials for the management of cerebral reperfusion after having instituted return of spontaneous circulation.
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25
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Ishikawa T, Quan L, Michiue T, Kawamoto O, Wang Q, Chen JH, Zhu BL, Maeda H. Postmortem catecholamine levels in pericardial and cerebrospinal fluids with regard to the cause of death in medicolegal autopsy. Forensic Sci Int 2013; 228:52-60. [DOI: 10.1016/j.forsciint.2013.02.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 01/30/2013] [Accepted: 02/04/2013] [Indexed: 01/19/2023]
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26
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Vernick WJ, Gutsche JT. Pro: Cerebral Oximetry Should be a Routine Monitor During Cardiac Surgery. J Cardiothorac Vasc Anesth 2013; 27:385-9. [DOI: 10.1053/j.jvca.2012.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Indexed: 12/13/2022]
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27
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Fujihara J, Kinoshita H, Tanaka N, Yasuda T, Takeshita H. Accuracy and usefulness of the AVOXimeter 4000 as routine analysis of carboxyhemoglobin. J Forensic Sci 2013; 58:1047-9. [PMID: 23551144 DOI: 10.1111/1556-4029.12144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Revised: 05/14/2012] [Accepted: 06/02/2012] [Indexed: 12/01/2022]
Abstract
The measurement of blood carboxyhemoglobin (CO-Hb) is important to determine the cause of death. The AVOXimeter 4000 (AVOX), a portable CO-oximeter, has the advantages of a low purchase price and operating cost, ease of operation, and rapid results. Little information is available on the usefulness of AVOX in the forensic sample, and the previous study investigated only six samples. Therefore, in this study, we confirmed the usefulness of the AVOX through a comparison of its results with data previously obtained using the double wavelength spectrophotometric method in autopsies. Regression analysis was performed between CO-Hb levels measured by the AVOX and those measured by the conventional double wavelength spectrophotometric method in postmortem blood samples: a significant correlation was observed. This study suggests the usefulness of the AVOX to analyze postmortem blood, and the AVOX is suitable for routine forensic analysis and can be applied at the crime scene.
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Affiliation(s)
- Junko Fujihara
- Department of Legal Medicine, Shimane University School of Medicine, 89-1 Enya, Izumo Shimane, 693-8501, Japan
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28
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Francony G, Bouzat P, Payen JF. [Near infrared spectroscopy monitoring in the neurointensive care]. ACTA ACUST UNITED AC 2012; 31:e133-6. [PMID: 22683164 DOI: 10.1016/j.annfar.2012.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Near infrared spectroscopy (NIRS) can noninvasively measure cerebral saturation in oxygen, that permits to estimate brain oxygenation and metabolism. This technique could be incorporated into a multimodal monitoring for severely brain-injured patients. This review presents the principles of NIRS, its limits, the main results from clinical studies and its perspectives. More clinical studies are needed before recommending the routine use of NIRS in the ICU.
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Affiliation(s)
- G Francony
- Pôle anesthésie-réanimation, hôpital Michallon, BP 217, 38043 Grenoble cedex 09, France.
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29
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Re-oxygenation of post-mortem lividity by passive diffusion through the skin at low temperature. Forensic Sci Med Pathol 2011; 7:333-5. [PMID: 21590457 DOI: 10.1007/s12024-011-9244-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2011] [Indexed: 10/18/2022]
Abstract
Post-mortem hypostasis develops due to passive settling of the blood under the effect of gravity after death. Due to consumption of oxygen in the tissues by residual cellular activity after the circulation has stopped, lividity is composed of deoxygenated blood. It has been previously shown that cooling of a body causes lividity to oxygenate, changing from a dark red/blue to a pink/red color, due to hemoglobin's increased affinity for oxygen at low temperature. This study has confirmed that this occurs by passive diffusion through the skin, but that this can only occur within a limited time frame. The reasons for this process and its potential forensic application require further investigation.
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30
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Maeda H, Ishikawa T, Michiue T. Forensic biochemistry for functional investigation of death: Concept and practical application. Leg Med (Tokyo) 2011; 13:55-67. [DOI: 10.1016/j.legalmed.2010.12.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 12/23/2010] [Indexed: 10/18/2022]
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31
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Quan L, Ishikawa T, Hara J, Michiue T, Chen JH, Wang Q, Zhu BL, Maeda H. Postmortem serotonin levels in cerebrospinal and pericardial fluids with regard to the cause of death in medicolegal autopsy. Leg Med (Tokyo) 2011; 13:75-8. [DOI: 10.1016/j.legalmed.2010.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 11/24/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
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32
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Ishikawa T, Michiue T, Maeda H. Evaluation of postmortem serum and cerebrospinal fluid growth hormone levels in relation to the cause of death in forensic autopsy. Hum Cell 2011; 24:74-7. [DOI: 10.1007/s13577-011-0012-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 12/09/2010] [Indexed: 11/27/2022]
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33
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Murkin JM, Arango M. Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth 2010; 103 Suppl 1:i3-13. [PMID: 20007987 DOI: 10.1093/bja/aep299] [Citation(s) in RCA: 527] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Continuous real-time monitoring of the adequacy of cerebral perfusion can provide important therapeutic information in a variety of clinical settings. The current clinical availability of several non-invasive near-infrared spectroscopy (NIRS)-based cerebral oximetry devices represents a potentially important development for the detection of cerebral ischaemia. In addition, a number of preliminary studies have reported on the application of cerebral oximetry sensors to other tissue beds including splanchnic, renal, and spinal cord. This review provides a synopsis of the mode of operation, current limitations and confounders, clinical applications, and potential future uses of such NIRS devices.
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Affiliation(s)
- J M Murkin
- Department of Anesthesiology and Perioperative Medicine, University Hospital-LHSC, University of Western Ontario, Rm C3-112, 339 Windermere Rd, London, ON, Canada N6A 5A5.
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34
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Quan L, Zhu BL, Ishikawa T, Michiue T, Zhao D, Li DR, Ogawa M, Maeda H. Postmortem serum erythropoietin levels in establishing the cause of death and survival time at medicolegal autopsy. Int J Legal Med 2008; 122:481-7. [DOI: 10.1007/s00414-008-0276-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 07/09/2008] [Indexed: 11/24/2022]
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35
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Ishikawa T, Quan L, Li DR, Zhao D, Michiue T, Hamel M, Maeda H. Postmortem biochemistry and immunohistochemistry of adrenocorticotropic hormone with special regard to fatal hypothermia. Forensic Sci Int 2008; 179:147-51. [DOI: 10.1016/j.forsciint.2008.04.023] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Revised: 04/03/2008] [Accepted: 04/30/2008] [Indexed: 11/28/2022]
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36
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Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Quan L, Oritani S, Bessho Y, Maeda H. Postmortem serum catecholamine levels in relation to the cause of death. Forensic Sci Int 2007; 173:122-9. [PMID: 17395415 DOI: 10.1016/j.forsciint.2007.02.013] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 02/08/2007] [Accepted: 02/12/2007] [Indexed: 11/17/2022]
Abstract
Catecholamines are major humoral factors and neurotransmitters that contribute to various stress responses. However, they have been considered unstable due to agony, terminal medical care and postmortem interference. The present study was a comprehensive investigation of postmortem serum levels of adrenaline (Adr), noradrenaline (Nad) and dopamine (DA) with regard to the cause of death in serial medicolegal autopsy cases (n=542) including fatalities from various traumas and diseases. There was a slight tendency toward postmortem increases of Nad and DA in cardiac blood as well as Adr and Nad in peripheral blood, a slight age-dependent decrease in Adr and DA in right heart blood, and a marked increase in serum DA due to administration during critical medical care. When these factors were taken into consideration, significantly higher cardiac blood levels were observed for Adr and Nad in injury and asphyxiation cases and for Adr in fatal methamphetamine (MA) abuse and other poisoning cases, whereas those levels were lower in fatal hypothermia. Drowning, fire fatality, acute cardiac death and cerebrovascular disease showed intermediate Adr and Nad levels. The DA level was elevated in cases of injury, hyperthermia, MA fatality and other poisoning. Topographical analyses suggested that the major sources of increased serum catecholamines in cases of injury was abdominal viscera including adrenal glands, and that in cases of asphyxiation, drowning, fire fatality, hyperthermia, MA fatality, other poisoning, acute cardiac death and cerebrovascular disease was the extremities in addition to abdominal viscera. However, there was in part a large case-to-case difference in each marker related to individual causes of death. These findings differed markedly from clinical observations and suggest that the postmortem serum catecholamine levels may reflect the magnitude of physical stress responses during the process of death in individual cases.
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Affiliation(s)
- Bao-Li Zhu
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan.
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37
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Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Bessho Y, Kamikodai Y, Tsuda K, Okazaki S, Maeda H. Postmortem cardiac troponin I and creatine kinase MB levels in the blood and pericardial fluid as markers of myocardial damage in medicolegal autopsy. Leg Med (Tokyo) 2007; 9:241-50. [PMID: 17459758 DOI: 10.1016/j.legalmed.2007.01.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 12/26/2006] [Accepted: 01/24/2007] [Indexed: 10/23/2022]
Abstract
The present study investigated cardiac troponin I (cTnI) and creatine kinase MB (CK-MB) in the blood and pericardial fluid from medicolegal autopsy cases (n=234, within 48h postmortem) with regard to the cause of death. The cTnI and CK-MB levels in cardiac, peripheral blood and pericardial fluid generally showed a mild and gradual postmortem time-dependent elevation (r=0.231-0.449, P<0.05-0.001). However, postmortem elevation of cTnI was larger for specific causes of death including acute myocardial infarction (AMI), cerebrovascular diseases (CVD), hyperthermia, fatal methamphetamine (MA) abuse and carbon monoxide (CO) intoxication and insignificant for recurrent myocardial infarction (RMI), chronic congestive heart diseases (CHD) and drowning, while that of CK-MB was greater for CO intoxication and insignificant for drowning. Cardiac blood and pericardial cTnI levels were relatively high for AMI, RMI, hyperthermia, MA abuse and CO intoxication, and was low for drowning. Elevated CK-MB level was observed for cardiac blood in asphyxiation and MA abuse cases and for peripheral blood in hyperthermia and MA abuse cases. When the cTnI/CK-MB ratio was estimated, it was independent of postmortem time, and the ratios for cardiac blood and pericardial fluid were significantly higher in cases of AMI, RMI, hyperthermia and CO intoxication but lower in cases of drowning. Elevations of cTnI levels in cardiac blood and pericardial fluid were related to the morphological severity of myocardial damage. These findings suggest that elevated cTnI and CK-MB levels in blood and pericardial fluid are related to ischemic, hypoxic and/or cytotoxic myocardial damage, which are characteristic of the cause of death, although the levels increase after death depending on myocardial damage at the time of death.
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Affiliation(s)
- Bao-Li Zhu
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan.
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38
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Ishikawa T, Zhu BL, Li DR, Zhao D, Michiue T, Maeda H. Immunohistochemical investigation of ubiquitin and myoglobin in the kidney in medicolegal autopsy cases. Forensic Sci Int 2007; 171:136-41. [PMID: 17166680 DOI: 10.1016/j.forsciint.2006.10.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Revised: 08/28/2006] [Accepted: 10/30/2006] [Indexed: 10/23/2022]
Abstract
We examined the immunohistochemical distributions of ubiquitin (Ub) and myoglobin (Mb) in human kidney tissues to assist the pathological assessment of death due to trauma. Medicolegal autopsy cases at our institute (n=138: 0-96 years of age, 105 males and 33 females) were examined. Causes of death were blunt injury (n=31), sharp injury (n=15), poisoning (n=11), drowning (n=10), fire fatalities (n=25), hypothermia (n=7), asphyxiation (n=14), hyperthermia (n=3), and natural diseases (n=22) for controls. Immunostaining of Ub and Mb was performed on the formalin-fixed paraffin-embedded kidney tissue sections. Quantitative analyses by estimating the proportion of Ub- and Mb-positive cells (%positivity) of renal tubule epithelial cells showed that the positivities for Ub and Mb were higher in subjects who died due to fire, blunt injury, sharp injury and fatal hypothermia than in other groups. The Ub-positivity correlated with the severity of airway thermal injury in fire deaths, survival time in blunt injury, and serum markers for renal failure in deaths due to sharp injury. Concomitant increases in the tubular Mb- and Ub-positivities were characteristic to deaths from injury and hypothermia. These findings suggest that Ub may serve as a sensitive indicator of the fatal influence of traumas.
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Affiliation(s)
- Takaki Ishikawa
- Department of Legal Medicine, Osaka City University Medical School, Asahi-Machi 1-4-3, Abeno, Osaka 545-8558, Japan.
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39
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Bohnert M, Schulz K, Belenkaia L, Liehr AW. Re-oxygenation of haemoglobin in livores after post-mortem exposure to a cold environment. Int J Legal Med 2007; 122:91-6. [PMID: 17345088 DOI: 10.1007/s00414-007-0162-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Accepted: 02/16/2007] [Indexed: 10/23/2022]
Abstract
When a body is exposed to a cold environment, the livid colour of livor mortis changes to cherry red. This colour change is due to an increase in the concentration of oxygenated haemoglobin. The chronological course and the extent of haemoglobin re-oxygenation associated with the exposure to low ambient temperatures have not been understood so far. The relations between refrigeration time under a constant ambient temperature (5 degrees C), skin temperature, body mass index (BMI), spectral reflectance curve and O2-Hb concentration in livor mortis were systematically investigated in 84 bodies brought to the Institute of Legal Medicine of the Freiburg University Hospital shortly after death. In the first measurements performed shortly after death, the reflectance curves of the livores of all bodies showed a broad minimum at 555 nm. After a refrigeration time of 44.9 +/- 17.9 h, the spectrum changed to the typical picture of O2-rich blood with 2 minima at 541 and 576 nm and a maximum at 560 nm in between. This qualitative change of the reflectance spectra was observed for a skin temperature of 10.3 +/- 2.7 degrees C. With the help of a physical skin model it was possible to calculate that due to the post-mortem exposure to cold the O2-Hb concentration in the livores rose from 0-1% to a value of up to 89.3%. The change in the reflectance curve was discernible from an oxygen saturation of 25 +/- 13.8%.
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Affiliation(s)
- Michael Bohnert
- Institute of Legal Medicine, Albert Ludwig University, Albertstrasse 9, 79104 Freiburg, Germany.
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40
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Zhu BL, Ishikawa T, Michiue T, Tanaka S, Zhao D, Li DR, Quan L, Oritani S, Maeda H. Differences in postmortem urea nitrogen, creatinine and uric acid levels between blood and pericardial fluid in acute death. Leg Med (Tokyo) 2007; 9:115-22. [PMID: 17197225 DOI: 10.1016/j.legalmed.2006.10.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Revised: 10/13/2006] [Accepted: 10/16/2006] [Indexed: 11/30/2022]
Abstract
Previous studies showed significant differences in postmortem urea nitrogen (UN), creatinine (Cr) and uric acid (UA) levels in heart blood depending on the causes of death, including acute death. In addition, the levels in pericardial fluid approximated the clinical serum reference ranges, and their elevations may be assessed based on clinical criteria. The present study investigated difference between blood and pericardial levels of these markers. Medicolegal autopsy cases (n=556, within 48h postmortem) of the following causes of death were examined: injury (n=136), asphyxiation (n=50), drowning (n=39), fire fatalities (n=99), hyperthermia (n=11), hypothermia (n=8), poisoning (n=26), delayed traumatic death (n=44) and natural diseases (n=143). When serum UN, Cr and UA levels were compared with the pericardial levels, there was an equivalency for delayed traumatic death and chronic renal failure, although each level was markedly elevated. Parallel increases in serum and pericardial UA and/or Cr levels were also observed for hypothermia and gastrointestinal bleeding. However, in drowning cases, the left cardiac and pericardial UN levels were lower than the right cardiac and peripheral levels, suggesting the influence of water aspiration. Significant elevations in serum and pericardial Cr and UA levels with a higher serum/pericardial UA ratio for fatal methamphetamine intoxication suggest progressive skeletal muscle damage due to advanced hypoxia/acidosis. Similar findings were often observed for other acute and subacute deaths. These findings suggest that a comparison between blood and pericardial nitrogenous compounds would be useful for investigating the cause and process of death.
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Affiliation(s)
- Bao-Li Zhu
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan.
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41
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Zhao D, Zhu BL, Ishikawa T, Li DR, Michiue T, Maeda H. Quantitative RT-PCR assays of hypoxia-inducible factor‐1α, erythropoietin and vascular endothelial growth factor mRNA transcripts in the kidneys with regard to the cause of death in medicolegal autopsy. Leg Med (Tokyo) 2006; 8:258-63. [PMID: 16963303 DOI: 10.1016/j.legalmed.2006.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Revised: 04/06/2006] [Accepted: 05/11/2006] [Indexed: 11/19/2022]
Abstract
Accumulating studies demonstrate that the expressions of hypoxia-inducible factor 1 (HIF-1), erythropoietin (EPO) and vascular endothelial growth factor (VEGF) depend on cellular oxygen tension, which is involved in the pathological process of tissue hypoxia and/or ischemia. The present study investigated hypoxia-inducible factor-1alpha (HIF-1alpha), EPO and VEGF mRNA expressions in the kidney with regard to the cause of death in medicolegal autopsy. Relative quantifications of HIF-1alpha, EPO and VEGF mRNAs, based on real-time TaqMan reverse transcription-polymerase chain reaction (RT-PCR), were performed on tissue specimens obtained from consistent sites of the bilateral renal cortices. The cases (total, n=245, 6-48h postmortem) included fatal blunt/sharp instrument injuries (n=53/31), asphyxia (n=28: aspiration, n=8; strangulation/hanging, n=20), drowning (n=27), fire fatality (n=62), acute myocardial infarction/ischemia (AMI, n=39), and gastrointestinal hemorrhage (n=5). Both HIF-1alpha and EPO mRNA levels were significantly lower in drowning cases. More characteristic findings were found for VEGF mRNA: it showed higher expression levels for AMI, acute blunt/sharp instrument injury, and aspiration, whereas it was lower for neck compression (strangulation/hanging), drowning, fire fatality with higher blood carboxyhemoglobin (COHb) levels (>60%), peracute blunt injury, and gastrointestinal hemorrhage. Quantitative assays of renal HIF-1alpha, EPO and VEGF mRNA transcripts are potentially useful for investigating the pathophysiology of death, and VEGF mRNA may be especially useful as an indication of acute circulatory failure.
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Affiliation(s)
- Dong Zhao
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan.
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Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Tanaka S, Kamikodai Y, Tsuda K, Okazaki S, Maeda H. Postmortem pericardial natriuretic peptides as markers of cardiac function in medico-legal autopsies. Int J Legal Med 2006; 121:28-35. [PMID: 16741745 DOI: 10.1007/s00414-006-0102-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Accepted: 04/24/2006] [Indexed: 11/29/2022]
Abstract
Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in the blood are clinical markers for the diagnosis of cardiac failure. This study was a comprehensive analysis of the postmortem pericardial levels of the natriuretic peptides in serial medico-legal autopsy cases (n=263, within 72 h postmortem) to assess their validity in investigating cardiac function. There was no significant relationship of pericardial ANP or BNP levels with postmortem time or the age of the subjects. The ANP and BNP levels showed negative correlations with the pericardial cardiac troponin T level. The ANP level was significantly elevated in drowning cases. Pericardial BNP and the BNP/ANP ratio were significantly higher for chronic congestive heart disease. However, asphyxiation, sharp instrument injury, hyperthermia, and fatal MA poisoning cases showed lower levels for both markers. These observations suggest that elevations in the postmortem pericardial ANP and BNP may mainly depend on acute atrial overload and subacute or chronic cardiac failure, respectively, and may be reduced by advanced myocardial damage.
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Affiliation(s)
- Bao-Li Zhu
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka, 545-8585, Japan.
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Edmonds HL. Pro: All Cardiac Surgical Patients Should Have Intraoperative Cerebral Oxygenation Monitoring. J Cardiothorac Vasc Anesth 2006; 20:445-9. [PMID: 16750751 DOI: 10.1053/j.jvca.2006.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Indexed: 11/11/2022]
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Li DR, Zhu BL, Ishikawa T, Zhao D, Michiue T, Maeda H. Immunohistochemical distribution of S-100 protein in the cerebral cortex with regard to the cause of death in forensic autopsy. Leg Med (Tokyo) 2006; 8:78-85. [PMID: 16338157 DOI: 10.1016/j.legalmed.2005.09.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Revised: 08/18/2005] [Accepted: 09/04/2005] [Indexed: 12/17/2022]
Abstract
S-100 protein (S100) is an acidic calcium-binding protein, which is abundantly found in the brain. The aim of the present study was to investigate the immunohistochemical distribution of S100 in the cerebral cortex in forensic autopsy cases with regard to the cause of death and relationship to its serum levels. The cases (n = 286, 3-48 h postmortem) included fatal head injuries (n = 89), acute death from other blunt injuries (n = 29), sharp instrument injuries (n = 20), asphyxiation (n = 29: strangulation/hanging, n = 22; aspiration, n = 7), drownings (n = 22), fire fatalities (n = 68), cerebrovascular diseases (n = 9) and acute myocardial infarction/ischemia (AMI, n = 20). S100-immunopositivity was mainly observed in the gliacytes, in part, in the neurons and myelins. For S100B-immunostaining, the gliacytes and myelins were positive, whereas the neurons were negative. Positivity in astrocytes was dependent on the cause of death, and was significantly lower in acute deaths due to strangulation/hanging and drowning, and mildly low in those due to injuries. Positivity in neurons and myelins was frequently observed in delayed head injury deaths and fire fatalities, showing an inverse relationship with the positivity in astrocytes in head injury cases. For cases of acute death, there was an inverse relationship between S100-positivity in the astrocytes and the serum S100B level. These observations suggest that astrocytes are more rapidly and severely injured than neurons during fatal brain damage, thereby causing an elevation in the serum S100B level.
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Affiliation(s)
- Dong-Ri Li
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan.
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Li DR, Zhu BL, Ishikawa T, Zhao D, Michiue T, Maeda H. Postmortem serum protein S100B levels with regard to the cause of death involving brain damage in medicolegal autopsy cases. Leg Med (Tokyo) 2006; 8:71-7. [PMID: 16337822 DOI: 10.1016/j.legalmed.2005.07.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2005] [Revised: 06/20/2005] [Accepted: 07/13/2005] [Indexed: 11/17/2022]
Abstract
The protein S100 is an acidic calcium-binding protein, and the subunit S100B is the most abundantly found in the brain. The aim of the present study was a comprehensive analysis of serum S100B levels in medicolegal autopsy cases (within 48 h postmortem, n = 283) including victims with head and non-head injuries and also non-injury fatalities with regard to the cause of death involving brain damage. The serum level was usually higher in the subclavian vein than in the right heart and external iliac vein, and the lowest in the left heart blood, showing no significant postmortem influence. The serum level in the right heart and subclavian vein was markedly higher for acute deaths from head injury and asphyxiation due to neck compression (strangulation and hanging), and moderately and mildly elevated for other blunt and sharp instrument injury cases, respectively. For head injury, the serum levels were lower for subacute deaths than for acute deaths. These observations suggest that the elevation of serum S100B may mainly be caused by leakage following massive brain damage due to injury and cerebral hypoxia/ischemia, and in part by systemic hypoxic/traumatic tissue damage, depending on the survival time.
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Affiliation(s)
- Dong-Ri Li
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan.
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Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Oritani S, Kamikodai Y, Tsuda K, Okazaki S, Maeda H. Postmortem cardiac troponin T levels in the blood and pericardial fluid. Part 1. Analysis with special regard to traumatic causes of death. Leg Med (Tokyo) 2006; 8:86-93. [PMID: 16338155 DOI: 10.1016/j.legalmed.2005.10.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Revised: 08/09/2005] [Accepted: 10/15/2005] [Indexed: 11/29/2022]
Abstract
In forensic pathology, previous studies have suggested the possible application of cardiac troponins in the diagnosis of myocardial infarction. However, there appears to be insufficient practical data on other causes of death. The present study was a comprehensive analysis of the cardiac, peripheral blood and pericardial levels of cardiac troponin T (cTnT) in serial medicolegal autopsy cases (n = 405) with a survival time <24 h and within 48 h postmortem to assess the validity of investigating myocardial damage with special regard to traumatic causes of death. These included blunt and sharp instrument injury (n = 122 and 21, respectively), asphyxiation (n = 35), drowning (n = 27), fire fatalities (n = 94), hyperthermia (n = 13), hypothermia (n = 6), fatal methamphetamine (MA) abuse (n = 12) and carbon monoxide (CO) poisoning (n = 5) in comparison with myocardial infarction (MI, n = 57) and cerebrovascular diseases (n = 13). Cases within 12h postmortem usually showed lower cardiac and pericardial cTnT levels than did those of longer postmortem time of 12-48 h. In the early postmortem period of <12 h, significantly elevated serum cTnT levels were observed for hyperthermia. Thereafter, fatal MA abuse, CO poisoning and MI cases also showed higher levels. However, cTnT remained at lower levels for hypothermia and drowning. The elevation of cTnT was associated with the pathology of advanced myocardial damage involving swelling and liquefactive necrosis. The above-mentioned differences were the smallest for peripheral blood. These findings suggest that elevations in postmortem serum and pericardial cTnT levels depend on the severity of myocardial damage at the time of death and are related to the pathological findings, although postmortem interference should be taken into consideration.
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Affiliation(s)
- Bao-Li Zhu
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan.
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Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Quan L, Maeda H. Evaluation of postmortem urea nitrogen, creatinine and uric acid levels in pericardial fluid in forensic autopsy. Leg Med (Tokyo) 2006; 7:287-92. [PMID: 16048740 DOI: 10.1016/j.legalmed.2005.04.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2004] [Revised: 03/17/2005] [Accepted: 04/04/2005] [Indexed: 11/19/2022]
Abstract
In postmortem biochemistry, there is insufficient data available for the practical analysis of factors in the pericardial fluid. The aim of the present study was to examine postmortem pericardial fluid for urea nitrogen (UN), creatinine (Cr) and uric acid (UA) levels to investigate the pathophysiology of death in forensic autopsy cases (total, n = 409; within 48 h postmortem), which included blunt, sharp instrument injury, asphyxiation, drowning, fire fatalities, hyperthermia, hypothermia, methamphetamine-related fatalities, other poisoning, delayed death from trauma and natural diseases. There was a significant elevation in the three markers for chronic renal failure, gastrointestinal bleeding, hyperthermia, hypothermia, methamphetamine fatalities and delayed traumatic death, which was comparable with the clinical criteria for their serum levels. These postmortem findings showed azotemia due to renal failure, elevated protein catabolism and rhabdomyolysis. Although the pericardial levels were otherwise similar to the clinical serum reference ranges, only the drowning fatalities showed significantly lower levels for each marker. These observations suggested the stability of UN, Cr and UA in the pericardial fluid within 48 h postmortem and their usefulness for the pathophysiological investigation of death involving azotemia.
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Affiliation(s)
- Bao-Li Zhu
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan.
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Taillefer MC, Denault AY. Cerebral near-infrared spectroscopy in adult heart surgery: systematic review of its clinical efficacy. Can J Anaesth 2005; 52:79-87. [PMID: 15625262 DOI: 10.1007/bf03018586] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE This systematic review is aimed at answering the following questions: 1) Is near-infrared spectroscopy (NIRS) clinically effective in detecting cerebral desaturation during heart surgery? 2) Are these results based on studies with solid methodology? SOURCES MEDLINE, internet, and hand searches up to February 2004 for English and French papers on NIRS. PRINCIPAL FINDINGS Forty-eight papers were retrieved, with a total of 5,931 cardiac surgery patients monitored by NIRS. More than 83% of patients underwent coronary artery bypass graft surgery. The majority of studies were prospective for the monitored group. Clinically, NIRS monitoring appears to detect brain desaturation episodes encountered during surgery. However, the majority of studies retrieved suffered from major methodological limitations and a low level of evidence. NIRS validity vs jugular bulb oximetry is questioned together with its predictive value in identifying those who will suffer postoperatively from neurological deficits. The sole randomized controlled trial appears to have recorded negative results in this respect. CONCLUSION The clinical application of NIRS in heart surgery as a brain-monitoring device seems interesting. However, NIRS has to be investigated more rigorously to prove its clinical utility in cardiac surgery.
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Affiliation(s)
- Marie-Christine Taillefer
- Department of Anesthesiology, Montreal Heart Institute, Room R-2230, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada.
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Zhu BL, Ishikawa T, Quan L, Li DR, Zhao D, Michiue T, Maeda H. Evaluation of postmortem serum calcium and magnesium levels in relation to the causes of death in forensic autopsy. Forensic Sci Int 2004; 155:18-23. [PMID: 16216707 DOI: 10.1016/j.forsciint.2004.10.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2003] [Accepted: 10/27/2004] [Indexed: 11/23/2022]
Abstract
There appears to be very poor investigation of postmortem serum calcium (Ca) and magnesium (Mg) for diagnostic evidence to determine the cause of death. The aim of the present study was a comprehensive analysis of the serum levels in relation to the causes of death in routine casework. Autopsy cases (total, n=360; 5-48 h postmortem), including blunt injury (n=76), sharp injury (n=29), asphyxiation (n=42), drownings (n=28: freshwater, n=11; saltwater, n=17), fire fatalities (n=79), methamphetamine (MA) poisoning (n=8), delayed death from traumas (n=37), and acute myocardial infarction/ischemia (AMI, n=61), were examined. In total cases, there was no significant postmortem time-dependent rise in serum Ca and Mg. Both Ca and Mg levels in the heart and peripheral blood were significantly higher in saltwater drowning compared with those of the other groups. In addition, a significant elevation in the Ca level was observed in freshwater drowning and fire fatalities, and in the Mg level in fatal MA intoxication and asphyxiation. Topographic analyses suggested a rise in serum Ca and Mg due to aspirated saltwater in drowning, that in serum Ca in freshwater drowning and fire fatalities of peripheral skeletal muscle origin and that in serum Mg in MA fatality and asphyxiation of myocardial and/or peripheral origin. These markers may be useful especially for diagnosis and differentiation of salt- and freshwater drownings and may be also helpful to determine the causes of death involving skeletal muscle damage, including burns and MA intoxication.
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Affiliation(s)
- Bao-Li Zhu
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan.
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Yao FSF, Tseng CCA, Ho CYA, Levin SK, Illner P. Cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth 2004; 18:552-8. [PMID: 15578464 DOI: 10.1053/j.jvca.2004.07.007] [Citation(s) in RCA: 248] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the relationship between cerebral oxygen saturation and neuropsychological dysfunction after cardiac surgery. DESIGN Prospective and observational study. SETTING Operating room and cardiac floor of a university hospital. PARTICIPANTS One hundred one patients undergoing elective cardiac surgery with cardiopulmonary bypass INTERVENTION Bilateral noninvasive cerebral oxygen saturations were monitored over the forehead. The anesthetic and surgical techniques were performed as usual, and no interventions were attempted based on the monitor. Neuropsychological outcome was assessed by the Mini-Mental State Examination (MMSE) and the antisaccadic eye movement test (ASEM). MEASUREMENTS AND MAIN RESULTS Preoperative baseline values of cerebral oxygen saturation (rSO(2)) were 58.6% +/- 10.2%. Patients with the nadir rSO(2) <35% had significantly higher incidences of postoperative ASEM and MMSE impairments than those with rSO(2) always above 35% (44% and 33% v 12% and 9%, respectively). Patients with areas of rSO(2) <40% for more than 10 minutes . % presented with a significantly higher incidence of postoperative ASEM and MMSE impairments than those with areas of rSO(2) <40% for less than 10 minutes . % (42% and 32% v 13% and 10%, respectively). Patients with postoperative ASEM or MMSE impairment had significantly lower nadir rSO(2) and significantly larger areas of rSO(2) <40%, <45%, and <50% than those with normal postoperative neuropsychological outcome. However, multivariate logistic regression analysis showed that areas of rSO(2) <40% were the only predictor for both postoperative ASEM and MMSE impairments. CONCLUSIONS Intraoperative cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery with cardiopulmonary bypass. However, it remains to be determined whether interventions to maintain adequate cerebral oxygenation may improve neuropsychological outcome.
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Affiliation(s)
- Fun-Sun F Yao
- Department of Anesthesiology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
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