Autopsy Cases Research Articles

A Comprehensive Retrospective Evaluation of Autopsy Findings and Histopathological Changes in Cases of Fatal Electrocution in Western Ghats of Karnataka, India.

Background: The aim of this study is to give an account of autopsy findings and histopathological changes in fatal electrocution cases. A secondary aim was to know the epidemiological profile, cause of death, and its relation to the survival period in fatal electrical injuries. study design: A retrospective study was undertaken of all fatal electrocution cases autopsied in the mortuary of Dr. Prabhakar Kore Charitable Hospital of Belagavi, Karnataka, India between January 2011 to December 2021. Data was collected from autopsy reports, police information, and hospital records. It was further analyzed and expressed in percentages. results: Cases represented 8.2% of all autopsy cases. Only 27% of cases were due to low voltage electric current. Burn injury was seen in 81% of total cases. 43% of cases showed both entry and exit marks. When the skin of this area was sent for histopathological examination there was a mononuclear infiltrate and subepidermal separation seen. There were interstitial hemorrhages on the right atrium of the heart and hemorrhagic foci were seen on the kidneys and lungs too. Petechial hemorrhages were seen on the heart, lungs, and brain. conclusions: Histopathological findings can be used as evidence in determining the cause of death. Deaths due to electrocution demand closer awareness.

Blunt Traumatic Brain Injury and Alzheimer Pathology

Introduction: Traumatic brain injury (TBI) has been associated with a greater risk of late-life dementia, including Alzheimer’s disease (AD), but only a few studies examined the relationship between residuals of blunt TBI and autopsy-proven AD. The objective of the present study was to examine the incidence of fully developed AD pathology after documented blunt TBI, and the frequency of residuals of blunt TBI in a series of cases with definite AD. Methods: Among a sample of 1,750 consecutive autopsy cases of elderly demented patients, those cases with residuals of blunt (closed) TBI and definite AD pathology were assessed, and among 933 individuals with autopsy-proven AD, those with residuals of blunt TBI were selected. Results: Among 190 autopsy cases with residuals of blunt TBI, 28 (14.7%; mean age 77.2 ± 10.6 years) revealed the pathological features of definite AD (Braak stage V or VI; ABC 3/3/3), while among 1,150 elderly controls (Braak stage < IV, mean age 77.3 ± 9.5 years), 160 (13.6%) showed residuals of blunt TBI. The second part of the study included 933 consecutive cases with definite AD (Braak stage V or VI; ABC 3/3/3, mean age 82.3 ± 8.4 years), in which 30 cases (3.3%; mean age 77.8 ± 10.7 years) showed morphological residuals of blunt TBI. Conclusion: The results of this retrospective study, on the one hand, did not support the idea that blunt TBI and its morphological residuals are responsible for the development of definite AD, whereas the second part of the study, showing morphological residuals of blunt TBI among 3.3% of definite AD cases were similar to the results in a clinical series who sustained moderate to severe TBI. Considering these conflicting results, further studies on the relationship between the severity and location of morphological residuals of blunt TBI and the development of AD pathology are warranted.

Fatal blast injuries in tyre blowouts: two autopsy case reports

BackgroundFatal blast injuries are generally reported as a consequence of explosions, mainly in terrorist events, work-related detonations, or domestic settings. Although quite rare, blast injuries of high kinetic energy can be seen in tyre blowouts and are very dangerous and potentially lethal because of their unpredictability. This phenomenon is rarely reported in the existing forensic literature.The aim of this study was to report two cases of fatal truck tyre bursts and to discuss the mechanisms leading to the burst and the pattern of injuries.Case presentationsCase 1 was of a 58-year-old truck driver man who was standing nearby a detached tyre that was being inflated in a repair shop when the burst occurred. The tyre struck him in the face and threw him. The medicolegal autopsy showed a right periorbital haematoma, a large wound of the left parietal scalp, a diffuse subarachnoid haemorrhage, an atlanto-occipital dislocation, a fracture of the hyoid bone, multiple rib fractures, and lacerations of the ascending aorta and the pulmonary arteries. Case 2 involved a young man of 24-year-old, a worker in a tyre repair shop, who was inflating a truck’s tyre when it burst violently. The injuries sustained included bleeding from the right ear, fractures of the facial bones, a left hemispheric subdural haematoma associated with the fracture of the skull base, a rib fracture, and diffuse areas of contusions to the lungs. Toxicological analyses were negative in both cases.ConclusionFatalities related to tyre blowout accidents are uncommon. The mechanisms leading to a blowout can be mechanical or chemical in origin, and the main danger of a burst often occurs when air enters the tyre during inflation. Internal damage caused by the pressure waves of the blast often exceeds what would be expected based on external signs alone.

Analysis of forensic autopsy cases associated with epilepsy: Comparison between sudden unexpected death in epilepsy (SUDEP) and not-SUDEP groups.

Epilepsy is a common and chronic neurological disorder characterized by seizures that increase the risk of mortality. SUDEP is the most common seizure-related category of death. The study aimed to evaluate the key characteristics between SUDEP and not-SUDEP death cases. A retrospective study of forensic autopsy cases from 2002 to 2021, performed by the Academy of Forensic Science (Ministry of Justice, China), identified a total of 31 deaths associated with epilepsy. We compared the different characteristics between individuals who died of SUDEP (SUDEP group) and individuals with epilepsy died suddenly due to unrelated causes (not-SUDEP group). 13 cases met the general accepted definition of SUDEP; and 18 cases were classified as not-SUDEP. The mean age of the not-SUDEP group was significantly higher than that of the SUDEP groups (p < 0.05) and there were more cases without a clear cause of epilepsy in the SUDEP group than in the not-SUDEP group (p < 0.05). Death position differed significantly between the two groups, with more cases dying in the prone position in the SUDEP group (p < 0.05). Complete autopsies were performed in 24 of the 31 cases. There were no significant differences in heart, lungs and brain weights, or in ventricular thickness (p > 0.05) between the SUDEP and not-SUDEP groups. In addition, compared to the not-SUDEP group, the SUDEP group featured a significantly more cases with coronary lesions (grades 1-3, p < 0.05). Neuropathological lesions were identified in 12 of the 13 SUDEP cases (92.3%), cardiac lesions were present in 10 cases (76.9%) and pulmonary edema and pulmonary congestion were present in all cases. The primary cause of death in 13 of the 31 cases was seizure disorder or epilepsy. The primary mechanism of death in SUDEP group was mainly asphyxia while that in the not-SUDEP group was cardiopulmonary failure (p < 0.05). Patients in the prone position had a significantly higher risk of asphyxia than those who were not. Here, we investigated the key characteristics between SUDEP and not-SUDEP death cases, which may help to facilitate forensic diagnosis in presumed SUDEP cases.

Gallbladder adenocarcinomas undergo subclonal diversification and selection from precancerous lesions to metastatic tumors.

We aimed to elucidate the evolutionary trajectories of gallbladder adenocarcinoma (GBAC) using multi-regional and longitudinal tumor samples. Using whole-exome sequencing data, we constructed phylogenetic trees in each patient and analyzed mutational signatures. A total of 11 patients including 2 rapid autopsy cases were enrolled. The most frequently altered gene in primary tumors was ERBB2 and TP53 (54.5%), followed by FBXW7 (27.3%). Most mutations in frequently altered genes in primary tumors were detectable in concurrent precancerous lesions (biliary intraepithelial neoplasia, BilIN), but a substantial proportion was subclonal. Subclonal diversity was common in BilIN (n=4). However, among subclones in BilIN, a certain subclone commonly shrank in concurrent primary tumors. In addition, selected subclones underwent linear and branching evolution, maintaining subclonal diversity. Combined analysis with metastatic tumors (n=11) identified branching evolution in 9 patients (81.8%). Of these, 8 patients (88.9%) had a total of 11 subclones expanded at least 7-fold during metastasis. These subclones harbored putative metastasis-driving mutations in cancer-related genes such as SMAD4, ROBO1, and DICER1. In mutational signature analysis, 6 mutational signatures were identified: 1, 3, 7, 13, 22, and 24 (cosine similarity >0.9). Signatures 1 (age) and 13 (APOBEC) decreased during metastasis while signatures 22 (aristolochic acid) and 24 (aflatoxin) were relatively highlighted. Subclonal diversity arose early in precancerous lesions and clonal selection was a common event during malignant transformation in GBAC. However, selected cancer clones continued to evolve and thus maintained subclonal diversity in metastatic tumors.

Anomalous papillary muscle insertion into mitral valve leaflet: Autopsy study and implications

Anomalous papillary muscle (APM) insertion into the anterior mitral valve leaflet is often associated with hypertrophic cardiomyopathy (HCM) but is reported in other cases as a rare finding. Mere presence does not strictly imply hemodynamic disturbance, and several types exist, with various impacts on left ventricular outflow tract (LVOT) obstruction. The interpretation of isolated anomaly is challenging at autopsy because significant LVOT obstruction is dynamic. We analyzed autopsy cases with APM regarding the site of PM insertion and origin, number of PM bellies, anomalous insertions, heart weight, left ventricle (LV) thickness, LV endocardial fibrosis, subjects' age, sex, cause, and manner of death. A total of 20 cases were identified. Fourteen were identified incidentally, while in 670 systematically examined hearts, the APM was identified in six cases, indicating a prevalence of 0.9%. In eight cases, the manner of death was natural (one case with HCM), and in 12 non-natural. Type II anomaly of PM was most frequent (n=8), followed by Type III (n=7) and Type I (n=5). Subjects who died of natural causes were significantly older and had heavier hearts (median 455 g vs. 330 g; p < 0.05) without difference in LV thickness (median 16 mm vs. 15 mm; p > 0.05). Histology performed in four cases showed a pattern of direct insertion of cardiomyocytes into the leaflet's thick fibrous tissue with a narrow overlapping zone. The APM is rare, can be easily overlooked, and does not imply significant pathology per se. We discussed proper assessment of the significance of this anomaly at autopsy.

CircSMARCC1 and CircLRBA are potential biomarkers in forensic postmortem diagnosis of acute myocardial infarction

Postmortem diagnosis of acute myocardial infarction (AMI), especially early AMI, is a challenge for forensic scientists. Circular RNAs (circRNA) are a unique type of RNA with a closed loop structure and more stability, compared with linear RNA. We aimed at evaluating whether circRNAs are ideal postmortem diagnostic markers for AMI. We employed bioinformatics methods to screen for target circRNAs. Divergent and convergent primers were used to confirm the loop structure. Ribonuclease R (RNaseR) digestion and artificial simulated room temperature test were performed to evaluate the stability of circRNAs. Furthermore, RT-PCR analysis was performed to assess the expressions of target circRNAs in a mouse model of AMI and in autopsy cases, while the diagnostic significance of circRNAs was evaluated by the receiver-operator characteristic (ROC) curve. The bioinformatics analysis screened out circSMARCC1 and circLRBA as target circRNAs. Agarose gel electrophoresis revealed the loop structure of target circRNAs. RNaseR digestion and the artificial simulated room temperature test showed that the stability of circRNAs was good. In mouse AMI model, circSMARCC1 levels were elevated while circLRBA levels were suppressed. Finally, in forensic autopsy cases, circSMARCC1 levels were significantly elevated, while circLRBA levels were significantly suppressed in the MI and early-MI group, relative to the normal control group. The ROC curve analysis showed that both circSMARCC1 and circLRBA can distinguish between AMI and normal control cases. Futher, a combination of the two circRNAs can increase the diagnostic efficacy of AMI. Thus, circSMARCC1 and circLRBA are potential biomarkers for postmortem diagnosis of AMI.

Neuropathological Validation of the Alzheimer’s Questionnaire

AbstractBackgroundThe Alzheimer’s Questionnaire (AQ) is a brief, informant‐based screening tool that has demonstrated good diagnostic accuracy in identifying clinical Alzheimer’s disease (AD) and amnestic mild cognitive impairment (aMCI). The AQ has been further validated by its correlations with established informant‐ and performance‐based cognitive assessments as well as with standard neuropsychological tests. Recent evidence has also demonstrated that the AQ correlates well with PET‐based measures of amyloid plaque. The aim of this study is to validate the AQ with the hallmark neuritic plaque (NP) and neurofibrillary tangle (NFT) pathology of AD.MethodData from 205 prospectively‐followed autopsy cases classified as AD (n=90), aMCI (n=42), or cognitively unimpaired (CU, n=73) were used in this analysis. The average age at death was 87.07±7.84 years with the average interval between the last clinical assessment and death of 16.48±14.32 months. Semi‐quantitative measures of NP and NFT pathology from five brain regions were used to assess total plaque and total tangle loads which were then correlated with the AQ, Clinical Dementia Rating Sum of Boxes (CDR‐SOB), and the Mini‐Mental State Exam (MMSE). Spearman correlations were used in the primary analyses and were followed up with robust regression models that adjusted for age at death, sex, education, and APOE ε4 carrier status.ResultThe AQ correlated significantly with NP load (r=0.37, p&lt;0.001) and NFT load (r=0.57, p&lt;0.001). These associations remained significant after covariate adjustment (NP: β=0.28, 95% CI: (0.21, 0.34), p&lt;0.001; NFT: β=0.22, 95% CI: (0.17, 0.28), p&lt;0.001). The MMSE and CDR‐SOB showed similar correlations with NP load (r=‐0.37, r=0.35, respectively) and NFT load (r=‐0.58, r=0.55, respectively).ConclusionThese findings extend previous clinical and neuroimaging findings of the AQ showing that it correlates well with the hallmark NP and NFT pathology of AD and provide additional confidence to clinicians who use the AQ to screen for AD‐related cognitive impairment.

Unusual case of infrarenal pheochromocytoma developed on ectopic adrenal tissue: An autopsy case report

Abstract Introduction: Pheochromocytomas are catecholamine-secreting tumors arising from the chromaffin cells of the adrenal medulla. We describe an unusual case of pheochromocytoma located in the infrarenal area and associated with bilateral adrenal hyperplasia. Case presentation: A 70-year-old patient was admitted for syncope, diaphoresis, and high blood pressure. Computed tomography showed a 73×70×72 mm retroperitoneal mass of the left infrarenal area. High levels of metanephrine and noradrenaline were found in the urine. A tumor resection was performed. A few days after surgery, the blood pressure suddenly decreased and could not be restored, resulting in the death of the patient. Histopathological examination of the surgical specimen revealed a proliferation of monotonous cells, with eosinophilic cytoplasm, round nuclei with prominent nucleoli arranged in clusters, and capsular and vascular invasion. The tumor cells expressed synaptophysin and chromogranin, without positivity for inhibin A or S100 protein. At the autopsy, both adrenal glands showed hyperplasia but unrelated to the tumor mass. The histological aspect, location, and immunophenotype indicated an ectopic infrarenal pheochromocytoma. Conclusions: In patients with pheochromocytoma developed on ectopic adrenal tissue, clinical management might be difficult, and diagnosis can be sometimes established only based on post-mortem histopathological examination. Autopsy can be extremely useful in such cases with unexplained evolution.

Clinical and genetic features of Lewy body pathology in autosomal dominant and sporadic Alzheimer disease

AbstractBackgroundLewy body pathology (LBP) occurs in a substantial portion of individuals with autosomal dominant (ADAD) and sporadic Alzheimer disease (sAD) (Ringman, 2016; Cairns, 2015; Leverenz, 2007; Lippa, 1998). Whereas other non‐AD pathologies are frequent in sAD, LBP seems to be the most common co‐pathology in the relatively young ADAD population (Cairns, 2015). Knowledge of clinical and genetic characteristics of LBP in both ADAD and sAD is incomplete.MethodData from the National Alzheimer’s Coordinating Center, the Dominantly Inherited Alzheimer Network, the Queen Square Brain Bank at University College London and the Neurobiobank Munich were leveraged to compare individuals with ADAD and neuropathologically diagnosed sAD with and without LBP. Chi‐squared and Student’s t‐test were used for comparison of categorical and continuous variables respectively.ResultThe study included 139 ADAD and 4661 sAD autopsy cases. LBP occurred in 59% of ADAD and 38% of sAD cases. LBP was associated with a longer survival in both ADAD (10.1 vs. 8.6 years, p=0.024) and sAD (10.5 vs. 10.2 years, p=0.016). Memory disturbance occurred more frequently as the first clinical AD symptom in both AD variants when LBP was present (ADAD: 90 vs. 65%, p=0.005; sAD: 78 vs. 71%, p&lt;0.001). In both ADAD and sAD, the presence of at least one APOE e4 allele was more common in individuals with LBP (ADAD: 40 vs. 21%, p=0.047; sAD: 57 vs. 46%, p&lt;0.001). In ADAD, frequency of LBP did not differ between individuals with PSEN1 and APP mutations.ConclusionIn this investigation of 139 ADAD and 4661 sAD autopsy cases, LBP occurred in about 60% with ADAD and 40% with sAD. In both ADAD and sAD, the presence of LBP was associated with longer survival, higher frequency of memory disturbance as the first AD symptom and positive APOE e4 status. Further study of these associations may increase our understanding of the role of LBP in AD.

Fatal peritonitis — causes, contributing factors and diagnostic challenges: an autopsy cases study

Abstract Delayed diagnosis of stomach, intestines, pancreas, and gallbladder diseases plays a significant role in the complicated non-traumatic peritonitis. The aim of the study was to analyse the causes of fatal peritonitis, and contributing factors to mortality and diagnostic discrepancies. A retrospective study of 52 peritonitis cases from selected 1350 autopsy records in three years was done. We analysed age, sex, length of hospital stays, clinical and pathological diagnosis, complications, comorbidities, laboratory values and diagnostic discrepancies. The results were statistically assessed by Excel and IBM SPSS® Statistics version 26. The most common causes of fatal peritonitis were non-oncological gastrointestinal pathologies (26%), malignancies (23%), pancreas and gallbladder (16%), HIV related (10%), vascular (7%) and other diseases (18%). Mean age of patients at death was 65 years. 61. 4% were males. Median hospitalisation time was two days. Six patients died outside the hospital. In 17.4% cases misdiagnoses were found. Common situations when misdiagnoses had occurred were intestinal ischaemia, malignancies of various origins and perforation of peptic ulcer. Fatal peritonitis was determined by the patient’s delayed hospitalisation with untreated oncological and non-oncological diseases of organs of the abdominal cavity and multiple concomitant diseases. Other contributing factors included not visiting general practitioners and lack of adherence to patients themselves.

Hemispheric asymmetry and atypical lobar progression of Alzheimer‐type tauopathy

AbstractBackgroundNeurofibrillary tau pathology spread in Alzheimer’s disease (AD) mostly shows a stereotypical pattern of topographical progression. Atypical patterns have also been described and associated with interhemispheric asymmetry. As histopathological studies that used bilateral sampling are limited, this study aimed to assess interhemispheric tau pathology differences and the presence of topographically atypical cortical spreading patterns.MethodImmunohistochemical staining for detection of tau pathology was performed in 23 regions of interest of 57 autopsy cases and compared between cortical regions and hemispheres.ResultFrequent mild (82% of cases) and occasional moderate (32%) interhemispheric density discrepancies were observed while marked discrepancies were uncommon (7%) and restricted to occipital regions. Left and right hemispheric tau pathology dominance was observed with similar frequencies, except in Braak stage VI that favored a left dominance. Interhemispheric Braak stage differences were observed in 16% of cases and was more frequent in advanced (IV‐VI) than early stages (I‐III). One atypical lobar topographical pattern, where occipital tau pathology density exceeded frontal lobe scores, was identified in 4 cases, favoring a left dominant asymmetry.ConclusionWe speculate that asymmetry and atypical topographical progression patterns may be associated with described atypical AD clinical presentations and progression characteristics, which should be tested by comprehensive clinicopathological correlations.

Methamphetamine-related forensic autopsy cases in a Japanese prefecture over a 7-year period: Characteristics of deaths and blood concentrations

Understanding the actual conditions of methamphetamine (MA)-related death is important from the perspectives of criminal justice and public health. In this report, we review 104 cases of MA-related death handled by our departments between January 2014 and December 2020. Based on information from police and autopsy examinations, we classified the cases into the following categories: “accidental intoxication” (“MA only” and “multiple drugs or alcohol”), “fatal disease” (“definitively MA-related,” “possibly MA-related,” and “unlikely MA-related”), “accident,” “suicide,” “homicide,” and “undetermined.” The total number and annual trends for each category and their respective femoral blood concentrations were investigated. “Fatal disease” was the most common category (48 cases), followed by “suicide” (25 cases), “accidental intoxication” (14 cases), and “accident” (11 cases). “Definitively MA-related” in which MA may have played a role in their onset or exacerbation accounted for the majority of “fatal disease”: 12 cases of heart disease, 4 cases of aortic dissection, 12 cases of cerebral hemorrhage, and 4 cases of subarachnoid hemorrhage. Cases classified as “definitively MA-related” died with lower femoral blood concentrations of MA compared with “MA only.” Cases with “fatal disease” might have been misdiagnosed as “death by natural causes” if a proper autopsy and toxicology examinations were not performed. In death investigations, it is necessary to keep in mind that there are some MA-related deaths, and efforts should be made to increase awareness about the risk of death in using this drug.

Fatal Nitrite Intoxication by Pickling Salt: Four Autopsy Cases

Pickling salt, also known as curing salt, is a mixture of sodium chloride and sodium nitrite, which is used for color agent and a means to facilitate food preservation. Recently, online purchase of pure sodium nitrite has been restricted, and pickling salts have been used as replacements in cases of suicidal nitrite intoxication. From November 2020 to December 2021, there were four autopsy cases of nitrite poisoning caused by pickling salt, and 10 autopsy cases of nitrite poisoning by pure sodium nitrite. Due to the low nitrite concentration in pickling salts, serum nitrite and nitrate concentration, and methemoglobin levels were relatively low in pickling salts cases. Especially, low methemoglobin levels may cause confusion in the postmortem diagnosis of fatal nitrite intoxication, so caution is required.

Birth Year Estimation of Skeletal Remains by Radiocarbon Dating for Teeth

Identifying remains is an important role of forensic medicine. For identification, dating, i.e., estimating the birth year and death year, is expected as useful, however has not yet been practically applied. A dating method using radiocarbon analysis was recently introduced and related studies have been reported. In this study, we conducted radiocarbon analysis on teeth and aimed to develop a formula to estimate the birth year. Fifteen autopsy cases from the National Forensic Service, from December 2014 to December 2020, with known birth year were selected for inclusion. For each case, dentin of the first molar in mandible was taken, radiocarbon analysis was carried out and the corresponding estimated birth year were calculated using the bomb peak curve. The differences between the birth year and the teeth year were determined and analyzed on the influence of variables. A formula for estimating the birth year was developed and the applicability of the formula was determined. The difference between the birth year and the teeth year was 2.6 years on average for cases born before 1963, and 5.7 years for those born after 1963. The estimation formula of birth year was as follows: (Before 1963) Birth year=0.565×(Tooth year)–0.446×(Age)+875.001, (After 1963) Birth year=Tooth year–5.7. This study is meaningful in that it reduced the error by using only the first molars of the lower jaw as a sample, and presented an estimation formula of birth year that can be applied in practice through radiocarbon analysis of teeth.

Assessing the applicability of cerebrospinal fluid collected from the spinal cord for the determination of ethyl alcohol in post-mortem toxicology

This paper presents the results of a study on the applicability of cerebrospinal fluid (CSF) collected from the spinal canal in the post-mortem determination of ethyl alcohol. The present study reviewed data of autopsy cases (n = 45), in which ethyl alcohol was detected in CSF using gas chromatography with a flame ionization detector (HS-GC-FID), to investigate ethyl alcohol concentrations in CSF, compared with blood. As a result of statistical analysis of the obtained data, a high positive correlation was found between blood ethanol concentration and cerebrospinal fluid collected from the spinal canal ethanol concentration. The Pearson correlation coefficient was statistically highly significant (p < 0.001) (r = 0.9503). The data obtained allowed us to conclude that cerebrospinal fluid collected from the spinal canal can be collected during an autopsy as an alternative biological specimen to assess the ethanol content. Cerebrospinal fluid collected from the spinal canal can corroborate and lend credibility to the results obtained for blood and, in special cases, when blood is drawn from putrefied bodies and may even be a superior specimen to blood for assessing ethyl alcohol intoxication status.

Glucagon-like Peptide-1 Receptor in the Human Hypothalamus Is Associated with Body Mass Index and Colocalizes with the Anorexigenic Neuropeptide Nucleobindin-2/Nesfatin-1.

Data on animals emphasize the importance of the neuronal glucagon-like peptide-1 (GLP-1) receptor (GLP-1R) for feeding suppression, although it is unclear whether astrocytes participate in the transduction of anorectic GLP-1R-dependent signals. In humans, the brain circuitry underlying these effects remains insufficiently investigated. The present study aimed to explore GLP-1R protein expression in the human hypothalamus and its correlation with body mass index (BMI). Sections of hypothalamus from 28 autopsy cases, 11 with normal weight (BMI < 25 kg/m2) and 17 with non-normal weight (BMI ≥ 25 kg/m2), were examined using immunohistochemistry and double immunofluorescence labeling. Prominent GLP-1R immunoexpression was detected in neurons of several hypothalamic nuclei, including paraventricular, supraoptic, and infundibular nuclei; the lateral hypothalamic area (LH); and basal forebrain nuclei. Interestingly, in the LH, GLP-1R was significantly decreased in individuals with BMI ≥ 25 kg/m2 compared with their normal weight counterparts (p = 0.03). Furthermore, GLP-1R was negatively correlated (τb = −0.347, p = 0.024) with BMI levels only in the LH. GLP-1R extensively colocalized with the anorexigenic and antiobesogenic neuropeptide nucleobindin-2/nesfatin-1 but not with the astrocytic marker glial fibrillary acidic protein. These data suggest a potential role for GLP-1R in the regulation of energy balance in the human hypothalamus. In the LH, an appetite- and reward-related brain region, reduced GLP-1R immunoexpression may contribute to the dysregulation of homeostatic and/or hedonic feeding behavior. Possible effects of NUCB2/nesfatin-1 on central GLP-1R signaling require further investigation.

Histopathological pulmonary findings of survivors and autopsy COVID-19 cases: A bi-center study.

The coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), evolved into a global pandemic. As ACE2 on the surface of alveolar cells of the lung epithelium is one of the potential target receptors for SARS-CoV-2, the respiratory symptoms are the most common presentation of COVID-19. The aim of our study was to investigate the morphological findings in lung tissue after being infected by SARS-CoV-2 and compare histopathologic changes in patients with COVID-19 infection history who died to those who survived. We analyzed lung tissue samples from 9 patients who died from COVID-19 and from 35 patients with COVID-19 infection history who survived and had undergone lung surgery for different reasons. Most of histopathological changes in autopsy and survivors' cases overlapped; however, they occurred with different frequency. The predominant histologic finding both in the case of the deceased and the survivors was patchy distribution of foamy macrophages in the alveolar spaces. In comparison with autopsy cases viral cytopathic-like changes in hyperplastic pneumocytes were rarely observed in the survivors' lung tissue. Pulmonary edema, fibrin deposition within alveoli, bronchopneumonia, small vessel thrombosis and type II pneumocyte hyperplasia were also more often observed within autopsy cases. Life-threatening complications such as hyaline membrane formations and diffuse alveolar damage were present only within the deceased, whereas changes requiring enough time to progress to the fibrotic phase, such as organizing pneumonia, bronchiolization of the alveoli, and interstitial fibrosis were observed in the lung parenchyma only in survivors. Additionally, 14 cases of pulmonary pneumo-hematocele in patients with COVID-19 infection history who survived were observed. It is a newly observed entity in the form of a cystic lesion formed by large accumulation of blood and fibrin between the collapsed and rejected lung parenchyma and/or present with air-fluid levels. The thin wall of pneumo-hematocele is formed by the inter lobar interstitial fibroconnective tissue and has no epithelial lining or bronchial wall elements. As the COVID-19 pandemic continues, new complications following SARS-CoV-2 infection are identified. Newly observed entity in patients with COVID-19 infection history who survived is pulmonary pneumo-hematocele. The appearance of these lesion has become increasingly frequent.

Neurogenic intermittent claudication caused by vasculitis in the cauda equina: an autopsy case report.

Intermittent claudication (IC) refers to leg pain that is induced by walking and relieved by rest. Neurogenic IC is usually associated with lumbar canal stenosis (LCS). We present rare findings from an autopsied patient who had neurogenic IC caused by vasculitis in the cauda equina. We performed antemortem neurological and electrophysiological assessments, sural nerve biopsy, and post-mortem examination of the spinal cord and brain. A 61-year-old man noted sudden-onset leg pain that was not associated with any traumatic trigger. His leg pain consistently appeared when the patient walked and quickly faded on stopping. Spine surgery and cardiovascular departments both made a diagnosis of IC. However, magnetic resonance imaging (MRI) did not show LCS, and all ankle-brachial pressure indices were normal. He subsequently developed diffuse muscle weakness of the legs a month after disease onset. Myeloperoxidase antineutrophil cytoplasmic autoantibody was seropositive (140IU/mL), and a sural nerve biopsy revealed axonal injury and angiitis. MRI showed multiple cerebral infarctions. He was diagnosed with microscopic polyangiitis (MPA) and underwent corticosteroid therapy. He died from complications two months after the onset. A post-mortem study revealed vasculitis in the subarachnoid space of the cauda equina, spinal cord, and brain parenchyma. The cauda equina showed a combined loss of small and large axonal fibres. The lumbar cord displayed central chromatolysis of the lower motor neurons. MPA is a rare cause of neurogenic IC when the symptom is acute and multimodal. Small-vessel vasculitis affecting the cauda equina may underlie MPA-associated IC.

Detection and Morphological Analysis of Micro-Ruptured Cortical Arteries in Subdural Hematoma: Three-Dimensional Visualization Using the Tissue-Clearing Clear, Unobstructed, Brain/Body Imaging Cocktails and Computational Analysis Method.

One of the causes of bleeding in subdural hematoma is cortical artery rupture, which is difficult to detect at autopsy. Therefore, reports of autopsy cases with this condition are limited and hence, the pathogenesis of subdural hematoma remains unclear. Herein, for the detection and morphological analysis of cortical artery ruptures as the bleeding sources of subdural hematoma, we used the tissue-clearing CUBIC (clear, unobstructed, brain/body imaging cocktails and computational analysis) method with light-sheet fluorescence microscopy and reconstructed the two-dimensional and three-dimensional images. Using the CUBIC method, we could clearly visualize and detect cortical artery ruptures that were missed by conventional methods. Indeed, the CUBIC method enables three-dimensional morphological analysis of cortical arteries including the ruptured area, and the creation of cross-sectional two-dimensional images in any direction, which are similar to histopathological images. This highlights the effectiveness of the CUBIC method for subdural hematoma analysis.