Age estimation based on a combined arteriosclerotic index.

This study introduces a new quantity, the combined arteriosclerotic index (CAI), which is defined as the ratio between the diameter and the longitudinal prestrain of an artery. The longitudinal prestrain has been adopted as the ratio between the in situ length and the excised length of the abdominal aorta, and is a measure of arterial elasticity. During ageing, arteriosclerosis is manifested by the loss of pretension and by enlargement of the diameter of the artery. CAI combines these two effects. A sample of 61 female and 194 male autopsy measurements of human abdominal aortas shows that CAI correlates significantly with chronological age (R = 0.916/0.921; female/male). The sample had the following parameters: age 53 ± 19/48 ± 16 years; diameter of the abdominal aorta 12.4 ± 2.2/13.4 ± 2.1 mm; and longitudinal prestrain 1.13 ± 0.10/1.15 ± 0.10 (mean ± sample standard deviation; female/male). The resulting CAI was 11.2 ± 2.7/11.9 ± 2.6 mm. The classical linear regression model was employed for age estimation by CAI. The model gave a residual standard deviation of 7.6/6.3 years and a 95% prediction interval range of ± 15.4/12.5 years (female/male). A two-sample t-test confirmed that there are significant differences between the female and male population during ageing, reflected by CAI, unlike longitudinal prestrain. It was concluded that CAI is a suitable predictor of age at time of death and is easily obtainable in the autopsy room.

Correlation between age, location, orientation, loading velocity and delamination strength in the human aorta.

Aortic dissection is a biomechanical phenomenon associated with a failure of internal cohesion, which manifests itself through the delamination of the aortic wall. The goal of this study is to deepen our knowledge of the delamination strength of the aorta. To achieve this, 661 peeling experiments were carried out with strips of the human aorta collected from 46 cadavers. The samples were ordered into groups with respect to (1) anatomical location, (2) orientation of the sample, and (3) extension rate used within the experiment. The obtained results are in accordance with the hypothesis that delamination resistance is not sensitive to the extension rates 0.1, 1, 10, and 50 mms-1. We arrived at this conclusion for all positions along the aorta investigated in our study. These were the thoracic ascending (AAs), thoracic descending (ADs), and the abdominal aorta (AAb), simultaneously considering both the longitudinal (L) as well as the circumferential (C) orientations of the samples. On the other hand, our results showed that the delamination strength differs significantly with respect to the anatomical position and orientation of the sample. The medians of the delamination strength were as follows, 4.1 in AAs-L, 3.2 in AAs-C, 3.1 in ADs-L, 2.4 in ADs-C, AAb-L in 3.6, and 2.7 in AAb-C case (all values are in 0.01·Nmm-1). This suggests that resistance to crack propagation should be an anisotropic property and that the aorta is inhomogeneous along its length from the point of view of delamination resistance. Finally, correlation analysis proved that the delamination strength of the human aorta significantly decreases with age.

CPR-related injuries after non-traumatic out-of-hospital cardiac arrest: Survivors versus non-survivors.

AIM: There have been no direct comparisons of cardiopulmonary resuscitation (CPR)-related injuries between those who die during CPR and those who survive to intensive care unit (ICU) admission. This study aimed to compare the incidence, severity, and impact on survival rate of these injuries and potential influencing factors. METHOD: This retrospective multicenter study analyzed autopsy reports of patients who experienced out-of-hospital cardiac arrest (OHCA) and were not admitted to hospital. CPR-related injuries were compared to OHCA patients with clinical suspicion of CPR-related injury confirmed on imaging when admitted to the ICU. RESULTS: A total of 859 out-of-hospital cardiac arrests (OHCA) were divided into 2 groups: those who died during CPR and underwent autopsy (DEAD [n = 628]); and those who experienced return of spontaneous circulation and admitted to the ICU (ICU [n = 231]). Multivariable analyses revealed that independent factors of 30-day mortality included no bystander arrest, cardiac etiology, no shockable rhythm, and CPR-related injury. Trauma was independently associated with older age, bystander CPR, cardiac etiology, duration of CPR, and no defibrillation. CPR-related injury occurred in 30 (13%) patients in the ICU group and 547 (87%) in the DEAD group (p < 0.0001). Comparison of injuries revealed that those in the DEAD group experienced more thoracic injuries, rib(s) and sternal fractures, and fewer liver injuries compared to those in the ICU group, without differences in injury severity. CONCLUSION: CPR-related injuries were observed more frequently in those who died compared with those who survived to ICU admission. Injury was an independent factor of 30-day mortality.

A comparison of age-related changes in axial prestretch in human carotid arteries and in human abdominal aorta.

It is known that large arteries in situ are subjected to significant axial prestretch. This prestretch plays an important physiological role in optimizing the biomechanical response of an artery. It is also known that the prestretch declines with age. However, a detailed description of age-related changes in prestretch is available only for the abdominal aorta and for the femoropliteal artery. Our study presents results of measurements of axial prestretch in 229 left common carotid arteries excised in autopsies. It was found that the prestretch of the carotid artery correlates significantly with age ([Formula: see text], p value < 0.001). A linear regression model was used to fit the observations. Simultaneously with the measurement of the prestretch in the carotid artery, the axial prestretch was also measured in abdominal aorta. By comparing data obtained from these locations, it was concluded that the axial prestretch in the carotid artery is greater than in the abdominal aorta, and that atherosclerosis develops more rapidly in the abdominal aorta than in the carotid artery. Histological sections obtained from 8 carotid arteries and aortas suggest that the medial layer of the left common carotid artery is significantly thinner than aortic media (median/IQR: 0.343/0.086 vs. 0.482/0.172 mm, [Formula: see text] in Wilcoxon signed-rank test) and simultaneously that carotid media contains a lower number of elastic membranes (median/IQR: 26.5/11.8 vs. 31.5/11.8, [Formula: see text] in the Wilcoxon signed-rank test). This could be a reason for the different extent of the prestretch observed in aorta and in carotid artery. Our data sample also contains 5 measurements of the axial prestretch in abdominal aortas suffering from an aneurysm. It was found that aneurysmatic aortas also exhibit axial retraction when excised from in situ position. To the best of our knowledge, this is the first time that detailed data characterizing axial prestretch of the human left common carotid artery have been presented.

Analysis of axial prestretch in the abdominal aorta with reference to post mortem interval and degree of atherosclerosis.

It is a well-known fact that the length of an artery in situ and the length of an excised artery differs. Retraction of blood vessels is usually observed. This prestretch plays an important role in arterial physiology. We have recently determined that the decrease of axial prestretch in the human abdominal aorta is so closely correlated with age that it is suitable for forensic applications (estimation of the age at time of death for cadavers of unknown identity). Since post mortem autolysis may affect the reliability of an estimate based on axial prestretch, the present study aims to detail analysis of the effect of post mortem time. The abdominal aorta is a prominent site of atherosclerotic changes (ATH), which may potentially affect longitudinal prestretch. Thus ATH was also involved in the analysis. Axial prestretch in the human abdominal aorta, post mortem interval (PMI), and the degree of ATH were documented in 365 regular autopsies. The data was first age adjusted to remove any supposed correlation with age. After the age adjustment of the sample, the correlation analysis showed no significant PMI effects on the prestretch in non-putrefied bodies. Analysis of the prestretch variance with respect to ATH suggested that ATH is not a suitable factor to explain the prestretch variability remaining after the age adjustment. It was concluded that, although atherosclerotic plaques may certainly change the biomechanics of arteries, they do not significantly affect the longitudinal prestretch in the human abdominal aorta.

Age-related distribution of longitudinal pre-strain in abdominal aorta with emphasis on forensic application.

It is a well-known fact that the length of an artery in situ and the length of an excised artery differs. Retraction of blood vessels is usually observed. This pre-tension plays crucial role in arterial biomechanics. It augments an artery wall load-bearing capacity. This paper presents the longitudinal pre-strain of the human aorta as an index of human age. The length of abdominal aortas was measured during autopsies before and after segment resection. The longitudinal pre-strain was calculated in 130 donors; 100 male and 30 female bodies. The pre-strain was defined as the ratio between in situ length and the length after the excision. The mean pre-strain was found to be 1.18±0.10 for male and 1.14±0.10 for female sample (mean±standard deviation). The age in the male group was 41.6±15.9 years; and 47.7±17.7 years in the female group. Statistical analysis revealed the correlation coefficient between age and pre-strain r=-0.821 and r=-0.839 in male and female group, respectively. The analysis also confirmed close correlation between aortic circumference and age; and between circumference and pre-strain. Linear and power law regression equations were employed and prediction intervals were computed. The power law estimates the age more accurately than linear one model. Nevertheless, especially for small values of the pre-strain (aged individuals) the linear model can be advantageous.

Correlations between age, prestrain, diameter and atherosclerosis in the male abdominal aorta.

The longitudinal prestrain of arteries facilitates their physiological function. Remodeling, adaptation and aging result in an age-dependent magnitude of the pretension. Although the phenomenon is known, detailed statistics, especially for human arteries, are lacking. This study was designed to propose the regression model capable of estimating the prestrain of the human abdominal aorta. The length of the abdominal aorta before, l, and after excision from the body, L, the diameter, heart weight, thickness of left ventricle and degree of atherosclerosis were collected in autopsies of 156 male cadavers of known age. Longitudinal prestrain was quantified by means of the stretch ratio λ=l/L. Statistical analysis revealed significant dependence between age, prestrain, diameter and atherosclerosis, which were best fitted to the power law equation. Longitudinal prestretch reduced with age significantly; λmean=1.30±0.07 for age<30 (n=29), whereas λmean=1.06±0.03 for age>59 (n=31) with p-value<0.0001. Raw data gave linear correlation coefficients as follows: λ-age (R=-0.842); l-age (R=0.023); L-age (R=0.476); (l-L)-age (R=-0.811). It was concluded that longitudinal prestrain decreases nonlinearly with age and both age and diameter are suitable predictors of the prestrain. Data suggests that unloaded length elongates with age in contrast to the elastic retraction.