Aconitum in traditional Chinese medicine: a valuable drug or an unpredictable risk?

Objectives: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered to have potential neuro-invasiveness that might lead to acute brain disorders or contribute to respiratory distress in patients with coronavirus disease 2019 (COVID-19). This study investigates the occurrence of structural brain abnormalities in non-survivors of COVID-19 in a virtopsy framework. Methods: In this prospective, monocentric, case series study, consecutive patients who fulfilled the following inclusion criteria benefited from an early postmortem structural brain MRI: death Results: Among the 62 patients who died from COVID-19 from 31/03/2020 to 24/04/2020 at our institution, 19 decedents fulfilled the inclusion criteria. Parenchymal brain abnormalities were observed in 4 decedents: subcortical micro- and macro-bleeds (2 decedents), cortico-subcortical edematous changes evocative of posterior reversible encephalopathy syndrome (PRES, one decedent), and nonspecific deep white matter changes (one decedent). Asymmetric olfactory bulbs were found in 4 other decedents without downstream olfactory tract abnormalities. No brainstem MRI signal abnormality was observed. Conclusions: Postmortem brain MRI demonstrates hemorrhagic and PRES-related brain lesions in non-survivors of COVID-19. SARS-CoV-2-related olfactory impairment seems to be limited to olfactory bulbs. Brainstem MRI findings do not support a brain-related contribution to respiratory distress in COVID-19.

/pdf/early-postmortem-brain-mri-findings-in-covid-19-non-2vmgt8jaia.pdf

Early postmortem brain MRI findings in COVID-19 non-survivors.

Objectives
A number of species belonging to herbal genus Aconitum are well-known and popular for their medicinal benefits in Indian, Vietnamese, Korean, Japanese, Tibetan and Chinese systems of medicine. It is a valuable drug as well as an unpredictable toxic material. It is therefore imperative to understand and control the toxic potential of herbs from this genus. In this review, the ethnomedicinal, phytochemistry, pharmacology, structure activity relationship and toxicology studies of Aconitum were presented to add to knowledge for their safe application.

Key findings
A total of about 76 of all aconite species growing in China and surrounding far-east and Asian countries are used for various medical purposes. The main ingredients of aconite species are alkaloids, flavonoids, free fatty acids and polysaccharides. The tuberous roots of genus Aconitum are commonly applied for various diseases such as rheumatic fever, painful joints and some endocrinal disorders. It stimulates the tip of sensory nerve fibres. These tubers of Aconitum are used in the herbal medicines only after processing. There remain high toxicological risks of the improper medicinal applications of Aconitum. The cardio and neurotoxicities of this herb are potentially lethal. Many analytical methods have been reported for quantitatively and qualitatively characterization of Aconitum.

Summary
Aconitum is a plant of great importance both in traditional medicine in general and in TCM in particular. Much attention should be put on Aconitum because of its narrow therapeutic range. However, Aconitum's toxicity can be reduced using different techniques and then benefit from its pharmacological activities. New methods, approaches and techniques should be developed for chemical and toxicological analysis to improve its quality and safety.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jphp.12310

A review on phytochemistry, pharmacology and toxicology studies of Aconitum.

OBJECTIVE. Postmortem investigations are becoming more and more sophisticated. CT and MRI are already being used in pathology and forensic medicine. In this context, the impact of postmortem angiography increases because of the rapid evaluation of organ-specific vascular patterns, vascular alteration under pathologic and physiologic conditions, and tissue changes induced by artificial and unnatural causes.CONCLUSION. In this article, the advantages and disadvantages of former and current techniques and contrast agents are reviewed.

https://www.ajronline.org/doi/pdf/10.2214/AJR.06.0787

Postmortem angiography: review of former and current methods.

Forensic radiology is a new subspecialty that has arisen worldwide in the field of forensic medicine. Postmortem computed tomography (PMCT) and, to a lesser extent, PMCT angiography (PMCTA), are established imaging methods that have replaced dated conventional X-ray images in morgues. However, these methods have not been standardized for postmortem imaging. Therefore, this article outlines the main approach for a recommended standard protocol for postmortem cross-sectional imaging that focuses on unenhanced PMCT and PMCTA. This review should facilitate the implementation of a high-quality protocol that enables standardized reporting in morgues, associated hospitals or private practices that perform forensic scans to provide the same quality that clinical scans provide in court.

/pdf/imaging-in-forensic-radiology-an-illustrated-guide-for-52zix75b04.pdf

Imaging in forensic radiology: an illustrated guide for postmortem computed tomography technique and protocols

Effects of long-term administrations of aconitine on electrocardiogram and tissue concentrations of aconitine and its metabolites in mice.

Postmortem pulmonary edema: A comparison between immediate and delayed postmortem computed tomography

Purpose
We investigated and identified postmortem changes on magnetic resonance imaging (MRI) of the brain to provide accurate diagnostic guidelines.

Characteristic signal intensity changes on postmortem magnetic resonance imaging of the brain

In Japan, the medical examiner system is not widespread, the rate of autopsy is low, and many medical institutions therefore perform postmortem imaging using clinical equipment. Postmortem imaging is performed to clarify cause of death, select candidates for autopsy, make a guide map for autopsy, or provide additional information for autopsy. Findings are classified into 3 categories: cause of death and associated changes, changes induced by cardiopulmonary resuscitation, and postmortem changes. Postmortem magnetic resonance imaging shows characteristic changes in signal intensity related to low body temperature after death; they are low temperature images.

Postmortem magnetic resonance imaging dealing with low temperature objects.

Purpose
The aim of this study was to investigate cerebral gas embolism (GE) on nontraumatic postmortem CT (PMCT), regarding its frequency, location (arterial or venous), and causes.

Hideyuki Hayakawa

Papers

Effects of long-term administrations of aconitine on electrocardiogram and tissue concentrations of aconitine and its metabolites in mice.

Postmortem pulmonary edema: A comparison between immediate and delayed postmortem computed tomography

Characteristic signal intensity changes on postmortem magnetic resonance imaging of the brain

Postmortem magnetic resonance imaging dealing with low temperature objects.

Nontraumatic postmortem computed tomographic demonstration of cerebral gas embolism following cardiopulmonary resuscitation