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In de publieke opinie wordt insuline al langer beschreven als het ideale moordwapen. Het aantonen in het lichaam van insuline of een derivaat is mogelijk en kan een belangrijke diagnostische aanwijzing zijn, doch geeft geen absolute zekerheid. Deze literatuurstudie geeft een overzicht van de bestaande onderzoeksmogelijkheden om een overdosis aan antidiabetische middelen, en meer specifiek insuline, en de daaruit volgende mogelijke schade aan te tonen. PubMed, EMBASE en Cochrane Library werden doorzocht doormiddel van vooropgestelde zoektermen. 39 artikels werden geïncludeerd en geanalyseerd door een auteur. Data werden geselecteerd betreffende diagnostisch hulpmiddel, sensitiviteit en specificiteit, toepasbaarheid, substraat, normaalwaarden en pathologische waarden van insuline en C-peptide en pathologische doses van insuline. De meest beschreven diagnostische hulpmiddelen waren massa-spectrometrie al dan niet in combinatie met chromatografie, immunoassays, immunohistochemie en microscopie. De toepasbaarheid van het hulpmiddel was afhankelijk van de bewaarwijze van het staal, het type staal en de beschikbaarheid van het hulpmiddel. De mogelijke substraten waren bloed, orgaan- en injectieplaatsweefsel, urine, glas- en pericardvocht, cerebrospinale vloeistof en gal. De normaalwaarden van insuline betroffen 5-200µU/mL, de pathologische waarden, 1 µU/mL-5551 mIU/L . De pathologische dosis was 70-3200 eenheden insuline. Expliciete cijfers voor sensitiviteit en specificiteit werden niet beschreven. In bewoordingen heeft massa-spectrometrie de beste sensitiviteit en specificiteit. Insuline-intoxicatie is niet ondetecteerbaar zoals in de media beweerd wordt, doch het bewijzen ervan vraagt veel expertise. Massa-spectrometrie in combinatie met gas- of liquid-chromatografie geeft de meest correcte insuline- en C-peptideconcentratie en heeft de mogelijkheid om insuline-analogen en metabolieten te detecteren en van elkaar te onderscheiden.

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Introduction: Sudden infant death syndrome (SIDS) remains an important cause of infant death. Many studies have tried to identify genetic variants that could predispose an infant to SIDS. However, the potential role of most genes remains unclear, raising doubts about the usefullness of routine postmortem genetic testing in SIDS. Objectives: In this systematic review, our aim is to answer the question whether routine postmortem genetic testing in SIDS is useful and if so, which genes should be screened. We will hereby focus on the cardiac and neurological genes. Methods: We performed a literature search in MEDLINE, EMBASE and Cochrane using both free text and MeSH terms to identify all genetic variants previously associated with SIDS. After combining the results of the 51 included studies, we compared them to the gene panel currently used at UZ Leuven for cases of sudden arrhythmic death syndrome (SADS). Results: After interpretation of our results, we concluded that cardiac channelopathy genes are most convincingly associated with SIDS, the most important being SCN5A, KCNQ1, KCNH2 and RyR2. Cardiomyopathy genes seem to be involved in the etiopathogenesis of SIDS as well, but the only gene with substantial evidence is MYBPC3. Of the genes involved in the central nervous system only PHOX2B might have a potential role in SIDS. Discussion: We conclude that a routine molecular autopsy in SIDS would be useful. However, caution is needed when interpreting the results of genetic testing. In the future, more large case-control studies using next-generation or whole-exome sequencing should be conducted. A more uniform classification system for variants should be introduced as well, in order to ease the interpretation of the results of future studies.

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Background: Bone Marrow is well known to change with age, resulting in the conversion of red marrow to yellow123. Starting from the distal parts of the bones the conversion taking place towards the center. Active, red bone marrow is being replaced with nonhematopoietic cells, adipocytes. This is a constant process throughout life. Material and methods: We performed full-body postmortem CT scans analysis to quantify these changes. 116 scans were obtained in total, 61 Male and 55 Female. Manual delineations of the femur head, lumbar vertebrae, and the iliac crest were done in line with semi-automated whole-body skeleton segmentation to detect and calculate the changes. The skeleton segmentation was done by three segments: head, thorax and arms, and the lower limbs. Results: Strong correlation (p<0.05) was found between the density, volume of bone marrow, and age in all examined bone sites, excluding the volume of the iliac crest, probably due to the small size of the region. Postmortem interval did not show any significant effect on the density or volume of the bone. Meaningful difference was also discovered between sexes (p<0.05). Generally, men had more compact bone marrow until the age of 80, when the values for both sexes becomes equal. With the semi-automated method, the discrepancy between the age and sexes was visualized. Women from 20 to 40 years old tend to have the highest density of the bones. Moreover, the analysis showed skull to be the densest region of the body within all ages. Conclusion: Our results nicely correlated with the previous findings, proving the usage of CT modality for such purposes, providing potential workflow for age estimation. Further goal based on the present study would be to create a fully automated method of segmenting exclusively the bone marrow, which will significantly contribute to the forensic field.