Epigenetic changes marked by DNA methylation have been proposed to play a role in age-related disease. We investigated DNA methylation changes in cardiovascular atherosclerotic tissues and in-vitro vascular senescence in the promoter of estrogen receptor beta gene, which has essential roles in vascular function. Coronary atherosclerotic tissues showed higher methylation levels (28.7%) than normal appearing arterial (6.7%-10.1%) and venous tissues (18.2%). In comparing estrogen receptor beta methylation between plaque and non-plaque regions in ascending aorta, common carotid artery, and femoral artery of two patients, the plaque lesions showed consistently higher methylation levels than non-plaque regions. Passage-dependent increased estrogen receptor beta methylation was observed in three of six human aortic endothelial or smooth muscle cell lines cultured in-vitro to vascular senescence. Estrogen receptor beta expression in these vascular cell lines was significantly activated by DNA-methyltransferase inhibition. This activity was augmented by histone deacetylase inhibition. These findings provide evidence of epigenetic dysregulation of estrogen receptor beta in atherosclerosis and vascular aging. We suggest that focal epigenetic changes in estrogen receptor beta contribute to the development of atherosclerosis and vascular aging.

No abstract

ObjectivePostoperative delirium is a common complication in the elderly after surgery but few papers have reported after spinal surgery. We analyzed various risk factors for postoperative delirium after spine surgery.MethodsBetween May 2012 and September 2013, 70 patients over 60 years of age were examined. The patients were divided into two groups : Group A with delirium and Group B without delirium. Cognitive function was examined with the Mini-Mental State Examination-Korea (MMSE-K), Clinical Dementia Rating (CDR) and Global Deterioration Scale (GDS). Information was also obtained on the patients' education level, underlying diseases, duration of hospital stay and laboratory findings. Intraoperative assessment included Bispectral index (BIS), type of surgery or anesthesia, blood pressure, fluid balance, estimated blood loss and duration of surgery.ResultsPostoperative delirium developed in 17 patients. The preoperative scores for the MMSE, CDR, and GDS in Group A were 19.1±5.4, 0.9±0.6, and 3.3±1.1. These were significantly lower than those of Group B (25.6±3.4, 0.5±0.2, and 2.1±0.7) (p<0.05). BIS was lower in Group A (30.2±6.8 compared to 35.4±5.6 in group B) (p<0.05). The number of BIS <40 were 5.1±3.1 times in Group A, 2.5±2.2 times in Group B (p<0.01). In addition, longer operation time and longer hospital stay were risk factors.ConclusionPrecise analysis of risk factors for postoperative delirium seems to be more important in spinal surgery because the surgery is not usually expected to have an effect on brain function. Although no risk factors specific to spinal surgery were identified, the BIS may represent a valuable new intraoperative predictor of the risk of delirium.

This study demonstrated the importance of PI and lumbar curvature in the pathogenesis of ULD. The higher prevalence of short LL and long TK with low PI in the ULD group implies that an increased mechanical stress at this level may be one of the risk factors of ULD.

ObjectiveWe prospectively compared whole-body multidetector computed tomography (MDCT) and 3.0T magnetic resonance (MR) images with autopsy findings.Materials and MethodsFive cadavers were subjected to whole-body, 16-channel MDCT and 3.0T MR imaging within two hours before an autopsy. A radiologist classified the MDCT and 3.0T MRI findings into major and minor findings, which were compared with autopsy findings.ResultsMost of the imaging findings, pertaining to head and neck, heart and vascular, chest, abdomen, spine, and musculoskeletal lesions, corresponded to autopsy findings. The causes of death that were determined on the bases of MDCT and 3.0T MRI findings were consistent with the autopsy findings in four of five cases. CT was useful in diagnosing fatal hemorrhage and pneumothorax, as well as determining the shapes and characteristics of the fractures and the direction of external force. MRI was effective in evaluating and tracing the route of a metallic object, soft tissue lesions, chronicity of hemorrhage, and bone bruises.ConclusionA postmortem MDCT combined with MRI is a potentially powerful tool, providing noninvasive and objective measurements for forensic investigations.

We provided a curve-fit equation to predict the normal heart weight (g) in Koreans by examining 422 autopsies (215 males and 207 females, from newborn to age 77 yr) who were relatively in good general condition. Heart weight was well correlated with body surface area (m2), body weight (kg), and body height (cm) but poorly with age in both sex. Heart weight progressively increased from birth to the earlier 3rd and 4th decades in male and female, respectively, and then gradually decreased; mean heart weight of all age group was greater in male than in female and significantly different from birth to 4th decade. In both sex, heart weight exponentially increased in accordance with the increase of body height, body weight, and body surface (in male, heart weight=0.00312 x body height(2.239), r2=0.750, p<0.0001; in female, heart weight=0.00443 x body height(2170), r2=0.781, p<0.0001; in male, heart weight=9.22 x body weight(0.853), r2=0.770, p<0.0001; in female, heart weight=9.00 x body weight0.855, r2=0.820, p<0.0001; in male, heart weight=155.18 x body surface area1.290, r=0.808, p<0.0001; in female, heart weight=124.13 x body surface area1.242, r=0.834, p<0.0001). These results indicate that heart weight is better correlated with body surface area than with body weight; however, body weight should be a better determinant of a predicted heart weight, since body surface area is entirely dependent on body height and body weight.

Quantitative RNA analyses of autopsy materials to diagnose the cause and mechanism of death are challenging tasks in the field of forensic molecular pathology. Alterations in mRNA profiles can be induced by cellular stress responses during supravital reactions as well as by lethal insults at the time of death. Here, we demonstrate that several gene transcripts encoding heat shock proteins (HSPs), a gene family primarily responsible for cellular stress responses, can be differentially expressed in the occipital region of postmortem human cerebral cortices with regard to the cause of death. HSPA2 mRNA levels were higher in subjects who died due to mechanical asphyxiation (ASP), compared with those who died by traumatic injury (TI). By contrast, HSPA7 and A13 gene transcripts were much higher in the TI group than in the ASP and sudden cardiac death (SCD) groups. More importantly, relative abundances between such HSP mRNA species exhibit a stronger correlation to, and thus provide more discriminative information on, the death process than does routine normalization to a housekeeping gene. Therefore, the present study proposes alterations in HSP mRNA composition in the occipital lobe as potential forensic biological markers, which may implicate the cause and process of death.

This statistical analysis of 4,709 legal autopsies performed in Korea in 2012 was conducted to obtain primary data about and related variables. The analysis revealed the following:1. Of the total number of deaths, men accounted for and women, 26.8%. Evidently, the number of deaths among men was more than twice that among women. 2. With respect to mode of death, 54.8% were recorded as unnatural deaths, 39.2% were natural deaths, and 6.0% had unknown causes. Of the 2,581 unnatural deaths, 44.8% were accidental deaths; 27.2%, suicidal; 17.5%, homicidal; and 10.3%, undetermined. 3. Of the total number of unnatural deaths, 43.0% were trauma-related deaths, for which falling down was the leading cause, accounting for 33.5% cases. Asphyxiation was accounted for 17.2%, among which the predominant cause was hanging (55.3%). Moreover, 12.5% of deaths were due to drowning; 11.5%, poisoning; 11.2%, thermal injuries; 2.7%, complications in medical procedures; and 0.3%, electrocution, starvation, or neglect. 4. Among 1,847 natural deaths, heart diseases accounted for 50.2% and vascular diseases accounted for 16.7%. 5. There were 207 cases of deaths among children under the age of 10, of which 94 were unnatural and 49 were homicidal deaths. Of all cases, 9.2% had an unknown cause of death, and of these 67.6%, were putrefied or skeletonized bodies.