Positronium Laser Cooling via the 1

We report on laser cooling of a large fraction of positronium (Ps) in free flight by strongly saturating the 1^{3}S-2^{3}P transition with a broadband, long-pulsed 243 nm alexandrite laser. The ground state Ps cloud is produced in a magnetic and electric field-free environment. We observe two different laser-induced effects. The first effect is an increase in the number of atoms in the ground state after the time Ps has spent in the long-lived 2^{3}P states. The second effect is one-dimensional Doppler cooling of Ps, reducing the cloud's temperature from 380(20) to 170(20) K. We demonstrate a 58(9)% increase in the fraction of Ps atoms with v_{1D}<3.7×10^{4} ms^{-1}.

Links between alcohol and external causes of deaths in males: an autopsy study.

OBJECTIVES: This study aimed to analyse deaths due to external causes in males in northwest Slovakia. STUDY DESIGN: This was a cross-sectional autopsy study. METHODS: The autopsy registry provided information on fatalities in males in northwest Slovakia due to external causes in 2015. Data were analysed by age, cause of death and blood alcohol concentration (BAC), and the contribution to overall mortality was calculated. RESULTS: From a total of 305 fatalities, the dominant cause of death was unintentional (other than traffic; 56.7%), followed by intentional (26.6%) and traffic (16.7%). A BAC of ≥0.5 g/kg was found in 43.9% of deaths. Lower levels of BACs (0.5-1.9 g/kg) were observed in relatively high proportions among the younger (aged ≤34 years) and older (aged ≥65 years) males (17.9% and 14.0%, respectively), as well as in the traffic and intentional injury cause of death categories (23.5% and 19.8%, respectively). Male deaths due to external causes had a 6.2% contribution to overall mortality in northwest Slovakia. CONCLUSIONS: Alcohol intoxication frequently co-occurs with fatalities from external causes, including at lower BACs, indicating the harmful role of alcohol at all concentrations.

Progranulin and chemerin plasma level in obese patients with type 2 diabetes treated with a long-acting insulin analogue and premixed insulin analogue.

Diabetes, referred to as the first non-infectious epidemic, covers a heterogenous group of metabolic diseases marked by hyperglycemia resulting from a defect of insulin secretion and/or insulin resistance. Highly endocrine active adipocytes, particularly those located in white adipose tissue, constitute a source of cytokines, growth factors and complement component as well as adipocytokines including chemerin and progranulin could be the key molecules in the pathomechanism of hypertension, dyslipidemia, metabolic disorders or diabetes type 2. In this study, it was decided to verify the existence of possible relationships between the plasma concentration of progranulin and chemerin and the values of intermediate indices of insulin sensitivity and insulin resistance in patients, both before and after the 6-month insulin therapy by long-acting insulin analogue and premixed insulin analogue. The level of laboratory parameters in blood plasma collected from the control group and from obese individuals with type 2 diabetes mellitus was estimated with the test kits using enzyme-linked immunosorbent assay (ELISA): the test of Mediagnost E103 GmbH GmbH, Reutlingen, Germany for progranulin; the test of BioVendor R&D, Brno, Czech Republic for chemerin. The aim of this study was to assess the progranulin and chemerin plasma level in obese individuals with type 2 diabetes, before and after 6 months of pharmacological treatment with a long-acting analogue human insulin or premixed insulin. In the blood plasma of untreated diabetics - in contrary to progranulin plasma concentration in diabetic patients after management implementation - progranulin was found to occur in a significantly higher concentration in relation to the level of this protein in the blood plasma of control group individuals. Despite the fact that 6-month therapy, both with the insulin mixture and with the long-acting analogue in people with diabetes, does not significantly affect the plasma chemerin concentration, the high, negative correlation between the progranulin and chemerin levels in the blood of individuals of the control group, and a positive one between the levels of progranulin and chemerin in people with diabetes before and after treatment was found. The conducted studies indicated the modified, in the course of diabetes type 2, mutual quantitative relations between progranulin and chemerin - the biological mediators of systemic metabolism, reflecting their active participation in the pathogenetic changes underlying type 2 diabetes. The obtained study results indicate a modification of mutual relationships of the adipocytokines assessed in the paper - progranulin and chemerin, associated with the development of the systemic inflammatory response occurring in the course of obesity which, by inducing insulin resistance, may consequently lead to type 2 diabetes. Taking into consideration the fact that the plasma progranulin and chemerin concentrations in obese patients with type 2 diabetes subjected to pharmacotherapy have not been assessed so far, it is possible that the obtained study results may cast light on the potential influence of the applied treatment on the systemic changes of the both adipocytokines involved in the pathomechanism of the mentioned disorder and thus create the possibility of implementing new therapeutic strategies in the management of patients with diabetes, which is an increasingly common, fast-spreading metabolic disease considered as a non-infectious epidemic of the 21st century.

The comparison of modified minimally invasive and open surgical approaches in the treatment of epithelial thymic tumours.

OBJECTIVES: Exploring the efficacy of a modified combined minimally invasive approach in patients with thymoma regardless of myasthenia gravis involvement in contrast to open surgery as the mainstay of treatment. BACKGROUND: Primary epithelial thymic tumours are rare malignancies of the anterior mediastinum, often present with myasthenia gravis, and with good prognosis when assuming complete surgical resection. We present a modified mini-invasive technique (MIT) that is unique in its extent. METHODS: Fifty-two patients were included in this retrospective study. Two groups of patients who had undergone different types of surgery were compared using the Mann-Whitney test (ordinal variables) and Fisher's exact test (binary variables). Changes after completing the surgical learning curve were observed. RESULTS: There was a statistical difference when comparing early Masaoka stages (I‒II) with later stages in favour of the mini-invasive method (p=0.013). The duration of surgery was longer in the mini­invasive group with a median value of 260 vs 133 min (p=0.001). The analysis of operation times revealed that after overcoming the learning curve period, the duration of surgery decreased (2008‒2012: 297 min; 2013‒2018: 199 min; p=0.005). The systemic complication rate was lower in the mini­invasive method (26.1 % vs 3.4 %; p=0.035). CONCLUSION: Our results showed the modified maximal minimally invasive thymectomy to be an effective and safe method, and after overcoming the learning curve, even superior to open surgery in cases with lower tumour stages in terms of its extent (Tab. 3, Fig. 1, Ref. 49).

Management of oesophageal anastomosis dehiscence after oesophagectomy for oesophageal cancer.

Oesophagectomy is being used in treatment of several oesophageal diseases, most commonly in treatment of oesophageal cancer. It is a major surgical procedure that may result in various complications. One of the most severe complications is anastomotic dehiscence between the gastric conduit and the oesophageal remnant. Anastomotic dehiscence after esophagectomy is directly linked to high morbidity and mortality. We propose a therapeutic algorithm of this complication based on published literature and our experience by retrospective evaluationof 164 patients who underwent oesophagectomy for oesophageal cancer. Anastomotic dehiscence was present in 29 cases.

“Maximal” minimally invasive thymectomy in patients with Nonthymomatous Myasthenia Gravis - short-term results over a 10year period - retrospective study.

INTRODUCTION: Thymectomy has always been considered an important treatment modality for patients with Myasthenia Gravis (MG). Because of the absence of randomized trials, its exact role was not clear and was even questioned by some. Indications for surgery were made on empirical basis. It was not until the results of the first randomized double- blinded multicentric study were published, where the combined surgical treatment of patients with nonthymomatous MG was proved superior to conservative treatment alone. In this study the technique of extensive thymectomy via longitudinal sternotomy was used as a mainstay of surgical treatment. In the advent of minimally invasive techniques a variety of options were presented for minimally invasive surgical treatment of thymic pathology. METHODS: The authors present a retrospective analysis of short term results using the slightly modified method of “Minimally Invasive Maximal Thymectomy” developed by Zielinski over a 10 year period (20082018). Besides the demographics, we assessed the peri- and postoperative results such as the length of surgery, blood loss, the need for conversion, learning curve impact, the lengths of drainage and hospital stay and the complication rate, both surgical and systemic. RESULTS: 48 patients underwent surgery using the above mentioned method for non-thymomatous MG. 81.25% (n=39) of patients were diagnosed with a seropositive generalized form of MG, 6 (12.5%) had seropositive ocular form and 3 patients (6.25%) had seronegative form of the disease. The sex ratio profoundly favored females (89.5%; n=43). The median value of the length of surgery was 186,5 minutes, the mean LOS and length of drainage were 4 and 3 days, respectively. CONCLUSION: According to our results and experience with Minimally Invasive Maximal Thymectomy, we found it to be an effective and safe method for MG patients after conquering the learning curve.

Complicated case of patient with cervical necrotising fasciitis and descending necrotizing mediastinitis case report.

Descending necrotizing mediastinitis is a severe, fulminant, life-threatening bacterial infection of the mediastinum. Even though improvements in diagnostics and treatment were achieved, the mortality rate remain shigh. Contrast-enhanced CT of chest and neck is the diagnostic gold standard. Radical debridement and drainage of the mediastinum should be considered the primary therapeutic target. The authors present a complicated case of a female patient with cervical necrotizing fasciitis and descending necrotizing mediastinitis. She was initially treated for a deep neck infection at the department of otorhinolaryngology. Surgical treatment, antibiotics, and intensive care became an integral part of the therapy after the transfer to the department of thoracic surgery. The authors had to face various complications with tracheostomy and extensively debrided soft tissues in the neck region. That is why the patient underwent repeated surgeries during several hospital stays, with an overall duration of treatment reaching 220 days.

A WALK-IN TYPE CALIBRATION CHAMBER FACILITY FOR 222Rn MEASURING DEVICES AND INTER-COMPARISON EXERCISES.

A walk-in type 222Rn calibration chamber of volume 22.7 m3, which has traceability to international standards, is established at the Centre for Advanced Research in Environmental Radioactivity, Mangalore University, India. It has a human-machine interface communication system, a programmable logic controller and sensor feedback circuit for controlling and data acquisition of relative humidity (RH) and temperature (T). An innovative method for the generation of desired 222Rn concentration (a few hundred Bq m-3 up to about 36 kBq m-3) using soil gas as a source was adopted. Leak rates of 222Rn from the chamber for the mixing fan ON and OFF conditions were determined to be 0.0011 and 0.00018 h-1 respectively. With the exhaust system fully turned on, the maximum clearance rate of the chamber was 0.58 ± 0.07 h-1. Excellent spatial uniformity in 222Rn concentration in the chamber was confirmed (with a mean value of relative standard deviation < 12%) through measurements at 23 locations using CR-39 film-based passive devices. Demonstration of calibration applications was performed using charcoal canister and PicoRad vials as the 222Rn adsorption devices. The study shows that gamma spectrometry is a convenient alternative approach to liquid scintillation analysis of PicoRad vials for 222Rn measurement.

Unexpected finding of an ablation catheter during thoracoscopic exploration for a spontaneous hemothorax - case report.

Varicose veins of lower extremities represent a common medical condition with minimally invasive percutaneous endovenous ablation techniques as a treatment of choice. A very rare complication is a catheter migration in the deep venous system. In the literature only 7 cases have been published so far, with only 2 cases with migration to the systemic circulation and heart involvement. In this paper we present an interesting case report from the perspective of a thoracic surgeon with the finding of a laser ablation catheter remnant in the left pleural cavity during thoracoscopic exploration for a spontaneous hemothorax in a 47-year old male patient after collapse. A similar complication affecting the pleural cavity has not been published before. In this paper we discuss possible routes of the cathether migration into the left pleural cavity, impending complications when a part of the catheter is left behind in the body and the means of prevention of these serious potentially fatal complications even after many years following the initial treatment.

CHARACTERISTICS OF INDOOR RADON AND THORON CONCENTRATIONS IN CAVE DWELLINGS IN GANSU PROVINCE, CHINA.

Short-term measurements were made in four different types of Chinese cave dwellings, 'ground', 'open-cut', 'aboveground' and 'underground', located in Gansu Province, China, in order to evaluate the diurnal and seasonal variations in indoor radon (222Rn) and thoron (220Rn) concentrations. As a result, in most of the 'ground' and 'open-cut' cave dwellings in summer, the indoor 222Rn concentrations during the nighttime were higher than those during the daytime. In the winter, such fluctuation was not observed. The daily indoor 222Rn concentrations in summer were higher than those in winter, excluding the 'aboveground' cave dwelling, and these concentrations depended on dwelling type, exhalation from the building materials and ventilation. In contrast with 222Rn, there seemed to be only very slight clear variations in 220Rn.

Evaluation of Liver Graft Recipient Workup in Predicting of Early Cardiovascular Events During Liver Transplantation: A Single-Center Experience.

BACKGROUND: Cardiovascular events (CVE) contribute to serious complications and death after liver transplantation (LT). Troponin I (TnI) level >0.07 mg/L and prior cardiac disease are known to be the independent predictors for posttransplant CVE. We evaluated single-center cardiac workup to predict early cardiovascular morbidity and mortality after LT. PATIENTS AND METHODS: We recruited 105 consecutive liver transplant recipients (male/female, 59/46; mean age, 51.66 ± 11.67 years). The cardiological assessment at evaluation for LT included medical history, electrocardiogram, echocardiography, Holter monitoring, and exercise test. We collected data regarding CVE including hypotonia with catecholamine usage, arrhythmia, sudden cardiac death, pulmonary edema, and myocardial infarction within 7 days after LT. RESULTS: CVE during LT occurred in 42 recipients (40%) and after LT in 9 patients (8.57%). Proposed cutoff level of TnI >0.07 mg/L did not correlate with CVE during operation (P = .73) or after LT (P = .47). CVE during LT was associated with arterial hypertension in medical history (P <.001), right ventricular systolic pressure (P< .05), and clinical scores: Child-Pugh (P = .04), Model for End-Stage Liver Disease (MELD) (P = .04), MELD incorporating serum sodium (P<.03), and integrated MELD score (P = .01). CVE after LT correlated only with arrhythmia (P<.001) and catecholamine usage (P < .05) perioperatively. Of interest, catecholamine usage during LT was associated with prolonged stay at the intensive care unit (P < .05). CONCLUSION: The single-center algorithm with noninvasive cardiac procedures without TnI assessment is optimal in evaluation before LT; however, medical history and severity of the liver disease are crucial for short-term cardiovascular morbidity after LT.

Troponin I Is Not a Predictor of Early Cardiovascular Morbidity in Liver Transplant Recipients.

BACKGROUND: Cardiovascular events (CVE) might occur in 20% to 70% of liver transplant recipients, and major CVE are associated with poor long-term survival. Overall, the ability to identify patients at the highest risk of death after liver transplantation (LT) has been improved. Abnormal pretransplant troponin I (TnI) level is regarded as one of predictors of postoperative CVE. We evaluated the number of early CVE after LT and the impact of pretransplant TnI on cardiovascular morbidity. PATIENTS AND METHODS: We prospectively enrolled 110 consecutive liver transplant recipients (M/F 67/43, age 53.3 ± 10.4 years, 32.7% with hepatitis C virus). Seven of them (6.4%) were on urgent protocol and 3 patients (2.7%) had re-LT. TnI level was measured at listing for LT and directly after LT; clinical outcomes were observed within the first 7 days after LT. RESULTS: CVE during LT occurred in 51 recipients (46.4%). CVE after LT at the intensive care unit were noticed in 13 patients (11.8%). One patient (0.9%) died in the first 7 days after LT. The level of TnI >0.07 did not correlate with CVE during operation and 7 days after LT (P > .05), but the subgroup with TnI >0.07 before LT had a trend with higher TnI after LT (P = .065). Recipients with hepatitis C virus had a trend for higher TnI after LT (P = .061). CVE directly after LT correlated significantly with Child-Pugh (P = .01), Model for End-Stage Liver Disease (MELD), MELD incorporating serum sodium, and integrated MELD scales (P < .001). CONCLUSION: In our single-center algorithm, TnI with canonical cutoff value of 0.07 was not an effective predictor for cardiac outcomes shortly after LT in our population.

Machine learning methods as a tool to analyse incomplete or irregularly sampled radon time series data.

Machine learning is a class of statistical techniques which has proven to be a powerful tool for modelling the behaviour of complex systems, in which response quantities depend on assumed controls or predictors in a complicated way. In this paper, as our first purpose, we propose the application of machine learning to reconstruct incomplete or irregularly sampled data of time series indoor radon (222Rn). The physical assumption underlying the modelling is that Rn concentration in the air is controlled by environmental variables such as air temperature and pressure. The algorithms "learn" from complete sections of multivariate series, derive a dependence model and apply it to sections where the controls are available, but not the response (Rn), and in this way complete the Rn series. Three machine learning techniques are applied in this study, namely random forest, its extension called the gradient boosting machine and deep learning. For a comparison, we apply the classical multiple regression in a generalized linear model version. Performance of the models is evaluated through different metrics. The performance of the gradient boosting machine is found to be superior to that of the other techniques. By applying learning machines, we show, as our second purpose, that missing data or periods of Rn series data can be reconstructed and resampled on a regular grid reasonably, if data of appropriate physical controls are available. The techniques also identify to which degree the assumed controls contribute to imputing missing Rn values. Our third purpose, though no less important from the viewpoint of physics, is identifying to which degree physical, in this case environmental variables, are relevant as Rn predictors, or in other words, which predictors explain most of the temporal variability of Rn. We show that variables which contribute most to the Rn series reconstruction, are temperature, relative humidity and day of the year. The first two are physical predictors, while "day of the year" is a statistical proxy or surrogate for missing or unknown predictors.

THE SCREENING INDOOR RADON AND PRELIMINARY STUDY OF INDOOR THORON CONCENTRATION LEVELS IN KUWAIT.

Indoor measurements of radon and thoron in Kuwait were conducted during the years 2015 and 2016. In this study, 65 dwellings were selected for the long-term radon-thoron survey using passive nuclear track monitors. The monitors (at least one) were used at various locations in the dwellings for 83-306 days. Some measurements were also repeated at the same locations in different seasons. This current study is a preliminary thoron survey with relatively small sample size. The results showed that the range of thoron concentration was from below the lower limit of detection to 35 Bq m-3, whereas the range of radon concentration was within 10-202 Bq m-3. Furthermore, 22% of the radon results exceeded the WHO radon reference level of 100 Bq m-3. The analysis of variance showed a correlation between indoor radon concentration and the season. However, the thoron measurements were rather limited and the values were low. In addition, the relationship was investigated between radon and thoron concentrations involving the floor levels and the type of ventilation systems used.

AN INTERNATIONAL COOPERATION BY USING AN ALL-ENCOMPASSING PASSIVE RADON MONITOR.

The recently developed radon film-badge makes it possible to measure radon indoors, in soil, in water and/or in aqueous media (e.g. mud). As a result of its wide response linearity, this monitor has been successfully used to measure radon in-water with concentrations from 10 to ~10 000 Bq/L. By exploiting the unique characteristics of this badge, a mini-survey has been carried out by Health Canada in which radon in water was measured from 12 private wells, as well as in tap water originating from the Ottawa River. Due to the widespread interest of different laboratories in using these passive monitors, laboratories were provided with plastic films to construct their own badges by using in-house CR-39 detectors. Monitors were then irradiated by a known radon concentration at the National Institute of Radiation Metrology (ENEA)'s radon chamber and sent back to each laboratory for processing and counting. Even though these laboratories have been using different etching- and counting-procedures, the film-badge responses varied only within ~12%.

Charge optimized many body (COMB) potentials for Pt and Au.

Interatomic potentials for Pt and Au are developed within the third generation charge optimized many-body (COMB3) formalism. The potentials are capable of reproducing phase order, lattice constants, and elastic constants of Pt and Au systems as experimentally measured or calculated by density functional theory. We also fit defect formation energies, surface energies and stacking fault energies for Pt and Au metals. The resulting potentials are used to map a 2D contour of the gamma surface and simulate the tensile test of 16-grain polycrystalline Pt and Au structures at 300 K. The stress-strain behaviour is investigated and the primary slip systems {1 1 1}〈1 [Formula: see text] 0〉 are identified. In addition, we perform high temperature (1800 K for Au and 2300 K for Pt) molecular dynamics simulations of 30 nm Pt and Au truncated octahedron nanoparticles and examine morphological changes of each particle. We further calculate the activation energy barrier for surface diffusion during simulations of several nanoseconds and report energies of [Formula: see text] eV for Pt and [Formula: see text] eV for Au. This initial parameterization and application of the Pt and Au potentials demonstrates a starting point for the extension of these potentials to multicomponent systems within the COMB3 framework.

[Short-term results of minimally invasive pectus excavatum repair in adult patients]. / Krátkodobé výsledky minimálne invazívnej korekcie pectus excavatum u dospelých pacientov.

INTRODUCTION: Pectus excavatum is the most common congenital chest wall deformity. Aproximatelly 1 out of 400 to 1000 newborns are affected by this diagnosis. Surgical correction is indicated in patients that fulfil the indication criteria. The highly modified Ravitch correction (HMRR) and minimally invasive pectus excavatum repair (MIRPE) are by far the most popular methods of correction. MIRPE has been established as the method of choice amongst children. Feasibility of the minimally invasive approach in the funnel chest correction in adult population still remains controversial. METHODS: The authors present a retrospective analysis of adult patients treated by MIRPE in their institution. Sixty adult patients with pectus excavatum underwent MIRPE from October 2010 to March 2015. Various parameters were evaluated retrospectively. The effectiveness and safety of both techniques were evaluated with the use of statistical software SPSS® version 21.0 (IBM, USA). Data were evaluated using Student´s t-test or Mann-Whitney U-test for normally and non-normally distributed data, respectively. The comparison of categorical variables between the groups was evaluated by Pearson´s chi-square test. A p value of less than 0.05 was considered statistically significant. RESULTS: 45 men and 15 women underwent MIRPE during the period. Median age in the group was 23 years without any statistically significant difference between males and females (p=0.386). Median Haller index was 3.93 and was slightly higher in women (p= 0.285). Asymmetric deformities were present in 20 patients (33.3%) without any statistically significant difference between the sexes (p=0.206). Median duration of the surgical correction was 73 minutes and was longer in males (p=0.312). Two bars were implanted in 27 patients with no significant difference between the sexes (p=0.454). Complication rate was 25% (15/60) without any significant difference based on the number of implanted bars (p=0.178), sex (p=0.863) or the presence of an asymmetric deformity (p=0.527). Wound seromas with 10% (6/60) were the most common complication. Median postoperative length of stay was 5 days without any significant difference between males and females (p=0.653) and patients with different number of bars implanted (p=0.600). The need for rehospitalisation and reoperation was indicated in 5 patients (8.3%). Allergy to chromium led to bar extraction in 1 patient and 4 patients were treated by V.A.C.® therapy (KCI, USA) because of wound abscess (1) and seroma (3). CONCLUSION: Minimally invasive pectus excavatum repair is an effective surgical technique for the treatment of pectus excavatum in adult patients. This technique can be learned and performed safely even without any former experience with this correction in children. KEY WORDS: adult patients - MIRPE pectus excavatum.

The most recent international intercomparisons of radon and thoron monitors with the NIRS radon and thoron chambers.

The fifth international intercomparison for radon and fourth for thoron monitors were conducted at National Institute of Radiological Sciences (Japan) with the radon and thoron chambers. The tests were made under two different exposures to radon and two exposures (in two rounds due to limited space in the thoron chamber) to thoron. In these most recent intercomparisons, two new graphical methods recommended by the ISO standard, Mandel's h statistic and the Youden plot, were implemented to evaluate the consistency between laboratories and within laboratories.The presented data indicated that the performance quality of laboratories for radon measurement as expressed by the percentage difference parameter has been stable since the first international intercomparison for passive monitors carried out in 2007, and it amounted to around 50 for 10 % of the difference from the reference value. The thoron exercise showed that further development and additional studies to improve its measuring methods and reliability are needed.

"Surgically created" excision of the back mimicking homicide: report of an unusual case.

Fatalities due to sharp force trauma, with respect to manner of death, may be homicidal, self-inflicted, or accidental in nature. This article presents a case of an unusual sharp force injury inflicted under very specific and seemingly obscured circumstances, initially suggestive of homicidal origin. A 69-year-old, socially isolated male was found dead with a strange, heavily blood-stained excision-like lesion on the right subscapular area. The autopsy confirmed that the wound led to fatal external blood loss. Toxicological analysis of the blood and urine revealed severe alcohol intoxication. The police investigation turned up that the man had suffered from a painful skin furuncle of the right upper back. As he was worried about receiving medical treatment, he voluntarily asked his two acquaintances for "surgical" assistance to remove the skin affection. Based on the circumstances surrounding death and findings at autopsy, it was concluded that the injury was inflicted without the intent to harm or cause death, as a result of simple negligence. Consequently, the manner of death was ultimately certified as an involuntary manslaughter. Our case has clearly illustrated that even highly suspicious and atypically shaped wounds created by sharp-edged instruments with localization in non-accessible body areas does not exclusively indicate homicidal activity, hence, the accidental, suicidal or even iatrogenic origin of the wounding mechanism must be taken into consideration.