Intrathoracic Petechial Hemorrhages in Sudden Infant Death Syndrome and Other Infant Deaths: Time for Re-examination?

The objective of this study was to provide a predictive tool to assist forensic and pediatric pathologists in the diagnosis of sudden unexpected infant death and to discuss the pathogenesis of intrathoracic petechial hemorrhages through a retrospective autopsy report review of 174 sudden infant death syndrome (SIDS) cases (2004 definition) and 67 age-matched comparison deaths. The setting was a qualitative assessment (presence or absence) of macroscopic intrathoracic petechiae in SIDS and age-matched comparison of sudden unexpected deaths that occurred in the late 1980s and early 1990s. Sensitivity, specificity, and positive and negative predictive values for thymic, pleural, and epicardial petechial hemorrhages were developed. Results showed 89.5%, 80%, and 79.9% SIDS (<12 months of age) had thymic, pleural, and epicardial petechiae, respectively, compared with 47.6%, 47.5% and 43.6% in non-SIDS deaths, respectively. Respective odds ratios were: 9.4 (4.5 to 19.9), 4.6 (2.3 to 9.1), 5.3 (2.6 to 10.8). When all 3 intrathoracic organ sites contain macroscopic petechiae, this is 84.9% predictive of SIDS; when all 3 sites have no detectable petechiae this is 93.1% predictive of a non-SIDS diagnosis. Thus, we conclude that careful assessment of intrathoracic petechiae at autopsy is likely to be diagnostically useful in the assessment of sudden unexplained infant death.Paul N. Goldwate

The human oviduct transcriptome reveals an anti-inflammatory, anti-angiogenic, secretory and matrix-stable environment during embryo transit.

The human oviduct serves as a conduit for spermatozoa in the peri-ovulatory phase and nurtures and facilitates transport of the developing embryo for nidation during the luteal phase. Interactions between the embryo and oviductal epithelial surface proteins and secreted products during embryo transit are largely undefined. This study investigated gene expression in the human oviduct in the early luteal versus follicular phases to identify candidate genes and biomolecular processes that may participate in maturation and transport of the embryo as it traverses this tissue. Oviductal RNA was hybridized to oligonucleotide arrays and resulting data were analysed by bioinformatic approaches. There were 650 genes significantly down-regulated and 683 genes significantly up-regulated (P<0.05) in the luteal versus follicular phase. Quantitative real-time PCR, immunoblot analysis and immunohistochemistry confirmed selected gene expression and cellular protein localization. Down-regulated genes involved macrophage recruitment, immunomodulation and matrix-degeneration, and up-regulated genes involved anti-inflammatory, ion transport, anti-angiogenic and early pregnancy recognition. The oviduct displayed some similarities and differences in progesterone-regulated genes compared with the human endometrium. Together, these data suggest a unique hormonally regulated environment during embryo development, maturation and transport through human oviduct and some conservation of progesterone signalling in tissues of common embryological origin. The oviduct serves as a conduit for spermatozoa in the peri-ovulatory phase and it nurtures and facilitates transport of the developing embryo during the luteal phase of the menstrual cycle, although precise interactions between the embryo and oviductal epithelium and secreted products are largely undefined. Herein, we investigated gene expression in human oviduct to identify candidate genes and processes that may participate in maturation and transport of the embryo as it develops implantation competence. Total RNA from human ampullary oviducts in the early luteal versus follicular phases was isolated and hybridized to oligonucleotide arrays. The data, analysed by bioinformatic approaches, revealed that 650 genes were significantly down- and 683 genes were significantly up-regulated in the luteal phase. Quantitative real-time PCR, immunoblot analysis and immunohistochemistry confirmed selected gene expression and cellular protein localization. The data demonstrated down-regulation of genes involved in macrophage recruitment, immunomodulation and matrix degeneration and up-regulation of ion transport and secretions, as well as anti-angiogenic and early pregnancy recognition. Together, these data suggest a unique hormonally regulated environment during embryo development, maturation and transport through the human oviduct and provide insight into mechanisms influencing acquisition of implantation competence of the human embryo during its passage through the oviduct en route to the uterine endometrium