Whiplash-Associated Disorders : Clinical and medico-legal guidelines on the methods of ascertainment.

The manuscript presents the International Guidelines developed by the Working Group on Personal Injury and Damage under the patronage of the International Academy of Legal Medicine (IALM) regarding the Methods of Ascertainment of any suspected Whiplash-Associated Disorders (WAD).The document includes a detailed description of the logical and methodological steps of the ascertainment process as well as a synoptic diagram in the form of Flow Chart.

Systematic review of surgical treatment of subclinical Cushing's syndrome.

BACKGROUND: Subclinical Cushing's syndrome (SCS) is a condition of biochemical cortisol excess without the classical clinical features of overt hypercortisolism; it may be associated with some consequences of metabolic syndrome. The most appropriate treatment remains controversial. This study aimed to assess the outcomes of adrenalectomy for SCS. METHODS: A systematic review was performed. MEDLINE, Embase and Cochrane Databases (1980-2013) were searched for studies reporting the outcomes of unilateral adrenalectomy with respect to hypertension, diabetes, dyslipidaemia, obesity and osteoporosis in patients with SCS. Studies with a questionable diagnosis of SCS, bilateral adrenal involvement and insufficient data were excluded. RESULTS: Of the 105 papers screened, seven were selected; there were six retrospective studies and one randomized clinical trial, including 230 patients. Data analysis was limited by heterogeneity in definition of SCS and endpoints. Hypercortisolism was cured in all operated patients. Laparoscopy was the preferred approach, with a morbidity rate of 0·8 per cent. A beneficial effect of surgery on blood pressure, glucometabolic control and obesity was evident in all studies, with cure or improvement in 72, 46 and 39 per cent of patients respectively, compared with conservative management. The results for lipid metabolism were equivocal, because of a decrease in triglyceridaemia but discordant effects on cholesterol metabolism among the different studies. No beneficial effects on osteoporosis were found. CONCLUSION: Laparoscopic adrenalectomy seems to be beneficial in reversing several metabolic effects of hypercortisolism, with a low morbidity rate. However, the heterogeneity and low quality of the available studies preclude definitive recommendations.

Markers of mechanical asphyxia: immunohistochemical study on autoptic lung tissues.

Forensic pathologists are often asked to provide evidence of asphyxia death in the trial and a histological marker of asphyxiation would be of great help. Data from the literature indicate that the reaction of lung tissue cells to asphyxia may be of more interest for forensic purposes than migrating cells. The lungs of 62 medico-legal autopsy cases, 34 acute mechanical asphyxia (AMA), and 28 control cases (CC), were immunostained with anti-P-selectin, anti-E-selectin, anti-SP-A, and anti-HIF1-α antibodies, in order to verify if some of them may be used as markers of asphyxia death. Results show that P- and E-selectins expression in lung vessels, being activated by several types of trigger stimuli not specific to hypoxia, cannot be used as indicator of asphyxia. Intra-alveolar granular deposits of SP-A seem to be related to an intense hypoxic stimulus, and when massively present, they can suggest, together with other elements, a severe hypoxia as the mechanism of death. HIF1-α was expressed in small-, medium-, and large-caliber lung vessels of the vast majority of mechanical asphyxia deaths and CO intoxications, with the number and intensity of positive-stained vessels increasing with the duration of the hypoxia. Although further confirmation studies are required, these preliminary data indicate an interesting potential utility of HIF1-α as a screening test for asphyxia deaths.

Forensic application of ESEM and XRF-EDS techniques to a fatal case of sodium phosphate enema intoxication.

Sodium phosphate enemas and laxatives are widely used for the treatment of constipation, even if a number of cases of significant toxicity due to alterations of the fluid and electrolyte equilibria (hypernatremia, hyperphosphatemia, and hypocalcemia) have been reported. We present the case of an 83-year-old man who died of fecal and chemical peritonitis secondary to an iatrogenic colon perforation (produced performing a Fleet enema through the patient's iliac colostomy) with peritoneal absorption of sodium phosphate. Environmental scanning electron microscopy coupled with an X-ray fluorescence energy dispersive spectrometry discovered multiple bright crystals formed of calcium, phosphorus, and oxygen in the brain, heart, lung, and kidney sections of the victim. The absence of these kinds of precipitates in two control samples chronically treated with Fleet enemas led us to assume that the deceased had adsorbed a great quantity of phosphorus ions from the peritoneal cavity with subsequent systemic dissemination and precipitation of calcium phosphate bindings.

A High Performance Biofilter for VOC Emission Control.

Biofiltration is a cleaning technique for waste air contaminated with some organic compounds. The advantages of the conventional biofilter over other biological systems are a high-superficial area best suited for the treatment of some compounds with poor water solubility, ease of operation, and low operating costs. It has crucial disadvantages, however; for example, it is not suitable to treat waste gases with high VOC concentrations and it has poor control of reaction conditions. To improve on these problems and to build a high-performance biofilter, three structured peat media and two trickling systems have been introduced in this study. The influences of media size and composition have been investigated experimentally. Peat bead blended with 30% (w/w) certain mineral material with a good binding capacity has advantages over other packing materials, for example, suitable size to prevent blockage due to microbial growth, strong buffering capacity to neutralize acidic substances in the system, and a pH range of 7.0-7.2 suitable for the growth of bacteria. Dropwise trickling system offers an effective measure to easily control the moisture content of the bed and the reaction conditions (pH, nutrient) and to partially remove excess biomass produced during the metabolic processes of microorganisms. The influence of nutrient supplementation has also been investigated in this study, which has revealed that the biological system was in a condition of nutrient limitation instead of carbon limitation. The biofilters built in our laboratory were used to treat waste gas contaminated with toluene in a concentration range of 1 to 3.2 g/m3 and at the specific gas flow rate of 24 to120 m3/m2.hr. Under the conditions employed, a high elimination capacity (135 g/m3.hr) was obtained in the biofilter packed with peat beads (blended with 30% of the mineral material), and no blockage problem was observed in an experimental period of 2-3 months.

Size-exclusion chromatographic reconstitution of the bovine brain benzodiazepine receptor. Effects of lipid environment on the binding characteristics.

The benzodiazepine receptor from calf brain was solubilized with sodium deoxycholate (2 mg/ml) in the presence of 0.5 M KCl and protease inhibitors, and bound flunitrazepam with an equilibrium dissociation constant (Kd) of 2.7 +/- 1.2 nM and with 0.40 +/- 0.04 pmol binding sites per mg protein (Bmax). Up to 60% of the benzodiazepine binding sites (average 25%) could be reconstituted in lipid vesicles, upon size-exclusion chromatography of protein-detergent-lipid mixtures on Sephadex G-50 Medium for detergent depletion. The flunitrazepam affinity for the reconstituted receptor varied with the lipid composition (Kd 1.4-4 nM). Freezing and thawing increased the size of the small proteoliposomes obtained by chromatographic reconstitution and, on the average, doubled the number of operative flunitrazepam binding sites. When the proteoliposomes were stored at -20 degrees C or -80 degrees C or in lyophilized state, the receptor retained its benzodiazepine binding affinity and Bmax over a period of 2 months.

Aberrant cGMP-binding activity in non-chemotactic Dictyostelium discoideum mutants.

The kinetics of cGMP-binding to the major cGMP-binding activity in Dictyostelium were investigated in 10 non-chemotactic mutants (KI mutants; KI-1 approximately 10). A wild-type cell contains about 3000 binding sites with a Kd of 1.5 nM. cGMP may dissociate from these binding sites with fast (F-type) or slow (S-type) kinetics, and DNA has been shown to promote the conversion of F- to S-type of cGMP-binding. The 10 mutants were placed in 4 classes, based on equilibrium and non-equilibrium binding properties and the effect of DNA. Class I mutants (KI-1, 3 and 8) have normal cGMP-binding properties. Class II mutants (KI-2, 6 and 7) show increased Kd values but nearly normal Bmax, normal F/S ratio and normal effects of DNA. Class III mutants (KI-4, 5 and 10) have a strongly decreased Kd and increased Bmax, nearly all binding sites are of the S-type and DNA does not affect the binding; apparently these mutants have a cGMP-binding protein locked in the S-form. cGMP-binding in class IV mutant (KI-9) is normal except that the number of binding sites is increased about 3-fold. The finding of seven mutants with altered cGMP-binding in 10 non-chemotactic mutants suggests that the cGMP-binding activity plays an important role in the chemotactic signal transduction pathway.

Localization of the nucleotide excision repair gene ERCC6 to human chromosome 10q11-q21.

We have cloned the human DNA excision repair gene ERCC6 by virtue of its ability to correct the uv sensitivity of Chinese hamster overy cell mutant UV61. This mutant is a member of complementation group 6 of the nucleotide excision repair-deficient rodent mutants. By means of in situ hybridization and Southern blot analysis of mouse x human somatic cell hybrids, the gene was localized to human chromosome 10q11-q21. An RFLP detected within the ERCC6 locus can be helpful in linkage analysis.