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@ARTICLE{Gava:893854,
author = {Gava, Giuseppe and Eickhoff, Simon B. and Filler, Timm J.
and Mayer, Felix and Mahlke, Nina S. and Ritz-Timme,
Stefanie},
title = {{A}cute or chronic pulmonary emphysema? {O}r both?—{A}
contribution to the diagnosis of death due to violent
asphyxiation in cases with pre-existing chronic emphysema},
journal = {International journal of legal medicine},
volume = {136},
issn = {1437-1596},
address = {Heidelberg},
publisher = {Springer},
reportid = {FZJ-2021-02878},
pages = {133–147},
year = {2022},
abstract = {The diagnosis of death due to violent asphyxiation may be
challenging if external injuries are missing, and a typical
acute emphysema (AE) "disappears" in pre-existing chronic
emphysema (CE). Eighty-four autopsy cases were
systematically investigated to identify a (histo-)
morphological or immunohistochemical marker combination that
enables the diagnosis of violent asphyxiation in cases with
a pre-existing CE ("AE in CE"). The cases comprised four
diagnostic groups, namely "AE", "CE", "acute and chronic
emphysema (AE + CE)", and "no emphysema (NE)". Samples from
all pulmonary lobes were investigated by conventional
histological methods as well as with the immunohistochemical
markers Aquaporin 5 (AQP-5) and Surfactant protein A1
(SP-A). Particular attention was paid to alveolar septum
ends ("dead-ends") suspected as rupture spots, which were
additionally analyzed by transmission electron microscopy.
The findings in the four diagnostic groups were compared
using multivariate analysis and 1-way ANOVA analysis. All
morphological findings were found in all four groups. Based
on histological and macroscopic findings, a multivariate
analysis was able to predict the correct diagnosis "AE + CE"
with a probability of $50\%,$ and the diagnoses "AE" and
"CE" with a probability of $86\%$ each. Three types of
"dead-ends" could be differentiated. One type ("fringed
ends") was observed significantly more frequently in AE. The
immunohistochemical markers AQP-5 and SP-A did not show
significant differences among the examined groups. Though a
reliable identification of AE in CE could not be achieved
using the examined parameters, our findings suggest that
considering many different findings from the macroscopical,
histomorphological, and molecular level by multivariate
analysis is an approach that should be followed.},
cin = {INM-7},
ddc = {610},
cid = {I:(DE-Juel1)INM-7-20090406},
pnm = {5254 - Neuroscientific Data Analytics and AI (POF4-525)},
pid = {G:(DE-HGF)POF4-5254},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:34181078},
UT = {WOS:000667638300001},
doi = {10.1007/s00414-021-02619-7},
url = {https://juser.fz-juelich.de/record/893854},
}