[Update on collaborative autopsy-based research in German pathology, neuropathology, and forensic medicine]

BACKGROUND

Autopsies are a valuable tool for understanding disease, including COVID-19.

MATERIALS AND METHODS

The German Registry of COVID-19 Autopsies (DeRegCOVID), established in April 2020, serves as the electronic backbone of the National Autopsy Network (NATON), launched in early 2022 following DEFEAT PANDEMIcs.

RESULTS

The NATON consortium's interconnected, collaborative autopsy research is enabled by an unprecedented collaboration of 138 individuals at more than 35 German university and non-university autopsy centers through which pathology, neuropathology, and forensic medicine autopsy data including data on biomaterials are collected in DeRegCOVID and tissue-based research and methods development are conducted. More than 145 publications have now emerged from participating autopsy centers, highlighting various basic science and clinical aspects of COVID-19, such as thromboembolic events, organ tropism, SARS-CoV‑2 detection methods, and infectivity of SARS-CoV-2 at autopsy.

CONCLUSIONS

Participating centers have demonstrated the high value of autopsy and autopsy-derived data and biomaterials to modern medicine. The planned long-term continuation and further development of the registry and network, as well as the open and participatory design, will allow the involvement of all interested partners.

Serum thrombomodulin. A novel marker of disease activity in systemic lupus erythematosus

OBJECTIVE

Soluble thrombomodulin (sTM), a proposed serum marker of endothelial cell injury, was investigated as a parameter of disease activity in patients with systemic lupus erythematosus (SLE).

METHODS

Levels of sTM were determined by enzyme-linked immunosorbent assay. Disease activity was assessed using 3 established scoring systems: the American College of Rheumatology (ACR), the New York Hospital for Special Surgery (NYHSS), and the Systemic Lupus Activity Measure (SLAM) systems.

RESULTS

A close correlation was found between sTM levels and disease activity as assessed with all 3 scoring systems: r = 0.52 by the ACR, 0.75 by the NYHSS, and 0.82 by the SLAM.

CONCLUSION

We found that sTM is a sensitive serologic marker of organ involvement in patients with SLE. Furthermore, sTM may prove to be an important marker for vasculitis in general.

Circulating intercellular adhesion molecule 1 as a new activity marker in patients with systemic lupus erythematosus

To determine the value of soluble intercellular adhesion molecule 1 (sICAM-1) as a measure of disease activity in patients with systemic lupus erythematosus (SLE), 25 patients with SLE were studied in an active and in a less active state. Disease activity was assessed according to the New York Hospital for Special Surgery System (NYHSS) score. The levels of sICAM-1 were significantly higher in an active than in a less active state of the disease (P < 0.001). The correlation between ICAM and the NYHSS score was r = 0.3412 (P < 0.001) and that between NYHSS index and soluble interleukin-2 receptors (sIL-2R) was r = 0.6620 (P < 0.001). There was a good correlation between levels of sICAM-1 and sIL-2R (r = 0.6792, P < 0.001). Both sICAM-1 and sIL-2R were positively and significantly correlated with an increase in the erythrocyte sedimentation rate, but only sIL-2R levels were significantly correlated with increased dsDNA antibodies and with a decrease in serum complement factor C3. Our data suggest that sICAM-1 reflects disease activity in patients with SLE, but this parameter per se should not be used to guide the therapeutic decision in SLE patients suspected of suffering from exacerbation of disease.

Platelet-induced thrombin generation time: a new sensitive global assay for platelet function and coagulation. Method and first results

A new sensitive test--platelet-induced thrombin generation time (PITT)--is described, in which the formation of thrombin in partially anticoagulated platelet-rich plasma (PRP) leads to aggregation immediately followed by coagulation of PRP. 0.6 ml PRP are rotated in a disk-shaped cuvette within the light beam of a photometer. In PITT, platelets stick to the cuvette wall and, mediated by a large PRP/surface/air interface at the cuvette wall, are activated and participate in thrombin formation which leads to aggregation and clotting. The times from onset of rotation until aggregation (Ta) and until coagulation (Tc) of the PRP samples are recorded. PITT was very sensitive and detected low concentrations of unfractionated heparin (0.01 IU/ml) in vitro. PITT parameters were significantly prolonged ex vivo 2 h after oral administration of acetylsalicylic acid (0.5 g) and after single subcutaneous injections of heparin (5,000 IU). Patients receiving phenprocoumon prophylaxis had markedly prolonged Ta and Tc values (longer than 20 min, n = 23). Patients with recent thrombotic episodes had markedly shorter values than healthy volunteers. PITT may become a very sensitive global test to detect mild hemorrhagic disorders, to monitor the effects of antithrombotic drugs and to detect patients with a risk of vascular occlusions.

Intermittent catheterisation versus percutaneous suprapubic cystostomy in the early management of traumatic spinal cord lesions

Spinal injury patients initially treated by intermittent catheterisation (IUC) and those who received a fine-bore suprapubic catheter (SPC) have been reviewed. The results show that fine-bore suprapubic catheterisation seems to be superior to intermittent catheterisation because the rate of urinary tract infections is significantly lower in the SPC-group (50%) than in the IUC-patients (71.9%), and the first infecting organisms in the SPC-group differ from those in the IUC-group and are much more easily treated by antibiotic therapy.