Association Between Cardiovascular Disease and Death by Anaphylaxis: A 20-Year Retrospective Study in Queensland, Australia.

ABSTRACT: Despite its severity, anaphylaxis carries a low mortality rate of less than 1%, making the cohort seen in the forensic pathology setting a small and unique subset of the majority of cases of anaphylaxis in the community. Clinically, cardiovascular disease has been recognized as a risk factor for fatal anaphylaxis; however, there is scant forensic pathology research investigating this risk factor, whereas autopsy textbooks emphasize physical respiratory changes seen in the broader clinical cohort. This 20-year retrospective study examined all fatal anaphylactic deaths in the state of Queensland, Australia, to document the underlying disease of the cases, tryptase levels, triggers, and postmortem findings. Our study found that cardiovascular disease was prevalent in 83.3% of cases of fatal anaphylaxis. Although asthma was prevalent in food-related fatal anaphylaxis (60%) in our cohort, it was poorly represented overall (28%), in contrast to clinical research. Additionally, only 43% of cases showed respiratory changes that were greater than mild. Our findings emphasize the difference between the clinical and postmortem anaphylaxis cohorts, and provide autopsy evidence of a potential role of cardiovascular disease in fatal anaphylaxis.

Suicide by an Electric Power Drill and Spade Drill Bit: An Unusual Mechanism of Death.

ABSTRACT: Self-inflicted penetrating brain injuries with drills have been reported but are uncommon and typically involve the use of conventional drill bits. We report an unusual case of a 56-year-old man with a history of psychiatric illness who completed suicide using an electric drill and spade-type drill bit. Multiple superficial scalp and deeper bony injuries were sustained, although without breach of the dura, and death was not from brain injury, but secondary to venous air embolism related to entrainment of air into diploic vessels.

A Possible Mechanism of Laryngohyoid Fractures in Hanging: A Preliminary Observation.

ABSTRACT: Fractures of the hyoid bone, particularly the greater horns, and thyroid cartilage (superior horns) are known to be associated with hanging deaths. Depending on the literature, the frequency of these fractures varies from 0% to 83%. The mechanism underlying these fractures is believed to be direct compression or indirect traction from the ligature. The relationship of these structures with the cervical spine cannot be visualized with traditional internal examination, due to obstruction by surrounding soft tissue. Postmortem computed tomography scan offers an unobscured view of the relationship of the laryngohyoid structures with the cervical spine.We aim to illustrate the phenomenon of displacement of the laryngohyoid structures associated with fractures of the horns. In our case reports, the laryngohyoid structures were displaced, not only superiorly and posteriorly, but also in 2 of the cases, by tilting, when the suspension point was at the posterior or posterolateral aspect of the neck. This displacement had caused the greater horns of the hyoid bone and superior horns of the thyroid cartilage to be approximated against the cervical spine, particularly the transverse processes. We believe that, in these circumstances, the fractures were caused by pressure of the horns of the laryngohyoid structures against the cervical spine.

Tumefactive demyelinating lesions versus CNS neoplasms, a comparative study.

BACKGROUND: Differentiating tumefactive demyelinating lesions (TDL) from neoplasms of the central nervous system continues to be a diagnostic dilemma in many cases. OBJECTIVE: Our study aimed to examine and contrast the clinical and radiological characteristics of TDL, high-grade gliomas (HGG) and primary CNS lymphoma (CNSL). METHOD: This was a retrospective review of 66 patients (23 TDL, 31 HGG and 12 CNSL). Clinical and laboratory data were obtained. MRI brain at presentation were analyzed by two independent, blinded neuroradiologists. RESULTS: Patients with TDLs were younger and predominantly female. Sensorimotor deficits and ataxia were more common amongst TDL whereas headaches and altered mental status were associated with HGG and CNSL. Compared to HGG and CNSL, MRI characteristics supporting TDL included relatively smaller size, lack of or mild mass effect, incomplete peripheral rim enhancement, absence of central enhancement or restricted diffusion, lack of cortical involvement, and presence of remote white matter lesions on the index scan. Paradoxically, some TDLs may present atypically or radiologically mimic CNS lymphomas. CONCLUSION: Careful evaluation of clinical and radiological features helps in differentiating TDLs at first presentation from CNS neoplasms.

Atomic-level chemical reaction promoting external quantum efficiency of organic photomultiplication photodetector exceeding 108% for weak-light detection.

Low-cost, solution-processed photomultiplication organic photodetectors (PM-OPDs) with external quantum efficiency (EQE) above unity have attracted enormous attention. However, their weak-light detection is unpleasant because the anode Ohmic contact causes exacerbation in dark current. Here, we introduce atomic-level chemical reaction in PM-OPDs which can simultaneously suppress dark current and increase EQE via depositing a 0.8 nm thick Al2O3 by the atomic layer deposition. Suppression in dark current mainly originates from the built-in anode Schottky junction as a result of work function decrease of hole-transporting layer of which the chemical groups can react chemically with the bottom surface of Al2O3 layer at the atomic-level. Such strategy of suppressing dark current is not adverse to charge injection under illumination; instead, responsivity enhancement is realized because charge injection can shift from cathode to anode, of which the neighborhood possesses increased photogenerated carriers. Consequently, weak-light detection limit of the forwardly-biased PM-OPD with Al2O3 treatment reaches a remarkable level of 2.5 nW cm-2, while that of the reversely-biased control is 25 times inferior. Meanwhile, the PM-OPD yields a record high EQE and responsivity of 4.31 × 108% and 1.85 × 106 A W-1, respectively, outperforming all other polymer-based PM-OPDs.

SLC17A3 rs9379800 and Ischemic Stroke Susceptibility at the Northern Region of Malaysia.

OBJECTIVES: The relationships of Paired Like Homeodomain 2 (PITX2), Ninjurin 2 (NINJ2), TWIST-Related Protein 1 (TWIST1), Ras Interacting Protein 1 (Rasip1), Solute Carrier Family 17 Member 3 (SLC17A3), Methylmalonyl Co-A Mutase (MUT) and Fer3 Like BHLH Transcription Factor (FERD3L) polymorphisms and gene expression with ischemic stroke have yet to be determined in Malaysia. Hence, this study aimed to explore the associations of single nucleotide polymorphisms (SNPs) and gene expression with ischemic stroke risk among population who resided at the Northern region of Malaysia. MATERIALS AND METHODS: Study subjects including 216 ischemic stroke patients and 203 healthy controls were recruited upon obtaining ethical clearance. SNP genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism assays. Gene expression levels were quantified by real-time polymerase chain reaction assays. Statistical and genetic analyses were conducted with SPSS version 22.2, PLINK version 1.07 and multifactor dimensionality reduction software. RESULTS: Study subjects with G allele, CG or GG genotypes of SLC17A3 rs9379800 demonstrated increased risk of ischemic stroke with the odds ratios ranging from 1.76-fold to 3.14-fold (p<0.05). When stratified study subjects according to the ethnicity, SLC17A3 rs9379800 G allele and CG genotype contributed to 2.14- and 2.96-fold of ischemic stroke risk among Malay population significantly, in the multivariate analysis (p<0.05). However, no significant associations were observed for PITX2, NINJ2, TWIST1, Rasip1, and MUT polymorphisms with ischemic stroke risk in the multivariate analysis for the pooled cases and controls as well as when stratified them according to the ethnicity. Lower mRNA expression levels of Rasip1, SLC17A3, MUT and FERD3L were observed among cases (p<0.05). After FDR adjustment, the mRNA level of SLC17A3 remained significantly associated with ischemic stroke among Malay population (q=0.034). CONCLUSION: In conclusion, this study suggests that SLC17A3 rs9379800 polymorphism and its gene expression contribute to significant ischemic stroke risk among Malaysian population, particularly the Malay who resided at the Northern Region of the country. Our findings can provide useful information for the future diagnosis, management and treatment of ischemic stroke patients.

Ocular Surface Disorders in Patients with Human Immunodeficiency Virus (HIV) Infection.

Purpose: To describe ocular surface disorders associated with human immunodeficiency virus (HIV). Methods: Narrative review. Results: Ocular surface neoplastic conditions, such as Kaposi's sarcoma, conjunctival lymphoma and ocular squamous cell carcinoma along with blepharitis, dry eye disease, and vernal keratoconjunctivitis, constitute ocular surface complications in HIV-infected individuals. Conclusion: This review will provide a summary of clinical presentations and treatment options for the most common HIV-related ocular surface diseases, indicating the need for a comprehensive ocular examination including ocular surface in all HIV patients 22.

Crack engineering for the construction of arbitrary hierarchical architectures.

Three-dimensional hierarchical morphologies widely exist in natural and biomimetic materials, which impart preferential functions including liquid and mass transport, energy conversion, and signal transmission for various applications. While notable progress has been made in the design and manufacturing of various hierarchical materials, the state-of-the-art approaches suffer from limited materials selection, high costs, as well as low processing throughput. Herein, by harnessing the configurable elastic crack engineering-controlled formation and configuration of cracks in elastic materials-an effect normally avoided in various industrial processes, we report the development of a facile and powerful technique that enables the faithful transfer of arbitrary hierarchical structures with broad material compatibility and structural and functional integrity. Our work paves the way for the cost-effective, large-scale production of a variety of flexible, inexpensive, and transparent 3D hierarchical and biomimetic materials.

Proceedings of the Inaugural Strategy Meeting for the Establishment of a Southeast Asia Regional Therapeutic Plasma Exchange Consortium for Neurological Disorders.

In conjunction with the third regional Southeast Asian (SEA) therapeutic plasma exchange (TPE) conference in Kuala Lumpur, Malaysia, 25 clinicians and researchers from SEA and South Asian countries attended the inaugural strategy meeting for the establishment of a regional TPE consortium for neurological disorders. The primary objective was to establish regional collaboration to improve delivery of TPE services in SEA. A pre-meeting survey was conducted to gather insights on disease spectrum, contextual practice challenges, and the need for a regional TPE consensus. Challenges identified include limited healthcare funding in support of diagnostic workup, TPE therapy, as well as development of clinical infrastructure and expertise capacity building. There was favorable interest in developing a working plan contextualized to this region. Strategies to overcome challenges were discussed. This included the need for a comprehensive referral system and network of regional TPE centers suited to local needs, supported by innovative TPE delivery programs.

Recurrent transient heading disorientation heralding acute posterior cerebral artery (PCA) infarction.

OBJECTIVE: Heading disorientation is a type of pure topographical disorientation. Reported cases have been very few and its underlying mechanism remains unclear. We report an unusual presentation of a 60-year-old man with recurrent transient heading disorientation heralding an acute posterior cerebral artery infarction. DESIGN: Case report. CONCLUSION: Acquired injury to the right retro-splenial region can result in a specific variant of topographical disorientation known as heading disorientation that may present as an atypical transient ischaemic attack-like symptom heralding acute cerebral infarction.

Exsanguination From an Ulcerated, Atypical, Superficial Venous Malformation.

Venous malformations (VMs) are the most common vascular malformations, and their diagnosis can be challenging. They may develop in any region of the body, with highly variable clinical presentations. Although they typically present early in life, many case reports have documented the sudden appearance of a previously unrecognized venous malformation in adulthood. Pain is the major complaint in most of the cases, and other complications include phlebolith formation and bleeding. To our knowledge, fatal hemorrhage from a VM has not previously been reported in the medical literature. We present a case of exsanguination from a previously undiagnosed lower limb superficial VM. This case stresses the importance of proper diagnosis and management of VM.

Finger drop sign-Characteristic pattern of distal weakness in Guillain-Barré Syndrome: A case report and review of the literature.

Guillain-Barré Syndrome is an acquired acute autoimmune polyradiculoneuropathy that commonly presents with limb weakness and occasional cranial nerve, respiratory and autonomic involvement. Although the classic description of Guillain-Barré Syndrome is that of a demyelinating neuropathy with ascending weakness, predominant bilateral finger drop as presenting feature has rarely been reported. A characteristic pattern of weakness involving the extensor components of the fingers known as "finger drop sign" has been first described to be specific in acute motor axonal neuropathy form of Guillain-Barré Syndrome in the literature. We report a case of acute motor-sensory axonal neuropathy, which showed characteristic pattern of predominant finger extensor weakness, and provide a summary of all reported cases to date. While previous reports suggested that this is a sign that carries good prognosis, our case report suggested otherwise as the patient succumbed to respiratory and autonomic complications. Further studies are needed to evaluate the clinical significance of this peculiar sign.

"Was the Infant Born Alive?" A Review of Postmortem Techniques Used to Determine Live Birth In Cases of Suspected Neonaticide.

The question of whether an infant was born alive has received much attention in the forensic literature. The volume of literature reflects the degree of controversy surrounding the techniques employed and their varied interpretation and utility. The majority of the investigation has been focused on the question "Has the infant breathed?" to determine if an infant was born alive by utilizing techniques that assess aeration of the lungs. However, caution must be employed when interpreting these techniques due to the well-recognized limitations in their interpretation, particularly in the presence of gaseous decomposition and/or resuscitation efforts. Although in some instances there may be irrefutable evidence that the infant was born alive, there is no single finding that can reliably be utilized to answer the question "Was the infant born alive?" in every case. Hence, the approach to postmortem investigation continues to include a wide range of observations, dissections, special techniques, and ancillary tests to assist the pathologist to form a considered opinion. There are a number of more recently described techniques which show great promise in assisting to answer this question including advanced imaging and immunohistochemical studies of the umbilical cord. It remains, though, that in many cases it is not possible to definitively answer this question and stillbirth should be assumed due to the potential legal implications of determining that an infant was born alive.

Novel Dimethylmethylene-Bridged Triphenylamine-PDI Acceptor for Bulk-Heterojunction Organic Solar Cells.

A novel, star-shaped electron acceptor, DMTPA-PDI3, derived from a planar dimethylmethylene-bridged triphenylamine core with three acetylene-linked perylene diimide (PDI) units is developed as a nonfullerene acceptor for organic solar cells (OSCs). DMTPA-PDI3 manifests significantly reduced intramolecular twisting, enabling sufficient system-wide π-electron delocalization leading to broadened spectral absorption and raised lowest unoccupied molecular orbital level. As a result, higher and more balanced hole and electron transport properties are observed. Active layers for OSCs comprising DMTPA-PDI3 acceptor and PBT7-Th donor exhibit suppressed intermolecular aggregation, giving rise to uniform nanophase network formation. These OSC devices have afforded respectably high power-conversion efficiency of about 5%.

Naphthalene diimide-difluorobenzene-based polymer acceptors for all-polymer solar cells.

Regio-random (P1) and -regular (P2) difluorobenzene-naphthalene-containing polymer acceptors were developed for bulk-heterojunction all-polymer solar cells (all-PSCs). P2 exhibited significantly higher crystallinity in thin films, providing high spectral absorptivity and electron mobility than P1. When used in all-PSC devices, P2 afforded a respectably higher power conversion efficiency of over 5%.

Study of Arylamine-Substituted Porphyrins as Hole-Transporting Materials in High-Performance Perovskite Solar Cells.

To develop new hole-transporting materials (HTMs) for efficient and stable perovskite solar cells (PSCs), 5,10,15,20-tetrakis{4-[N,N-di(4-methoxylphenyl)amino-phenyl]}-porphyrin was prepared in gram scale through the direct condensation of pyrrole and 4-[bis(4-methoxyphenyl)amino]benzaldehyde. Its Zn(II) and Cu(II) complexes exhibit excellent thermal and electrochemical stability, specifically a high hole mobility and very favorable energetics for hole extraction that render them a new class of HTMs in organometallic halide PSCs. As expected, ZnP as HTM in PSCs affords a competitive power conversion efficiency (PCE) of 17.78%, which is comparable to that of the most powerful HTM of Spiro-MeOTAD (18.59%) under the same working conditions. Meanwhile, the metal centers affect somewhat the photovoltaic performances that CuP as HTM produces a lower PCE of 15.36%. Notably, the PSCs employing ZnP show a much better stability than Spiro-OMeTAD. Moreover, the two porphyrin-based HTMs can be prepared from relatively cheap raw materials with a facile synthetic route. The results demonstrate that ZnP and CuP can be a new class of HTMs for efficient and stable PSCs. To the best of our knowledge, this is the best performance that porphyrin-based solar cells could show with PCE > 17%.