Postmortem imaging (PMI) is increasingly used in postmortem practice and is considered a potential alternative to a conventional autopsy, particularly in case of sudden cardiac deaths (SCD). In 2017, the Association for European Cardiovascular Pathology (AECVP) published guidelines on how to perform an autopsy in such cases, which is still considered the gold standard, but the diagnostic value of PMI herein was not analyzed in detail. At present, significant progress has been made in the PMI diagnosis of acute ischemic heart disease, the most important cause of SCD, while the introduction of postmortem CT angiography (PMCTA) has improved the visualization of several parameters of coronary artery pathology that can support a diagnosis of SCD. Postmortem magnetic resonance (PMMR) allows the detection of acute myocardial injury-related edema. However, PMI has limitations when compared to clinical imaging, which severely impacts the postmortem diagnosis of myocardial injuries (ischemic versus non-ischemic), the age-dating of coronary occlusion (acute versus old), other potentially SCD-related cardiac lesions (e.g., the distinctive morphologies of cardiomyopathies), aortic diseases underlying dissection or rupture, or pulmonary embolism. In these instances, PMI cannot replace a histopathological examination for a final diagnosis. Emerging minimally invasive techniques at PMI such as image-guided biopsies of the myocardium or the aorta, provide promising results that warrant further investigations. The rapid developments in the field of postmortem imaging imply that the diagnosis of sudden death due to cardiovascular diseases will soon require detailed knowledge of both postmortem radiology and of pathology.

Inherited retinal diseases can result from various genetic defects and are one of the leading causes for blindness in the working-age population. The present study aims to provide a comprehensive description of changes in retinal structure associated with phenotypic disease entities and underlying genetic mutations. Full macular spectral domain optical coherence tomography scans were obtained and manually segmented in 16 patients with retinitis pigmentosa, 7 patients with cone–rod dystrophy, and 7 patients with Stargardt disease, as well as 23 age- and sex-matched controls without retinal disease, to assess retinal layer thicknesses. As indicated by generalized least squares models, all IRDs were associated with retinal thinning (p < 0.001), especially of the outer nuclear layer (ONL, p < 0.001). Except for the retinal nerve fiber layer, such thinning was associated with a reduced visual acuity (p < 0.001). These advances in our understanding of ultrastructural retinal changes are important for the development of gene-, cell-, and optogenetic therapy. Longitudinal studies are warranted to describe the temporal component of those changes.

Zusammenfassung Hintergrund Die Medien berichten über die erhöhte Gewaltbereitschaft von Patienten sowie Angehörigen gegenüber medizinischem Personal. Bislang wurden wenige Untersuchungen zu diesem Thema durchgeführt, entsprechend schwach ist die Datenlage. Gerade Augenärzte haben an der Spaltlampe engen Kontakt zum Patienten und sind oft mit Patienten allein. Methodik Auf Grundlage der Aggressions-Wahrnehmungsskala (POPAS Fragebogen, Oud 2000) sowie der Umfrage zu Aggressionen und Gewalt unter Allgemeinmedizinern (Vorderwülbecke et al. 2015) wurde ein Fragebogen entwickelt. Im Herbst 2018 erhielten alle Mitglieder der Deutschen Ophthalmologischen Gesellschaft (DOG) und des Berufsverbandes der Augenärzte (BVA) per Mail eine Einladung, um den Fragebogen online auszufüllen. Ergebnisse Von 9411 angeschriebenen Augenärzten nahmen insgesamt 1508 (Alter: 49 ± 12 Jahre) an der Befragung teil (16 %). 806 (53,7 %) Befragte waren weiblich. 1139 (75,5 %) Teilnehmer arbeiteten in Praxen. Insgesamt 1264 (83,3 %) der Augenärzte hatten Aggressionen/Gewalt in ihrer Tätigkeit erfahren. 986 (65 %) Befragte hatten verbale Übergriffe ohne Drohung erlebt. Von bedrohlich körperlichen Gewalterfahrungen berichteten 363 (24,1 %) Ärzte. 30 (2 %) Teilnehmer erhielten aufgrund schwerer körperlicher Gewalt eine ärztliche Behandlung. Sexuelle Einschüchterung/Belästigung bejahten 322 (21,4 %) der Befragten, von diesen waren 243 (75,5 %) weiblich. 533 (47,9 %) Ärzte empfanden, dass aggressive/gewalttätige Verhaltensweisen in den letzten 5 Jahren zugenommen haben. Schlussfolgerung Die hohe Teilnehmeranzahl weist auf die hohe Relevanz des Themas hin. Die Umfrage hat erstaunliche Ergebnisse geliefert, die weitere Diskussionen und Handlungen zur Folge haben sollten, um die Sicherheit der Mitarbeiter zu verbessern.

BackgroundThe prevalence for rheumatoid arthritis (RA) is 0,5 - 1,0% [1], rises with age and occurs more frequently in women with the ratio 3: 1 [2]. It is probably the reason why research has been focusing on women and knowledge about men is scarce. RA is strongly associated with patients experiences of physical, emotional, and social restrictions and quality of life is poor compared to the general population [3]. What is missing from the literature is how men with RA perceive, interpret and understand to live with a chronic illness.ObjectivesThe aim of this study was to to develop an understanding of how men live with RA and their coping strategies to live with a chronic disease like RA.MethodsA qualitative interview study was conducted based on individual semi-structured interviews. A purposive sample of 17 men with RA, (average age 58 (range 33-70)), diagnosed with RA on average 15 years previously (min. 5, max 34 years) were recruited from the rheumatology outpatient department, Glostrup Hospital. Semi-structured interviews were conducted to understand men's experiences living with RA. The recorded interviews were transcribed verbatim, and analysed using Interpretive Description as described by Thorne [4] and by use of the Nvivo software. An interpretive description of the men's experiences was established.ResultsThe analysis revealed that men with RA are affected in several dimensions of their every daily life. Seven categories influencing men with RA were extracted: (1) Frame time of diagnosis, (2) Loss of bodily capacity, (3) Adapting to life with medicine, (4) Connecting to job situation, (5) Health literacy, (6) To navigate as a social individual and (7) The challenged to masculine rationality.ConclusionsStudy participants from a wide range of age and disease duration described their experience of living with RA as being related to essential issues about masculinity, social network and strategies to handle consequences of RA in everyday life. These findings demonstrate that RA has an impact on how men define themselves as partner and their masculine identity. Physical activity was highlighted as an important part of being a man. Knowledge from this study will be used in the planning of our subsequent intervention study targeted men with RA.ReferencesScott, D.L., F. Wolfe, and T.W.J. Huizinga, Rheumatoid arthritis. The Lancet, 2010. 376(9746): p. 1094-1108.Alamanos, Y. and A.A. Drosos, Epidemiology of adult rheumatoid arthritis. Autoimmun Rev, 2005. 4(3): p. 130-6.Ovayolu, N., O. Ovayolu, and G. Karadag, Health-related quality of life in ankylosing spondylitis, fibromyalgia syndrome, and rheumatoid arthritis: a comparison with a selected sample of healthy individuals. Clin Rheumatol, 2011. 30(5): p. 655-64.Thorne, S., Interpretive Description 2008, Walnut Creek, CA: Left Coast Press.Disclosure of InterestNone declared