Lethal accidents caused by lightning are divided into observed and unobserved events. Pathognomonic or characteristic findings are often overlooked during external postmortem examination. Classical mistakes may be made which may often lead to an incorrect diagnosis. An analysis of 270 fatalities was performed on a historical collection of the Committee for Lightning Conductor Construction for the United Economic Area e. V. (ABBW) on lethal accidents due to lightning that occurred in Germany for the period 1951-1965. Furthermore, a selective literature research was carried out. The aim of the study was to analyze the death scene, the clothing, and the victim. The authors focused on chief findings which were relevant to the correct diagnosis of \"death by lightning.\" Both Lichtenberg figures and singed body hair were considered pathognomonic for a lightning strike. The question arose as to whether Lichtenberg figures, for example, represented the finding that most often led to the correct diagnosis. Of the 270 lightning-struck victims from the case collection, 129 (47.8%) had singed body hair and 25 (9.3%) had Lichtenberg figures. A comparison of the frequency of the two reported findings, singed body hair versus Lichtenberg figures, has only been performed in the literature for case numbers below 40. This study is the first evaluation of a relatively large number of lethal accidents due to lightning. Singed body hair was reported more frequently in lightning-struck victims than Lichtenberg figures. This study showed that singed body hair is probably more diagnostically important than Lichtenberg figures.

Introduction Most people would prefer end-of-life care to be provided at home. Although Japan has tried to promote home care and end-of-life care, very few people die at home in Japan. On the other hand, deaths at home are not necessarily attended deaths at home by end-of-life care because they include many deaths, such as deaths from external causes and solitary deaths. We obtained the data on the number of postmortem examinations at home in the main areas of Osaka City and calculated the estimated number of attended deaths at home by subtracting the number of postmortem examinations at home from the number of total deaths at home. We analyzed the contribution of medical resources to end-of-life care from a forensic perspective for a closer analysis of the actual situation. Methods The data about the population, the number of total deaths, deaths at home, and medical resources related to home care in Osaka City was obtained from the website of a public institution in Japan. The data about the number of postmortem examinations in Osaka City was obtained from the Osaka Medical Examiner\'s Office. The estimated number of attended deaths at home was calculated by subtracting postmortem examinations at home from total deaths at home. We conducted univariate and multivariate analyses between the number of medical resources and the prevalence of attended deaths at home. Results In the univariate analysis of the prevalence of attended deaths at home, a high positive correlation was observed in \"doctors,\" \"total clinics,\" \"clinics except HCSC,\" and \"general beds.\" A high negative correlation was observed in \"long-term care beds.\" In the multivariate analysis, a positive coefficient was observed in \"clinics except HCSC,\" and a negative one was observed in \"HCSC or HCSH.\" Conclusion The policy of shifting general clinics and hospitals to HCSC and HCSH may not be as effective for end-of-life care because the criteria do not include any restrictions on the number or use of beds. However, general clinics may have played an important role in end-of-life care, even if they were not HCSC.

Diffuse large B-cell lymphoma is the most common lymphoma, accounting for 30% of all non-Hodgkin lymphomas; they can grow rapidly and often present as masses infiltrating tissues or obstructing organs. We report the case of a 58-year-old female who presented with a one-month history of generalized body weakness and weight loss with a two-week history of yellowness of the eyes, fever, dyspnea, and bilateral leg swelling. Examination at presentation revealed pallor, fever, jaundice, hepatomegaly, and bilateral pitting pedal edema. Laboratory investigations revealed severe anemia, deranged clotting profile, azotemia, elevated liver enzymes, and elevated tumor markers CA125, CEA, and CA 19.9. Abdominal ultrasound showed hepatomegaly and a large head of the pancreas. The initial diagnosis was obstructive jaundice due to carcinoma of the head of the pancreas. Despite all care offered, her clinical condition deteriorated until she died on the 12th day of admission. A postmortem examination showed a mass in the head of the pancreas and bile duct, enlarged para-aortic and mesenteric lymph nodes with ascites, pericardial nodules, and bronchopneumonia. Histological and immunohistochemical analysis of postmortem biopsies confirmed the diagnosis of a diffuse large B cell lymphoma.  This case highlights the diagnostic dilemma often seen in disseminated diffuse large B-cell lymphoma. The patient presented with features referable to different organs and systems. If detected early, most cases respond to standard immuno-chemotherapy. However, it can also become rapidly fatal and ultimately lead to death, as seen in this case.

The 22q11.2 deletion syndrome (22q11.2 DS) is known as the most common microdeletion syndrome. Due to its variable clinical phenotype, prenatal diagnosis can be challenging. The aim of this retrospective study was to evaluate the clinical course and pregnancy outcome of cases with prenatally diagnosed 22q11.2 deletion syndrome (DS) as well as to evaluate the role of prenatal magnetic resonance imaging (MRI) and postmortem examination. In total, 21 cases who underwent prenatal ultrasound examination and pregnancy care at the Department of Obstetrics and Gynecology at the Medical University of Vienna between 2012 and 2022 were included. The majority of the cases were genetically diagnosed using fluorescent in situ hybridization (FISH). The median gestational age (GA) at genetic diagnosis was 23.0 weeks (IQR 21.4-24.8 weeks). CHDs were detected in all fetuses and the most common extracardiac manifestation was thymus hypo/aplasia followed by genitourinary anomalies. Prenatal magnetic resonance imaging (MRI) revealed additional diagnostic information in three of ten cases. Overall, 14 patients opted for drug-induced TOP, of which 9 cases had a feticide prior to the induction of labor. The majority of craniofacial malformations were only detected by autopsy. In conclusion, the majority of cases prenatally diagnosed with 22q11.2 DS had an absent or hypoplastic thymus noted antenatally in addition to the detected CHD, and almost half of the cases had another extracardiac malformation of predominantly genitourinary origin. Furthermore, prenatal MRIs confirmed previously detected malformations, but only provided additional diagnostic information in three out of ten cases, whereas postmortem examination diagnosed most of the craniofacial anomalies and should always be conducted, serving as an important quality indicator for prenatal imaging.

Tuberculosis (TB) presents a substantial health risk to autopsy staff, given its three to five times higher incidence of TB compared to clinical staff. This risk is notably accentuated in South Korea, which reported the highest TB incidence rate and the third highest TB mortality rate among OECD member countries in 2020. The standard TB diagnostic method, histopathological examination of sputum or tissue for acid-fast bacilli (AFB) using Ziehl-Neelsen staining, demands microscopic examination of slides at 1000× magnification, which is labor-intensive and time-consuming. This article proposes a computer-aided diagnosis (CAD) system designed to enhance the efficiency of TB diagnosis at magnification less than 1000×. By training nine neural networks with images taken from 30 training slides and 10 evaluation slides at 400× magnification, we evaluated their ability to detect M. tuberculosis. The N model achieved the highest accuracy, with 99.77% per patch and 90% per slide. We discovered that the model could aid pathologists in preliminary TB screening, thereby reducing diagnostic time. We anticipate that this research will contribute to minimizing autopsy staff\'s infection risk and rapidly determining the cause of death.

UNASSIGNED: Stillbirth causes considerable loss to the pig farming industry. Methods aimed at reducing stillbirth should base on the understanding of risk factors for intrapartum stillbirth because it accounts for 75% of all stillbirths. Unfortunately, few studies have differentiated between intrapartum and prepartum stillbirths leading to inadequate information about risk factors for sole intrapartum stillbirth. This study investigated risk factors for piglet\'s intrapartum stillbirth.
UNASSIGNED: Data of 1527 piglets born from 103 sows in one herd were recorded. Generalized linear mixed models were used to determine the relationship between investigated risk factors and intrapartum stillbirth at the piglet level. The potential risk factors were parity, gestation length (GL), litter size (LS), birth order (BO), birth interval (BI), cumulative farrowing duration (CFD), gender, crown-rump length, birth weight (BW), body mass index, ponderal index (PI), and BW deviation.
UNASSIGNED: About 60% (60.2%, 62/103) litters had stillborn piglet(s), and the intrapartum stillbirth rate was 5.8% (89/1527). BW deviation (≤0.1 and >0.6 kg), LS >13, GL (<114 and >117 days), PI ≤54, and BO >10 were the most significant factors associated with increased intrapartum stillbirth. No effect of parity, sex, BI, and CFD on intrapartum stillbirth was detected.
UNASSIGNED: These data stressed the importance of piglets\' size and shape in the prediction of intrapartum stillbirth. Furthermore, large LS, high BO, short, and long GL were associated with increased intrapartum stillbirth. The results of this study suggest that procedures aimed at increasing litter homogeneity, optimizing piglets\' size and shape, avoiding short and long gestation, and increasing supervision rate, especially at the second half, of the farrowing may reduce piglet\'s intrapartum stillbirth.

The welfare of cattle, pigs, sheep and goats was assessed by measuring trauma detected during veterinary postmortem inspection at slaughterhouses. The subject of this evaluation were all bovine, porcine, ovine and caprine animals slaughtered at Czech slaughterhouses in the monitored period, i.e., a total of 1,136,754 cows, 257,912 heifers, 1,015,541 bulls, 104,459 calves, 586,245 sows, 25,027,303 finisher pigs, 123,191 piglets, 22,815 ewes, 114,264 lambs, 1348 does and 5778 kids. The data on the numbers of traumatic findings were obtained retrospectively from a national veterinary database collecting data from slaughterhouse postmortem examinations. The results showed that findings of trauma were observed at a low frequency in the studied species. Injuries were detected most frequently in cows (1.71%). In contrast, no findings associated with the presence of trauma were recorded in does and kids. From the viewpoint of trauma localization, findings on the limbs were more frequent than findings on the body (p < 0.01). The only exceptions to this were lambs, does and kids, for which there was no statistically significant difference between findings on the limbs and the body (p = 1.00). The results show that housing system (bedding, the presence of slats, floor hardness), transport of animals to the slaughterhouse (moving animals to the vehicle, loading ramps, floors in transport vehicles and the transport of animals itself) and design of the slaughterhouse (unloading ramps, passageways and slaughterhouse floors) have a greater impact on the limbs than the bodies of animals in the majority of species. A difference was also demonstrated in the occurrence of findings of trauma in the limbs and body (p < 0.01) between culled adult animals and fattened animals, namely in cattle and pigs. A difference (p < 0.01) between ewes and lambs was found only in the occurrence of traumatic injury to the limbs. The results showed that fattened animals are affected by the risk of trauma to a lesser extent than both culled adult animals and young animals. Statistically significant differences (p < 0.01) were also found between the studied species and categories of animals. The category most affected from the viewpoint of injury both to the limbs and body was cows. In contrast to cows that are typically reared indoors, the low frequency of traumatic findings was found in small ruminants and in bulls, i.e., animals typically reared outdoors. Assumedly, access to pasture may be beneficial considering the risk of traumatic injury.

Clinical trials of the effects of physical activity have reported improvements in symptoms and quality of life in patients with Parkinson\'s disease (PD). Additionally, morphological brain changes after exercising were reported in PD animal models. However, these lifestyle-related changes were not evaluated in postmortem brain tissue.
OBJECTIVE: We aimed to evaluate, by immunohistochemistry, astrocytes, tyrosine hydroxylase (TH) and structural proteins expression (neurofilaments and microtubules - MAP2) changes in postmortem brain samples of individuals with Lewy body pathology.
METHODS: Braak PD stage≥III samples, classified by neuropathology analysis, from The Biobank for Aging Studies were classified into active (n=12) and non-active (n=12) groups, according to physical activity lifestyle, and paired by age, sex and Braak staging. Substantia nigra and basal ganglia were evaluated.
RESULTS: Groups were not different in terms of age or gender and had similar PD neuropathological burden (p=1.00). We observed higher TH expression in the active group in the substantia nigra and the basal ganglia (p=0.04). Astrocytes was greater in the non-active subjects in the midbrain (p=0.03) and basal ganglia (p=0.0004). MAP2 levels were higher for non-active participants in the basal ganglia (p=0.003) and similar between groups in the substantia nigra (p=0.46). Neurofilament levels for non-active participants were higher in the substantia nigra (p=0.006) but not in the basal ganglia (p=0.24).
CONCLUSIONS: Active lifestyle seems to promote positive effects on brain by maintaining dopamine synthesis and structural protein expression in the nigrostriatal system and decrease astrogliosis in subjects with the same PD neuropathology burden.
Estudos dos efeitos da atividade física relataram melhora nos sintomas e na qualidade de vida de pacientes com doença de Parkinson (DP). Além disso, alterações morfológicas do cérebro após o exercício físico foram relatadas em modelos animais da DP. No entanto, essas mudanças relacionadas ao estilo de vida não foram avaliadas em tecido cerebral post-mortem.
OBJECTIVE: Avaliar a expressão de astrócitos, tirosina hidroxilase (TH) e a expressão de proteínas estruturais (neurofilamentos e microtúbulos — MAP2) por imuno-histoquímica, em amostras cerebrais post-mortem de indivíduos com corpos de Lewy.
UNASSIGNED: Amostras com estágio de Braak para DP≥III, classificação neuropatológica, fornecidas pelo biobanco de estudos do envelhecimento foram classificadas em grupos ativos (n=12) e não ativos (n=12), de acordo com o estilo de vida (atividade física), e pareados por idade, sexo e estadiamento de Braak. Analisou-se a substância negra e gânglios da base.
RESULTS: Idade, sexo e classificação para DP foram semelhantes (p=1,00). Observou-se maior expressão de TH no grupo ativo (p=0,04). Amostras de não ativos revelaram maior expressão de astrócitos no mesencéfalo (p=0,03) e nos gânglios da base (p=0,0004); MAP2 nos gânglios da base (p=0,003); os níveis de neurofilamentos foram maiores na substância negra (p=0,006).
UNASSIGNED: O estilo de vida ativo parece promover efeitos positivos no cérebro, mantendo a síntese de dopamina e a expressão estrutural de proteínas no sistema nigrostriatal e com diminuição da ativação de astrócitos em indivíduos com a mesma classificação neuropatológica para a DP.

In this paper, we provide an overview of the causes of death of roe deer (Capreolus capreolus) diagnosed within the national passive health surveillance of roe deer in Slovenia. From 2000 to 2019, postmortem examinations of 510 free-ranging roe deer provided by hunters were conducted at the Veterinary Faculty, Slovenia. A comprehensive necropsy was performed. According to the results of the necropsy, the samples were subjected to microscopic, histopathological, bacteriological, parasitological, or virological examination. The most frequent causes of death in roe deer were infectious diseases (67%), followed by noninfectious diseases (28%). Of all deaths, parasitic infections represented 48%, bacterial infections 14.8%, trauma 12.5%, and metabolic disorders 9.8%. Less frequent causes were diseases like neoplasia and mycotic infections, winter starvation, hernias, and lightning strike. This study covered an estimated 1% of the total disease-related mortality of roe deer in Slovenia. Comparisons of sex/age structure indicated that hunters did not provide random samples (e.g., young males were disproportionately represented). Therefore, such monitoring does not ensure an unbiased assessment of the significance of the individual disease for the mortality of the population; however, it can provide credible evidence of whether or not a particular disease is present in a population. We show that no identified disease in roe deer in Slovenia can be considered a significant health threat to roe deer, other wildlife species, or humans.

OBJECTIVE: With COVID-19 infections resulting in death according to a hierarchy of risks, with age and pre-existing health conditions enhancing disease severity, the objective of this study is to estimate the condition-specific case fatality ratio (CFR) for different subpopulations in Italy.
METHODS: The design of the study was to estimate the \'pre-existing comorbidity\'-conditional CFR to eventually explain the mortality risk variability reported around in different countries.
METHODS: We use the available information on pre-existing health conditions identified for deceased patients \'positive with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)\' in Italy. We (i) estimated the total number of deaths for different pre-existing health conditions categories and (ii) calculated a conditional CFR based upon the number of comorbidities before SARS-CoV-2 infection.
RESULTS: Our results show a 0.6% conditional CFR for a population with zero pre-existing pathology, increasing to 13.9% for a population diagnosed with one and more pre-existing health conditions.
CONCLUSIONS: Condition-specific mortality risks are important to be evaluated during the COVID-19 pandemic, with potential elements to explain the CFR variability around the globe. A careful postmortem examination of deceased cases to differentiate death \'caused by COVID-19\' from death \'positive with SARS-CoV-2\' is therefore urgently needed and will likely improve our understanding of the COVID-19 mortality risk and virus pathogenicity.