Postmortem whole-body CT angiography: evaluation of two contrast media solutions

OBJECTIVE: The objective of our study was to establish a standardized procedure for postmortem whole-body CT-based angiography with lipophilic and hydrophilic contrast media solutions and to compare the results of these two methods. MATERIALS AND METHODS: Minimally invasive postmortem CT angiography was performed on 10 human cadavers via access to the femoral blood vessels. Separate perfusion of the arterial and venous systems was established with a modified heart-lung machine using a mixture of an oily contrast medium and paraffin (five cases) and a mixture of a water-soluble contrast medium with polyethylene glycol (PEG) 200 in the other five cases. Imaging was executed with an MDCT scanner. RESULTS: The minimally invasive femoral approach to the vascular system provided a good depiction of lesions of the complete vascular system down to the level of the small supplying vessels. Because of the enhancement of well-vascularized tissues, angiography with the PEG-mixed contrast medium allowed the detection of tissue lesions and the depiction of vascular abnormalities such as pulmonary embolisms or ruptures of the vessel wall. CONCLUSION: The angiographic method with a water-soluble contrast medium and PEG as a contrast-agent dissolver showed a clearly superior quality due to the lack of extravasation through the gastrointestinal vascular bed and the enhancement of soft tissues (cerebral cortex, myocardium, and parenchymal abdominal organs). The diagnostic possibilities of these findings in cases of antemortem ischemia of these tissues are not yet fully understood.

Stability of coagulation assays performed in plasma from citrated whole blood transported at ambient temperature

Many preanalytical variables affect the results of coagulation assays. A possible way to control some of them would be to accept blood specimens shipped in the original collection tube. The aim of our study was to investigate the stability of coagulation assays in citrated whole blood transported at ambient temperature for up to two days after specimen collection. Blood samples from 59 patients who attended our haematology outpatient ward for thrombophilia screening were transported at ambient temperature (outdoor during the day, indoor overnight) for following periods of time: <1 hour, 4-6, 8-12, 24-28 and 48-52 hours prior to centrifugation and plasma-freezing. The following coagulation tests were performed: PT, aPTT, fibrinogen, FII:C, FV:C, FVII:C, FVIII:C, FIX:C, FX:C, FXI:C, VWF:RCo, VWF:Ag, AT, PC activity, total and free PS antigen, modified APC-sensitivity-ratio, thrombin-antithrombin-complex and D-dimer. Clinically significant changes, defined as a percentage change of more than 10% from the initial value, were observed for FV:C, FVIII:C and total PS antigen starting at 24-28 hours, and for PT, aPTT and FVII:C at 48-52 hours. No statistically significant differences were seen for fibrinogen, antithrombin, or thrombin-antithrombin complexes (Friedman repeated measures analysis of variance). The present data suggest that the use of whole blood samples transported at ambient temperature may be an acceptable means of delivering specimens for coagulation analysis. With the exception of factor V and VIII coagulant activity, and total PS antigen all investigated parameters can be measured 24-28 hours after specimen collection without observing clinically relevant changes.

A multiplex real-time PCR assay for rapid detection and differentiation of 25 bacterial and fungal pathogens from whole blood samples

Early detection of bloodstream infections (BSI) is crucial in the clinical setting. Blood culture remains the gold standard for diagnosing BSI. Molecular diagnostic tools can contribute to a more rapid diagnosis in septic patients. Here, a multiplex real-time PCR-based assay for rapid detection of 25 clinically important pathogens directly from whole blood in <6 h is presented. Minimal analytical sensitivity was determined by hit rate analysis from 20 independent experiments. At a concentration of 3 CFU/ml a hit rate of 50% was obtained for E. aerogenes and 100% for S. marcescens, E. coli, P. mirabilis, P. aeruginosa, and A. fumigatus. The hit rate for C. glabrata was 75% at 30 CFU/ml. Comparing PCR identification results with conventional microbiology for 1,548 clinical isolates yielded an overall specificity of 98.8%. The analytical specificity in 102 healthy blood donors was 100%. Although further evaluation is warranted, our assay holds promise for more rapid pathogen identification in clinical sepsis.

Will Whole-Tree Harvest of Jack Pine (Pinus banksiana) deplete soil nutrients in low-productivity sand soils?

In 2009 and 2010 a study was conducted on the Hiawatha National Forest (HNF) to determine if whole-tree harvest (WTH) of jack pine would deplete the soil nutrients in the very coarse-textured Rubicon soil. WTH is restricted on Rubicon sand in order to preserve the soil fertility, but the increasing construction of biomass-fueled power plants is expected to increase the demand for forest biomass. The specific objectives of this study were to estimate biomass and nutrient content of above- and below-ground tree components in mature jack pine (Pinus banksiana) stands growing on a coarse-textured, low-productivity soil, determine pools of total C and N and exchangeable soil cations in Rubicon sand, and to compare the possible impacts of conventional stem-only harvest (CH) and WTH on soil nutrient pools and the implications for productivity of subsequent rotations. Four even-aged jack pine stands on Rubicon soil were studied. Allometric equations were used to estimate above-ground biomass and nutrients, and soil samples from each stand were taken for physical and chemical analysis. Results indicate that WTH will result in cation deficits in all stands, with exceptionally large Ca deficits occurring in two stands. Where a deficit does not occur, the cation surplus is small and, chemical weathering and atmospheric deposition is not anticipated to replace the removed cations. CH will result in a surplus of cations, and will likely not result in productivity declines during the first rotation. However even under CH, the surplus is small, and chemical weathering and atmospheric deposition will not supply enough cations for the second rotation.

The long-term effects of whole-tree harvest at final felling on soil properties in a Norway Spruce (Picea Abies (L) Karst.) Stand

Increased demand for forest-derived biomass has resulted in changes in harvest intensities in Finland. Conventional stem-only harvest (CH) has to some extent been replaced with whole-tree harvest (WTH). The latter involves a greater removal of nutrients from the forest ecosystem, as all the above ground biomass is exported from the site. This has raised concerns that WTH could result in large changes in the nutrient dynamics of a forest stand and could eventually lower its site productivity. Little empirical data exists to support this assumption as only a limited number of studies have been conducted on the topic. A majority of these discuss the short-term effects, thus the long-term consequences remain unknown. The objective of this study was to compare differences in soil properties after CH and WTH in a fertile Norway spruce (Picea abies (L) Karst.) stand in Southern Finland. The site was clear-felled in August 2000 and spruce seedlings were planted in the following summer. Soil sampling in the form of systematic randomized sampling was carried out in May 2011. Changes in base saturation, cation exchange capacity, elemental pools (total and exchangeable) and acidity were studied in both organic and mineral horizons. The results indicate that WTH lowered effective cation exchange capacity and base saturation particularly in the humus layer. The pools of exchangeable Al and Fe were increased in the humus layer, whereas the amount of exchangeable Ca decreased in both layers. WTH also resulted in lower Ca/Al-ratios across the sampled layers. Treatment did not have a significant effect on pH, total pools of elements or on the C/N-ratio of the soil. The results suggest that although the stand possesses significant pools of nutrients at present, WTH, if continued, could have long-term effects on site productivity.

Whole body postmortem angiography with a high viscosity contrast agent solution using poly ethylene glycol as contrast agent dissolver

Postmortem minimal invasive angiography has already been implemented to support virtual autopsy examinations. An experimental approach in a porcine model to overcome an initially described artificial tissue edema artifact by using a poly ethylene glycol (PEG) containing contrast agent solution showed promising results. The present publication describes the first application of PEG in a whole corpse angiographic CT examination. A minimal invasive postmortem CT angiography was performed in a human corpse utilizing the high viscosity contrast agent solution containing 65% of PEG. Injection was carried out via the femoral artery into the aortic root in simulated cardiac output conditions. Subsequent CT scanning delivered the 3D volume data of the whole corpse. Visualization of the human arterial anatomy was excellent and the contrast agent distribution was generally limited to the arterial system as intended. As exceptions an enhancement of the brain, the left ventricular myocardium and the renal cortex became obvious. This most likely represented the stage of centralization of the blood circulation at the time of death with dilatation of the precapillary arterioles within these tissues. Especially for the brain this resulted in a distinctively improved visualization of the intracerebral structures by CT. However, the general tissue edema artifact of postmortem minimal invasive angiography examinations could be distinctively reduced.

Monitoring thrombin generation by electrochemistry: development of an amperometric biosensor screening test for plasma and whole blood

BACKGROUND: Complete investigation of thrombophilic or hemorrhagic clinical presentations is a time-, apparatus-, and cost-intensive process. Sensitive screening tests for characterizing the overall function of the hemostatic system, or defined parts of it, would be very useful. For this purpose, we are developing an electrochemical biosensor system that allows measurement of thrombin generation in whole blood as well as in plasma. METHODS: The measuring system consists of a single-use electrochemical sensor in the shape of a strip and a measuring unit connected to a personal computer, recording the electrical signal. Blood is added to a specific reagent mixture immobilized in dry form on the strip, including a coagulation activator (e.g., tissue factor or silica) and an electrogenic substrate specific to thrombin. RESULTS: Increasing thrombin concentrations gave standard curves with progressively increasing maximal current and decreasing time to reach the peak. Because the measurement was unaffected by color or turbidity, any type of blood sample could be analyzed: platelet-poor plasma, platelet-rich plasma, and whole blood. The test strips with the predried reagents were stable when stored for several months before testing. Analysis of the combined results obtained with different activators allowed discrimination between defects of the extrinsic, intrinsic, and common coagulation pathways. Activated protein C (APC) predried on the strips allowed identification of APC-resistance in plasma and whole blood samples. CONCLUSIONS: The biosensor system provides a new method for assessing thrombin generation in plasma or whole blood samples as small as 10 microL. The assay is easy to use, thus allowing it to be performed in a point-of-care setting.