Molecular Study of Sudden Cardiac Death.

The aim of the Special Issue "Molecular study of sudden cardiac death" was to gather new studies on the molecular biology of cardiac death, from both a fundamental and clinical perspective [...].

The vertical topography of the carotid bifurcation - original study and review.

PURPOSE: The vertical level of carotid bifurcation (CB) is commonly indicated at the superior margin of the thyroid cartilage. Few studies observed the CB vertical topography. It was aimed at studying the vertical location of the CB as referred to vertebral and anterior cervical landmarks. METHODS: An archived lot of 147 computed tomography angiograms was documented for the vertical level of CB referred to vertebral and anterior cervical landmarks. The topography of the CB in relation to anterior landmarks was classified into seven types: (1) at the superior margin of the thyroid cartilage; (2) between the hyoid and the thyroid cartilage; (3) at the hyoid level; (4) between the hyoid and mandible; (5) subgonial or supragonial CB; (6) lower cervical level; (7) intrathoracic. RESULTS: The most common locations of CB were at C3 (27.21%), C3/C4 (26.19%) and C4 (25.51%). Bilateral symmetry of CB was found in 51.7%, except for C2 and C5/C6. Type 7 was not found, type 3 occurred in 39.12%, type 2 in 24.49%, type 1 in 13.95%, type 4 in 13.61%, type 5 in 6.12%, and type 6 in 2.72% (294 CBs). Bilateral symmetry of anterior types was found in 59.86%. Statistically significant correlations were found between sex and both left and right types and vertebral levels of CB. CONCLUSIONS: The vertical topography of the CB is highly variable and has sex-related specificity. This detail should be included in the teaching of anatomy. Surgeons and interventionists should better document the carotid anatomy on a case-by-case basis.

Current Trends in Biohumoral Screening for the Risk of Sudden Cardiac Death: A Systematic Review.

Background and Objectives: Sudden cardiac death (SCD) represents a challenge to health systems globally and is met with increased frequency in the population. Over time, multiple screening methods have been proposed, including the analysis of various plasma biomarkers. This article aims to analyze for illustrative purposes the specialized literature in terms of current biomarkers and testing trends, in the case of cardiovascular diseases and implicitly sudden cardiac death. Materials and Methods: In this regard, we searched the PubMed database from 2010 to the present time using the keywords "sudden cardiac death" and "biomarkers". The inclusion criteria were clinical trials that analyzed the effectiveness of screening methods in terms of biomarkers used in stratifying the risk of cardiac distress and/or sudden cardiac death. We excluded reviews, meta-analyses, and studies looking at the effectiveness of treatments. Results: An extended approach was found, through studies that brought to the forefront both classical markers analyzed by new, more performant methods, markers for other pathologies that also determined cardiovascular impact, non-specific molecules with effects on the cardiovascular system, and state-of-the-art markers, such as microRNA. Some molecules were analyzed simultaneously in certain groups of patients. Conclusion: The observed current trend revealed the tendency to define the clinical-biological particularities of the person to be screened.

Anatomical Possibilities of the Alveolar Bone at the Upper Second Premolar Level.

Background and Objectives: The upper posterior teeth are typically regarded as being exclusively inferior to the maxillary sinus (MS). The expansion of the nasal fossa above the maxillary alveolar base (MAB) needs better investigation. The hypothesis was raised that the MAB in the upper premolar region, which is usually addressed by surgeons for the elevation of the antral floor, is not exclusively beneath the MS. Therefore, we aimed to document the possible upper relations of the MAB as antral, nasal, or both. Materials and Methods: A total of 145 CBCT scans were used to study four types of MAB: type 1-antral; type 2-antral with a palatal recess; type 3-antral and nasal; type 4-nasal. In type 2, the orthoradial width of the alveolar bone, the rectilinear width of the antral floor, and the maximum depth of the palatal recess were measured. For type 3, the MAB width and the straight widths of the antral and nasal segments of the MAB were measured. Results: Type 1 was found in 67.24%, type 2 in 13.45%, type 3 in 16.21%, and type 4 in 3.1% of the 290 MSs investigated. Palatal recesses were found in 11.72% of the MSs on the right side and 15.17% of the MSs on the left side. Types 1 and 2 exhibited strongly statistically significant bilateral symmetry (Pearson's Chi2 = 86.42, p < 0.001). Type 3 correlated equally with contralateral types 1 and 3. The bilateral symmetry for types 1-3 was stronger in the males (Pearson's Chi2 = 47.83, p < 0.001) than in the females (Pearson's Chi2 = 56.96, p < 0.001). There were no statistically significant associations between sex and the unilateral anatomical type. Conclusions: The MAB in the upper second premolar area should not be considered to be exclusively antral during surgeries or in anatomical teaching.

Quality of Life in Patients Undergoing Emergency Surgery for Complex Colorectal Cancer: Protocol and Piloting of the Surgical Utilization and Recovery Patterns for Advanced Stage Colorectal Cancer Study.

Introduction: Globally, cancer is the leading cause of mortality, with colorectal neoplasia ranking third in terms of incidence and mortality worldwide. Patients face disease- and treatment-specific impacts, which can significantly influence their quality of life (QoL). Aim: This study aimed to propose a protocol to measure in-hospital and long-term QoL in patients with complicated colorectal cancer (CRC). Material and Methods: multicenter prospective observational cohort study. Results: QoL is a multidimensional concept that includes criteria for physical, mental, emotional, and social functionality as perceived by the patient. Periodically evaluating QoL offers measurable and objective tools to intervene at the appropriate time to decrease the Years of Life Lost and Years Lived with Disabilities for CRC patients. However, a structured and functional system requires dedicated and common institutional effort. A pilot study using this protocol included 69 patients, 65.12+-10.92 years, M:F ratio = 56.5:43.5%. Surgical procedure was right hemicolectomy, left colectomy, transverse colectomy, sigmoidectomy, total colectomy, rectal resection, and colorectal resection with stoma (ileostomy or colostomy) in 21.7%, 11.6%, 2.9%, 11.6%, 1.4%, 23.2%, and 27.5% of the cases, respectively. The mean Global Health Status Score, Symptom Score, and Functional Score was 82.36+-18.60, 11.89+-10.27, and 86.27, 74.50-94.11, respectively. Conclusions: CRC diagnosis has major effects on patients physical and psychological status, and concentrated efforts should be made by the involved medical team and healthcare systems to improve QoL throughout the treatment pathway.

Dignity as a Central Issue in Treating Patients with Dementia Associated with COVID-19 Infection.

COVID-19 was initially considered a primary respiratory disorder associated with various short- and long-term complications, affecting many patients and imposing a significant burden. Patients who have dementia are especially vulnerable to the SARS-CoV2 infection, which is associated with an increased risk for neuropsychiatric complications. These patients need a unique approach to managing ethical issues related to the COVID-19 pandemic, including autonomy, veracity, non-maleficence, justice, compassion, and dignity. The latter is one of the most elusive and misunderstood concepts in medical ethics and is extremely important in debates surrounding the proper management of patients with dementia. However, it is often left out of ethical analysis, as most clinicians, when debating issues associated with clinical practice, often evaluate only the "classical" principles of biomedical ethics. In this article, we aim to assess the unique features of dignity in treating this group of patients during the COVID-19 pandemic. We will briefly analyze dignity as a bioethical concept. We will further explore its principal axes, namely compassion, creating a humane and purposeful environment, employing persuasion to meet the person's essential needs, exerting a certain degree of mild restraint to meet the person's critical needs, minimizing harm in terminal care, and justice, through the lens of people who had dementia during the COVID-19 pandemic. Applying this principle in clinical practice requires significant commitment from all healthcare workers. New approaches to the analysis of dignity, such as through the Ring Theory of Personhood, may facilitate its understanding by practitioners and aid its implementation in populations with multiple vulnerabilities, such as dementia patients, during an infectious outbreak that generates significant social and medical changes.

The Fetal Type of Posterior Cerebral Artery.

Background and Objectives: Anatomical variations of the arterial circle of Willis (cW) are common. A posterior cerebral artery (PCA) fed mostly or exclusively from the internal carotid artery is a fetal PCA (FPCA), partial (p-FPCA), or full/complete (f-FPCA), respectively. Because FPCA occurs in different anatomical configurations of the cW sides, we aimed to document in detail these morphological possibilities of FPCA within the cW. Materials and Methods: FPCAs were documented on a retrospective set of 139 computed tomography angiograms. Results: FPCAs were found in thirteen cases, nine males and four females. In 7/13 cases there were two modified sides of the cW. In 5/13 cases there were three altered sides of the cW. Another case with FPCA showed four altered sides of the cW. In 10/13 cases, FPCA was unilateral and in the other three cases it was bilateral. Compared to the overall group, unilateral p-FPCAs were found in 1.43%, while unilateral f-FPCAs were found in 5.75%. A bilateral p-FPCA-f-FPCA combination was found in 0.71% and a bilateral f-FPCA-f-FPCA combination occurred in 1.43%. An anatomically isolated ICA was found in just one case with bilateral f-FPCA (0.71%). In 7/13 FPCA cases there were arterial variants exclusively in the posterior cW. In the other 6/13 FPCA cases, there were variants in both anterior and posterior circulation. There were no statistically significant associations of FPCA with sex or age. The higher prevalence of right-sided FPCA was not statistically significant. Conclusions: Anatomical assessments of cW should be performed on a case-by-case basis, as they may correspond to different cW morphologies.

Vertical Levels of the Occipital Artery Origin.

Background and Objectives. The occipital artery (OA) is a posterior branch of the external carotid artery (ECA). The origin of the OA is commonly referred to a single landmark. We hypothesized that the origin of the OA could be variable as referred to the hyoid bone and the gonial angle. We thus aimed at patterning the vertical topographic possibilities of the OA origin. Materials and Methods. One hundred archived computed tomography angiograms were randomly selected, inclusion and exclusion criteria were applied, and 90 files were kept (53 males, 37 females). The cases were documented bilaterally for different levels of origin of the OA origin: type 1-infrahyoid; type 2-hyoid; 3-infragonial; 4-gonial; 5-supragonial; 6-origin from the internal carotid artery (ICA). Results. The incidence of unilateral types in the 180 OAs was: type 1-1.11%, type 2-5.56%, type 3-40.56%, type 4-28.33%, type 5-23.33% and type 6, ICA origin of the OA-1.11%. There was found a significant association between the location of the left and right origins of the OAs (Pearson Chi2 = 59.18, p < 0.001), which suggests the presence of a strong symmetry of the origins. Bilateral symmetry of the vertical types of the OA origin was observed in 56.67% of cases; in 43.33% there was bilateral asymmetry. Conclusions. The ICA origin of the OA is an extremely rare variant. For surgical planning or prior to endovascular approaches the topography of the OA origin should be carefully documented, as it may be located from an infrahyoid to a supragonial level.

The Carotid-Hyoid Topography Is Variable.

Background and Objectives: The carotid bifurcation (CB) is presented in most anatomy textbooks as having a unique location at the upper margin of the thyroid cartilage. Although a number of case reports have provided evidence of the possibility of carotid artery location either lateral or medial to the greater hyoid horn, these reports have not established specific anatomic possibilities and prevalences. Materials and Methods: We retrospectively analysed a batch of 147 CT angiograms for 12 types of carotid-hyoid relationships and classified the bilateral combination possibilities of these types. Results: In 168/294 sides there were no carotid-hyoid relationships. Type I, external carotid artery (ECA) medial to the greater horn of the hyoid bone (GHHB), was observed in 0.34%; type II, internal carotid artery (ICA) medial to GHHB, in 0.34%; type III, ICA and ECA medial to GHHB, in 1.02%; type IV, common carotid artery (CCA) medial to GHHB, in 1.02%; type V, CB medial to GHHB, in 0.34%; type VI, ECA lateral to GHHB, in 20.41%; type VII, ICA lateral to GHHB, was not recorded; type VIII, ECA and ICA lateral to GHHB, in 3.74%; type IX, CCA lateral to GHHB, in 8.5%; type X, CB lateral to GHHB, in 6.46%; type XI, ECA lateral and ICA medial to GHHB, in 0.34%; and type XII, ICA lateral and ECA medial to GHHB, in 0.34%. Bilateral symmetry was found in 70.74% of cases, including the null types without carotid-hyoid relationships as well as types IV, VI, VIII, IX, and X. There was a highly significant association between the left and right variants of the carotid-hyoid relationship. Conclusions: Mechanical compression of the hyoid bone on the carotid arteries has various undesirable effects on the ICA and cerebral circulation. Underlying these are several variational anatomical patterns of carotid-hyoid relationships, which can be accurately documented on CT angiograms. A case-by-case anatomical study is better than assuming the carotid anatomy learned from textbooks.

Subtle vascular and astrocytic changes in the brain of coronavirus disease 2019 (COVID-19) patients.

BACKGROUND AND PURPOSE: In the central nervous system, a multitude of changes have been described associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, such as microglial activation, perivascular lymphocyte cuffing, hypoxic-ischaemic changes, microthrombosis, infarcts or haemorrhages. It was sought here to assess the vascular basement membranes (vBMs) and surrounding perivascular astrocytes for any morphological changes in acute respiratory syndrome (coronavirus disease 2019, COVID-19) patients. METHODS: The light microscopy morphology of the vBMs and perivascular astrocytes from brains of 14 patients with confirmed SARS-CoV-2 infection was analysed and compared to four control patients utilizing fluorescent immunohistochemistry for collagen IV and astrocytes (GFAP), endothelia (CD31), tight junction 1 (TJ1) adhesion protein, as well as the aquaporin 4 (AQP4) water channel. On 2D and 3D deconvoluted images from the cortex and white matter, vessel densities, diameters, degree of gliosis, collagen IV/GFAP and GFAP/AQP4 colocalizations were calculated, as well as the fractal dimension of astrocytes and vBMs viewed in tangential planes. RESULTS: Fractal dimension analysis of the GFAP-stained astrocytes revealed lower branching complexities and decreased GFAP/collagen IV colocalization for COVID-19 patients. Interestingly, vBMs showed significantly increased irregularities (fractal dimension values) compared to controls. Vessel diameters were increased in COVID-19 cases, especially for the white matter, TJ1 protein decreased its colocalization with the endothelia, and AQP4 reduced its co-expression in astrocytes. CONCLUSIONS: Our data on the irregularity of the basement membranes, loss of endothelial tight junction, reduction of the astrocyte end-feet and decrease of AQP4 suggest subtle morphological changes of the blood-brain barrier in COVID-19 brains that could be linked with indirect inflammatory signalling or hypoxia/hypercapnia.

Relationship Between Injury Pattern and Domestic Violence in a Romanian Population.

ABSTRACT: Physical violence is a cause of morbidity and mortality worldwide. An often-underreported subtype of physical violence is domestic violence (DV). The main aim of this study was to identify DV-specific patterns of traumatic injuries in comparison to other types of interpersonal violence (OV) in a Romanian population from a medical-legal standpoint. We performed a retrospective study drawing on 500 medical-legal certificates (medical-legal document attesting the traumatic injuries) of victims of interpersonal violence issued by the National Institute of Legal Medicine Bucharest during the 2017-2020 period. A total of 500 victims comprised the sample, including 188 DV victims and 312 victims of OVs. A majority of the DV victims were women (153 victims; 81%), whereas a majority of the OV victims were men (231 victims, 74%). Overall, DV victims were older compared with OV victims (40.9 ± 15.4 vs 37.3 ± 14.8 years, respectively). We found a pattern of frequent upper limb injuries specific to DV, whereas head injuries were specific to OV.

Identification of Risk Genes Associated with Myocardial Infarction-Big Data Analysis and Literature Review.

Acute myocardial infarction occurs when blood supply to a particular coronary artery is cut off, causing ischemia or hypoxia and subsequent heart muscle destruction in the vascularized area. With a mortality rate of 17% per year, myocardial infarction (MI) is still one of the top causes of death globally. Numerous studies have been done to identify the genetic risk factors for myocardial infarction, as a positive family history of heart disease is one of the most potent cardiovascular risk factors. The goal of this review is to compile all the information currently accessible in the literature on the genes associated with AMI. We performed a big data analysis of genes associated with acute myocardial infarction, using the following keywords: "myocardial infarction", "genes", "involvement", "association", and "risk". The analysis was done using PubMed, Scopus, and Web of Science. Data from the title, abstract, and keywords were exported as text files and imported into an Excel spreadsheet. Its analysis was carried out using the VOSviewer v. 1.6.18 software. Our analysis found 28 genes which are mostly likely associated with an increased risk for AMI, including: PAI-1, CX37, IL18, and others. Also, a correlation was made between the results obtained in the big data analysis and the results of the review. The most important genes increasing the risk for AMI are lymphotoxin-a gene (LTA), LGALS2, LDLR, and APOA5. A deeper understanding of the underlying functional genomic circuits may present new opportunities for research in the future.

Physician-Patient Relationship in Current Cosmetic Surgery Demands More than Mere Respect for Patient Autonomy-Is It Time for the Anti-Paternalistic Model?

The ethical framework of cosmetic surgery is distinct from the one associated with clinical medicine. This distinctiveness has led to significant difficulties in conceptualizing the physician-patient relationship (PPR), as most models have been developed specifically for the latter. The purpose of this article is to show that the PPR in cosmetic surgery can be better described through a distinct approach that we name the anti-paternalistic model of the PPR, and we will briefly present the differences between it and autonomy-based models. We will analyze the principle of non-interference, the variable degree of autonomy of both the patient and the physician within this relationship, the handling of the relevant information, the principle of beneficence as satisfaction, the difficulties regarding the informed consent, the algorithm allowing for the refusal of the procedure, and children-related issues. Based on this analysis, we will show that an anti-paternalistic model of the PPR is preferable to an autonomy-based one, as it allows for better clarification of the underlying ethical issues involved in cosmetic surgery.

Transcallosal and Pericallosal Courses of the Anterior Cerebral Artery.

(1) Background: The anterior cerebral artery (ACA) has a precommunicating A1 segment, followed by a postcommunicating A2 segment. Anatomically, after it sends off from the callosomarginal artery (CMA), it continues as the pericallosal artery (PCalA). A detailed pattern of the anatomical variations of the PCalA are needed for practical reasons. (2) Methods: There were 45 retrospectively documented Computed Tomography Angiograms of 32 males and 13 females. (3) Results: In 90 sides, eleven different types of PCalA were documented: type 1: normal origin, above the genu of the corpus callosum (CC) (51.11%); type 2: low origin, below the rostrum of the CC (8.88%); type 3: late origin, above the body of the CC (3.33%); type 4, initial transcallosal course (3.33%); type 5, duplicated PCalA (1.11%); type 6, azygos PCalA (2.22%); type 7, absent PCalA (CMA type of ACA) (7.78%); type 8: CMA continued as PCalA (5.56%); type 9: PCalA continued as the cingular branch (1.11%); type 10: PCalA type of ACA, absent CMA (14.44%); type 11: triple PCalA, with an added median artery of the CC (1.11%). Different types of CMA were also documented: type 0, absent CMA (17.78%); type 1, CMA with frontoparietal distribution (45.56%); type 2, CMA with parietal distribution (22.22%); type 3, low origin of CMA, either from A1, or from A2 (8.88%); type 4, CMA continued as PCalA (5.56%). Ipsilateral combinations of PCalA and CMA types were classified as types A-P. In 33/45 cases (73.3%), the bilateral asymmetry of the combined anatomical patterns of PCalA and CMA was documented. Additional rare variations were found: (a) huge fenestration of A2; (b) bihemispheric ACAs (6/45 cases); (c) twisted arteries within the interhemispheric fissure. (4) Conclusions: The PCalA and CMA are anatomically diverse and unpredictable. Therefore, they should be documented on a case-by-case basis before surgical or endovascular approaches.

Extruded Nucleoli of Human Dental Pulp Cells.

Background and Objectives: The dental pulp stem cells are highly proliferative and can differentiate into various cell types, including endothelial cells. We aimed to evaluate the ultrastructural characteristics of the human dental pulp cells of the permanent frontal teeth. Materials and Methods: Human adult bioptic dental pulp was collected from n = 10 healthy frontal teeth of five adult patients, prior to prosthetic treatments for aesthetic purposes. Tissues were examined under transmission electron microscopy. Results: We identified cells with a peculiar trait: giant nucleoli resembling intranuclear endoplasmic reticulum, which mimicked extrusion towards the cytoplasm. These were either partly embedded within the nuclei, the case in which their adnuclear side was coated by marginal heterochromatin and the abnuclear side was coated by a thin rim of ribosomes, or were apparently isolated from the nuclei, while still being covered by ribosomes. Conclusions: Similar electron microscopy features were previously reported in the human endometrium, as nucleolar channel system; or R-Rings induced by Nopp140. To our knowledge, this is the first report of extruded nucleolar structure in the dental pulp. Moreover, the aspect of giant extruded nucleoli was not previously reported in any human cell type, although similar evidence was gathered in other species as well as in plants.

Perspectives and Values of Dental Medicine Students Regarding Domestic Violence.

Background and Objectives: The purpose of this study is to evaluate dental medical students' opinions concerning domestic violence from a social and medical standpoint and from the perspective of the moral values of the physician-patient relationship. Materials and Methods: We performed an observational study with 4- and 5-year dental medical students at the UMF "Carol Davila" in Bucharest from October 2020-May 2021, using a questionnaire containing 20 items on domestic violence (DV). The questionnaire was uploaded online on the e-learning platform where the students have access. To collect the data, we used Microsoft Excel 365, and the statistical analysis was performed using Jamovi. Results: Of the 600 students enrolled, 415 answered the questionnaire, the answering rate being 69.16%. A total of 215 (53.1%) personally knew victims of DV, 4 (1.0%) considered that violence within a couple is necessary for certain situations, 401 (99.0%) considered that domestic violence is a fundamental problem in today's society, and 170 (41.5%) felt that in domestic violence situations, the blame lies solely with the partner who resorts to physical violence. Regarding the role of the physician, 220 (56%) considered that the physician should breach confidentiality and report cases when patients state they are a victim of DV, 337 (88.2%) thought that free medical treatment should be provided for DV victims who have a dire financial situation, and 212 (56.7%) considered that victims of DV are non-compliant patients. Conclusions: Domestic violence is a phenomenon well-known to stomatology students, which creates the premise of an excellent physician-patient relationship with them, aiding in proper management of ethical issues such as a potential need to breach confidentiality or evaluate the potential conflicts between autonomy and beneficence.

Particularities of Offenders Imprisoned for Domestic Violence from Social and Psychiatric Medical-Legal Perspectives.

Background and Objectives: It is known that there may be an interconditionality between social status, personality disorders, and aggressive behavior. This study aimed to analyze the social and psychiatric diagnosis characteristics in subjects imprisoned for domestic violence acts compared to other types of aggressive behaviors. Materials and Methods: We performed a retrospective study using psychiatric medical-legal reports at the National Institute of Legal Medicine "Mina Minovici" Bucharest from 2016 to 2020. Results: We included 234 cases in our analysis, from which 132 (56%) were domestic violence offenders (DVO), and 102 (44%) were violence offenders imprisoned for other aggressions (OVO). Overall, DVOs were older than OVOs (43.0 +/- 14.7 vs. 36.1 +/- 16.6 years-old). In both study groups, most subjects were men, but the DVO group had more women than the OVO group: 23 cases (17%) and 3 cases (3%), respectively. In 14 cases (11%), previous criminal records were found from the DVO and 31 (30%) from the OVO group. Significantly fewer DVO were chronic psychoactive substance users: 83 (63%) in the DVO group versus 78 (86%) in the OVO group. Significantly more DVO had suicidal tendencies 26 (20%) compared to OVO 9 (9%). DVO subjects had significantly less often unsocialized conduct disorder or antisocial personality disorder compared to the OVO group. Conclusions: We found that DVO, compared to the OVO, were more numerous, older, less abusive, with a less frequent history of psychoactive substance abuse and addictions, and were less frequently indifferent to the committed acts.

Epidemiology of injuries from fire, heat and hot substances: global, regional and national morbidity and mortality estimates from the Global Burden of Disease 2017 study.

BACKGROUND: Past research has shown how fires, heat and hot substances are important causes of health loss globally. Detailed estimates of the morbidity and mortality from these injuries could help drive preventative measures and improved access to care. METHODS: We used the Global Burden of Disease 2017 framework to produce three main results. First, we produced results on incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years from 1990 to 2017 for 195 countries and territories. Second, we analysed these results to measure mortality-to-incidence ratios by location. Third, we reported the measures above in terms of the cause of fire, heat and hot substances and the types of bodily injuries that result. RESULTS: Globally, there were 8 991 468 (7 481 218 to 10 740 897) new fire, heat and hot substance injuries in 2017 with 120 632 (101 630 to 129 383) deaths. At the global level, the age-standardised mortality caused by fire, heat and hot substances significantly declined from 1990 to 2017, but regionally there was variability in age-standardised incidence with some regions experiencing an increase (eg, Southern Latin America) and others experiencing a significant decrease (eg, High-income North America). CONCLUSIONS: The incidence and mortality of injuries that result from fire, heat and hot substances affect every region of the world but are most concentrated in middle and lower income areas. More resources should be invested in measuring these injuries as well as in improving infrastructure, advancing safety measures and ensuring access to care.

Retrocaval ureter: a meta-analysis of prevalence.

INTRODUCTION: Retrocaval ureter is a congenital abnormality of the right ureter, which has been shown, in rare cases to cause clinical symptoms, mainly due to the development of ureterohydronephrosis. PURPOSE: The purpose of this article is to identify the prevalence of the retrocaval ureter, and to emphasize its clinical and surgical importance. DESIGN: A meta-analysis of prevalence, on cases obtained from PubMed, Web of Science, and Scopus databases. RESULTS: A total number of 13 studies contained data that allowed us to estimate the prevalence of the retrocaval ureter, which was identified overall in 9 cases, out of 18,493 subjects. The overall prevalence of retrocaval ureter was 0.13%, with a 95% confidence interval between 0.06 and 0.27%. There was no publication bias, all studies being under the funnel. CONCLUSIONS: The overall prevalence of retrocaval ureter is 0.13%. Even if this is obviously a rare condition, its presence must be suspected by practitioners, especially in the presence of urological symptoms without a clear cause.

An Immunohistochemical Study of Gastric Mucosa and Critical Review Indicate that the Subepithelial Telocytes are Prelymphatic Endothelial Cells.

There are only a few studies regarding gut subepithelial telocytes (TCs). The telopodes, namely peculiar TCs' prolongations described on two-dimensional cuts, are not enough to differentiate this specific cell type. Subepithelial TCs were associated with the intestinal stem niche but a proper differential diagnosis with lymphatic endothelial cells (LECs) was not performed. In this study, we will critically review studies suggesting that distinctive TCs could be positioned within the lamina propria. Additionally, we performed an immunohistochemical study of human gastric mucosa to test the expression of D2-40, the lymphatic marker, as well as that of CD31, CD34, CD44, CD117/c-kit, α-smooth muscle actin (α-SMA) and vimentin in the gastric subepithelial niche. The results support the poorly investigated anatomy of intramural gastric lymphatics, with circumferential collectors located on both sides of the muscularis mucosae (mucosal and then submucosal) and myenteric collectors in the muscularis propria. We also found superficial epithelial prelymphatic channels bordered by D2-40+ but CD31-TC-like cells. Deep epithelial lymphatic collectors drain in collectors within the lamina propria. Blood endothelial cells expressed CD31, CD34, CD44, and vimentin. Therefore, the positive diagnosis of TC for subepithelial CD34+ cells should be regarded with caution, as they could also be artefacts, resulting from the two-dimensional examination of three dimensional structures, or as LECs. Lymphatic markers should be routinely used to discriminate TCs from LECs.