1,720,968 research outputs found
Ischemia/Reperfusion Injury following Acute Myocardial Infarction: A Critical Issue for Clinicians and Forensic Pathologists
No full textAcute myocardial infarction (AMI) is a leading cause of morbidity and mortality. Reperfusion strategies are the current standard therapy for AMI. However, they may result in paradoxical cardiomyocyte dysfunction, known as ischemic reperfusion injury (IRI). Different forms of IRI are recognized, of which only the first two are reversible: reperfusion-induced arrhythmias, myocardial stunning, microvascular obstruction, and lethal myocardial reperfusion injury. Sudden death is the most common pattern for ischemia-induced lethal ventricular arrhythmias during AMI. The exact mechanisms of IRI are not fully known. Molecular, cellular, and tissue alterations such as cell death, inflammation, neurohumoral activation, and oxidative stress are considered to be of paramount importance in IRI. However, comprehension of the exact pathophysiological mechanisms remains a challenge for clinicians. Furthermore, myocardial IRI is a critical issue also for forensic pathologists since sudden death may occur despite timely reperfusion following AMI, that is one of the most frequently litigated areas of cardiology practice. In this paper we explore the literature regarding the pathophysiology of myocardial IRI, focusing on the possible role of the calpain system, oxidative-nitrosative stress, and matrix metalloproteinases and aiming to foster knowledge of IRI pathophysiology also in terms of medicolegal understanding of sudden deaths following AMI
DONOR SELECTION FOR ALLOGENIC HAEMOPOIETIC STEM CELL TRANSPLANTATION: CLINICAL AND ETHICAL CONSIDERATIONS
Full text linkAllogenic haematopoietic progenitor cell transplantation (allo-HSCT) is an established treatment for many diseases. Stem cells may be obtained from different sources: mobilized peripheral blood stem cells, bone marrow and umbilical cord blood. The progress in transplantation procedures, the establishment of experienced transplant centres, and the creation of unrelated adult donor registries and cord blood banks gave those without an HLA- identical sibling donor the opportunity to find a donor and cord blood units worldwide.
HSCT imposes operative cautions so that the entire donation/transplantation procedure is safe both for donors and recipients; it carries with it significant clinical, moral and ethical concerns, mostly when donors are minor. The following points have been stressed: the donation should be excluded when excessive risks for the donor are reasonable; donors must receive an accurate information regarding eventual adverse events and health burden for the donors themselves; a valid consent is required; the recipient’s risks must be outweighed by the expected benefits. The issue of conflict of interest, when the same physician has the responsibility for both donor selection and recipient care, are highlighted as well as the need of an adequate insurance protection for all the parties involved
Multi-phase post-mortem CT-angiography: A pathologic correlation study on cardiovascular sudden death
No full textMulti-phase post-mortem CT-angiography (MPMCTA) has the great potential to increase the quality of the post-mortem investigation, especially in the area of sudden death; however, its role as routine complement to the pathology toolbox is still questioned as it needs to be further standardized. The aim of this study is to investigate the contribution of MPMCTA in cases of sudden unexplained death in adults and in particular in sudden cardiovascular death. Sixty-eight sudden unexpected deaths of adults were investigated at our institution between 2012 and 2013. Ten cases underwent MPMCTA and autopsy and were included in the study. Before the angiographic step by complete filling of the vascular system, prior to any manipulation of the body, a non-contrast CT-scan was carried out. Image reconstructions were performed on a CT workstation (Vitrea) and two radiologists experienced with post mortem imaging interpreted the MPMCTA findings. In all 10 cases, we could state a good correlation between combination of post-mortem CT and MPMCTA and autopsy procedures, confirming a high diagnostic sensitivity. With this case series we want to illustrate the advantages offered by performing MPMCTA when facing a sudden death, regardless of specific suspicion for acute coronary syndrome or other vascular or ischemic disease
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Use of contrast media in diagnostic imaging: medico-legal considerations
Full text linkContrast media (CM) are used in imaging techniques to enhance the differences between body tissues on images. The ideal contrast medium should achieve very high concentration in the tissues without producing any adverse effects. Unfortunately, this has not been possible so far and all CM have adverse effects. The increasing use of CM is likely to give rise to a wide range of pitfalls, including compliance with and appropriateness of indications for the use of CM themselves, the choice of the ‘best’ contrast agent, off-label use, evaluation of special populations of patients, and competence to tackle emergency scenarios following the administration of CM. Even more prominent, and potentially more important, is the issue of informed consent which brings with it a duty to inform patients awaiting the administration of CM with regard to the nature of the procedure, the existence of alternative procedures, the extent of the risks relating to the use of CM and, finally, the risks relating to refusal of the procedure. All these issues may give rise to concerns about liability for failure to offer adequate information to patients or to carefully evaluate and balance the potential risks and benefits of the procedure or, finally, for being unprepared in the event of adverse reactions to CM, especially when these are severe and life-threatening. Educational and training programmes for radiologists are likely to shape change in the medical liability environment in the coming years
Multi-phase post-mortem CT-angiography (MPMCTA) is a very significant tool to explain cardiovascular pathologies. A sudden cardiac death case
No full textMulti-Phase Post-Mortem CT-Angiography (MPMCTA) is a standardized technique performed by a protocol that increases the radiological interpretation by decreasing artifacts due to the perfusion and by reaching a complete filling of the vascular system. The quality of the CT angiographies was evaluated radiologically by observing the opacification of the vascular system and assessing the interpretability of the resulting images, and by comparing radiological diagnoses to conventional autopsy conclusions. Here we describe a sudden death case in which Multi-Phase Post-Mortem CT-Angiography was helpful to define the diagnosis. A 72 year-old man that during a violent quarrel with his wife he complained of thoracic pain, and he suddenly died. Multi-Phase Post-Mortem Computed Tomography Angiography was carried out using the standardized protocol and it visualized the blood in pericardial sac and the ruptured wall situated in the posterior part of the left ventricle, as the contrast agent leaked through the rupture. The following autopsy confirmed the hemopericardium; the inspection of the left ventricle showed on the lateral and posterior wall a darkish and stiff area. Axial slices from the apex to the atrioventricular valves revealed a large area of pale myocardium diffused to the lateral and posterior free wall of the left ventricle, and in the forth section the rupture of the ventricular wall was visible. In all sections the marginal and the posterior branches of the left circumflex artery were totally occluded by darkish thrombosis. This catastrophic complication of the extensive myocardial infarction often remains undiagnosed and constitutes an autopsy finding. In this way the post-mortem imaging, in particular the CT-Angiography, is an useful tool to investigate all the vascular system and it enables better visualization of the ruptured ventricular wall
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