Typical or atypical progressive supranuclear palsy: a comparative clinicopathologic study of three Chinese cases

Progressive supranuclear palsy (PSP) is an atypical parkinsonism, which is the third most common geriatric neurodegenerative disease. We reported three pathology-confirmed Chinese PSP cases with special focus on the pathological accumulations of tau, a-synuclein and A-beta in the three PSP brains. Cases 1 and 2 initiated with extrapyramidal signs and gait disorders, while case 3 suffered behavioral abnormalities with cognitive decline at the beginning. In neuropathology, PSP-changes such as tau-positive tufed astrocytes, oligdendrocytes with the tau-positive coiled-body and threads and globose NFTs were widely seen in the basal ganglia, isocortex and allocortex, as well as in brainstem, cerebellum and spinal cord. In addition, numerous AGs were found in the hippocampus of cases 1 & 2, while Aβ amyloid depositions were found in hippocampus and leptomeningeal vessels of case 1 and in neocortex, entorhinal cortex, hippocampus, cingulate gyrus and amygdale of case 3. Vessel infarcts were observed in cases 1. Cortical laminar III necrosis in case 1 suggested the ischemic damage. Cervical spinal cords in cases 2 & 3 were obtained with tau-positive globose NFTs, tufted astrocytes and neuropil threads were respectively found in the neurons of anterior horn and surrounding white matters. In summary, pathological examination is crucial for the ambiguous cases to exclude other neurodegenerative diseases. Furthermore, cervical spinal cord should be routinely examined in the PSP autopsy.     

Stillbirths and early neonatal mortality in rural Northern Ghana

Objective To calculate perinatal mortality (stillbirth and early neonatal death: END) rates in the Upper East region of Ghana and characterize community‐based stillbirths and END in terms of timing, cause of death, and maternal and infant risk factors. Methods Birth outcomes were obtained from the Navrongo Health and Demographic Surveillance System over a 7‐year period. Results Twenty thousand four hundred and ninty seven pregnant women were registered in the study. The perinatal mortality rate was 39 deaths/1000 deliveries, stillbirth rate 23/1000 deliveries and END rates 16/1000 live births. Most stillbirths were 31 weeks gestation or less. Prematurity, first‐time delivery and multiple gestation all significantly increased the odds of perinatal death. Approximately 70% of END occurred during the first 3 postnatal days, and the most common causes of death were birth asphyxia and injury, infections and prematurity. Conclusion Stillbirths and END remain a significant problem in Navrongo. The main causes of END occur during the first 3 days and may be modifiable with simple targeted perinatal policies.     

Pathology of vaccine-preventable infectious disease and the central nervous system

Infections of the central nervous system are important sources of morbidity and mortality worldwide. The risk for infections with specific bacterial, viral, fungal and parasitic agents varies greatly with the patient's age, immune status, prior vaccination history, seasonality and geographic exposures. While vaccines are available for many viral and bacterial pathogens, there has been a resurgence of vaccine-preventable diseases in recent years due to under-vaccination of eligible children and adults. This review will discuss key pathognomonic features of vaccine-preventable infectious diseases of the central nervous system that may be encountered in general surgical and autopsy practice.     

腰椎极外侧微创手术的解剖学研究及其临床价值

目的明确国人腰椎侧方解剖层次以及重要组织结构的毗邻关系,评价腰椎极外侧椎体间融合术(XLIF)的可行性和安全性。方法选取10具新鲜尸体标本和2具福尔马林固定的尸体标本,取侧卧位(XLIF体位),在C臂机透视下模拟XLIF手术入路,将克氏针打入L2~5椎间盘中央,沿克氏针方向逐层解剖。测量腰椎侧面正中线腰神经与腰椎前缘交感干之间的距离、腰椎侧面正中线相邻腰节段血管之间的距离以及腰椎各椎体中线位置前后缘距离。结果 XLIF的手术入路相对安全,入路周围未见神经、血管等重要结构。在腰椎侧方,腰节段血管、交感干和腰神经之间存在着一个相对无血管、神经的"安全范围",其大小约为29 mm×30 mm;交感干至腰神经的垂直距离左右两侧差异无统计学意义(P0.05);椎体侧面相邻节段血管的距离左右侧差异无统计学意义(P0.05)。腰椎侧面XLIF微创手术操作的安全范围:L_(2 ~ 3):27 mm×30 mm(修正值0.72 mm×0.65 mm),L_(3 ~ 4):30 mm×32 mm(修正值0.76 mm×0.71 mm),L_(4~5):29 mm×32 mm(修正值0.76 mm×0.69 mm)。结论在XLIF入路周围,腰椎侧方"安全范围"较大,在该范围内进行XLIF手术操作安全性较高。     

The radioactive autopsy: safe working practices

Autopsy cases involving individuals retaining radioactive substances are fortunately rare, but when they occur they can impose significant radiation safety and legal requirements. This review aims to improve the understanding of these issues so that appropriate precautions are implemented when necessary. This review describes the properties of ionizing radiations, natural and man-made sources of ionizing radiation and its use in healthcare. It identifies the most likely circumstances leading to radioactive substances being present during autopsy and sources of information, including radiation protection advice. It discusses precautions that may need to be implemented prior to, during and following autopsy. Despite the issue of appropriate information to patients and next of kin, it is inevitable that some cases will be identified only at autopsy and it is important that robust local procedures are maintained. Information must be communicated to assist safe management of the body and liaison between relevant professional groups may be needed to standardize methods of communication. Provided that appropriate precautions are implemented, determined through consultation with a qualified expert in radiation protection and by completion of risk assessment, the radioactive autopsy can be undertaken safely and in compliance with relevant legislative requirements.