A comparative analysis of the findings of postmortem computed tomography scan and traditional autopsy in traumatic deaths: Is technology mutually complementing or exclusive?

Background: Postmortem examination is indispensable to ascertain the cause of an unnatural death and as such is mandatory by the law. From ages, traditional autopsy (TA) has proved its worth in establishing the cause of death in the deceased despite some inherent difficulties and challenges and has enjoyed an insurmountable status. The increasing use of application of the modern-day radiology for postmortem examination has however opened a new arena overcoming some of the difficulties of the TA. There are conflicting reports in the published literature regarding superiority of one modality of the postmortem over the other. Objective: The objective of this study was to compare the findings of postmortem computed tomography (CT) scan and TA in the victims of traumatic deaths and to analyze whether postmortem CT can be used to replace TA. Materials and Methods: All patients with a history of trauma that were declared brought dead on arrival in the emergency department were subjected to full-body CT scan. An experienced radiologist reported the findings of CT scan. Subsequently, a forensic expert subjected the patients to TA. The physician who performed autopsy was blinded to the findings of CT scan and vice versa. An individual who was not part of the radiology or forensic team then entered the findings of CT scan and autopsy in a predesigned Pro forma. An unbiased assessor finally compared the findings of the two modalities and analyzed the results. McNemar's test was used to ascertain the level of significance between the findings reported by these two modalities considering P = 0.05 as statistically significant. The agreement or disagreement on cause of death reported by these two modalities was also assessed. Results: About 95 of the deceased were males. The mean age of the corpses was 35 years (range 1667 years). CT was found superior in picking up most of the bony injuries, air-containing lesions, hemothorax, and hemoperitoneum. However, autopsy was found more sensitive for soft-tissue and solid visceral injuries. Both modalities were equally helpful in identifying extremity fractures. Statistically significant agreement (>95) on cause of death by both modalities was not achieved in any patient of trauma. Conclusion: Postmortem CT scan is promising in reporting injuries in traumatic deaths and can significantly complement the conventional autopsy. However, at present, it cannot be considered as a replacement for TA

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Deletion of ARNT (Aryl hydrocarbon receptor nuclear translocator) in β-cells causes islet transplant failure with impaired β-cell function.

BACKGROUND: Replacing β-cells by islet-transplantation can cure type 1 diabetes, but up to 70% of β-cells die within 10 days of transplantation. ARNT (Aryl hydrocarbon Receptor Nuclear Translocator) regulates β-cell function, and potentially survival. Lack of ARNT impairs the ability of β-cells to respond to physiological stress and potentiates the onset of diabetes, but the exact role of ARNT in graft outcome is unknown. AIM: To investigate the effect of β-cell deletion of ARNT on graft outcomes. METHODS: Islets were isolated from donor mice which had β-cell specific ARNT-deletion (β-ARNT) or littermate floxed controls. The islets were transplanted into diabetic SCID recipients in ratios of (a) 3 donors: 1 recipient, (b) 1 donor: 1 recipient or (c) ½ of the islets from 1 donor: 1 recipient. After 28 days, the kidney containing the graft was removed (nephrectomy) to exclude regeneration of the endogenous pancreas. RESULTS: In the supra-physiological-mass model (3:1), both groups achieved reasonable glycaemia, with slightly higher levels in β-ARNT-recipients. In adequate-mass model (1:1), β-ARNT recipients had poor glucose control versus floxed-control recipients and versus the β-ARNT donors. In the low-β-cell-mass model (½:1) β-ARNT transplants completely failed, whereas controls had good outcomes. Unexpectedly, there was no difference in the graft insulin content or β-cell mass between groups indicating that the defect was not due to early altered β-cell survival. CONCLUSION: Outcomes for islet transplants lacking β-cell ARNT were poor, unless markedly supra-physiological masses of islets were transplanted. In the 1:1 transplant model, there was no difference in β-cell volume. This is surprising because transplants of islets lacking one of the ARNT-partners HIF-1α have increased apoptosis and decreased islet volume. ARNT also partners HIF-2α and AhR (aryl hydrocarbon receptor) to form active transcriptional complexes, and further work to understand the roles of HIF-2α and AhR in transplant outcomes is needed

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Pre-transplant glucose tolerance and β-cell mass and number of islets isolated.

<p>(<b>A</b>) β-ARNT donor mice had significant glucose intolerance compared to floxed controls and RIP-CRE alone mice (*** = p<0.001, ** = p<0.01, * = p<0.05). (<b>B</b>) Both β-ARNT and control mice show similar β-cell mass pre-transplantation. (<b>C</b>) Both β-ARNT and control mice had similar number of islets isolated. Average = 236 islets/β-ARNT mouse and 231 islets/control mouse. Data are presented as means ± SEMs.</p

β-ARNT and control donor versus recipient mice glucose tolerance test (in 1∶1 transplant model).

<p>(<b>A</b>) Comparing glucose tolerance in both β-ARNT and control donors versus their recipients, the control recipients exhibit similar glucose tolerance compared to the control donors. (n = 4–6 per group) (<b>B</b>) Both β-ARNT recipients and donors have impaired glucose tolerance. (n = 4–6 per group) (*** = p<0.001, ** = p<0.01). Data are presented as means ± SEMs.</p

Timeline for transplant experiments.

<p>Donor mice undergo a GTT prior to islet isolation (∼3 days). Recipient mice are given an intraperitoneal injection of streptozotocin and diabetes occurrence is confirmed in approximately 5 days. Islets isolated from the donor mice are transplanted immediately into diabetic recipient mice. Recipient mice are checked for random-fed glucose levels at least 3 times a week until nephrectomy (28 days). GTT is performed on recipient mice on day 25 and nephrectomy on day 28 post-transplantation. Kidney with graft is collected for histology at nephrectomy.</p