Documentation:FIB book/Impact of Cadaveric Preservation Techniques on Tissue Mechanics
Introduction
The study of human tissue mechanics is fundamental to developing accurate models of injury and developing prevention technology. Cadaveric specimens are prominently used in biomechanics research, since they allow for more injurious testing conditions than live volunteers, and can be instrumented. Because of this, human cadavers have aided in the development of seatbelts, airbags, panel padding, and other safety apparatuses.[1] However, the method of cadaveric preservation significantly influences the mechanical properties of the tissues, impacting the reliability and applicability of findings from cadaveric studies.
Preservation techniques such as freezing, formalin embalming, and Thiel embalming enable the usability of these tissues to be extended, but can introduce variations in tissue properties like elasticity and tensile strength. These properties can be critical to biomechanical testing.
This literature review explores the impacts of different cadaveric preservation methods on tissue mechanics, examining a range of studies to highlight how these techniques affect the properties of various types of tissues. The review will also discuss the implications for biomechanical research and its applications, and identify areas of futures research.
History and Preservation Methods
History
Human body preservation has been practiced throughout history for religious, cultural, and scientific reasons. In Ancient Egypt, acceptance into the afterlife was associated with preservation of the post-mortem body[2]. In northern Chile and southern Peru, the ancient Chinchorro people were among the first to perform mummification. Early documentation of embalming in Europe, dating back to 500 AD, describes processes involving natron, herbs, cedar oils, tree-derived resins, tars, and pitch. By the middle ages, alcohol was being experimented with as an immersion fluid, along with the insertion of herbs into incision sites. Throughout the 19th century, British, French, and Italian anatomists experimented with arterial injection, a method now highly favoured in preservation. Arsenic, turpentine, and chamomile oils were increasingly popular injection fluids in this time, until the discovery of Formaldehyde in 1869 by German chemist August Wilhelm von Hoffmann replaced almost all prior embalming fluids. Plastination was developed by Professor Gunther von Hagens in 1977, and revolutionized anatomical education by allowing long-term preservation of biological structures. [3]
Cryogenic Preservation
Cryogenic preservation involves storing biological materials at extremely low temperatures to halt biochemical reactions that lead to cell death. A study by Chang et al. focused on assessing the mechanical, structural integrity, and microbiological properties of cryopreserved human cadaveric iliac arteries over varying durations, comparing them to their fresh counterparts[4]. The study found that the mechanical properties of arteries, such as stiffness, varied with the length of cryopreservation. Specifically, arteries stored for shorter periods maintained mechanical properties closest to fresh tissues, with increasing stiffness noted in arteries preserved for longer periods. Cryopreservation was found to potentially aid in maintaining sterility, showing no bacterial growth post-thaw in initially colonized samples. This suggests that while cryogenic preservation can maintain the structural and microbiological integrity of arterial tissues, the duration of storage significantly impacts their mechanical properties, necessitating careful consideration in medical applications such as vascular grafts.
Formalin Embalming
Formaldehyde is a gas consisting of CH²O. When mixed in a solution with water, it is called formalin, with concentrations ranging from 3-10%. It is an excellent preservative of tissue, with bactericidal, fungicidal, and insecticidal properties, but low corrosion of tissue microstructures[2]. However, it can cause extreme rigidity in cadavers, turns tissues grey when mixed with blood, and dehydrates tissues. Additionally, long-term exposure to formaldehyde gas from embalmed specimens has been associated with cancers of the nose, pharynx, head, neck, respiratory system, lymphocytes, brain, and central nervous system.
Thiel Embalming
Thiel’s embalming technique is a soft-fix embalming method that aims to produce flexible cadavers. The process of embalming with Thiel’s method involves applying a specific embalming mixture called Thiel’s embalming mixture. A study by Munirama et al. examined this process and investigated the effect on physical properties for the embalmed cadavers[6]. They reported that the cadavers are submerged in a mixture consisting of monopropylene glycol, ammonium nitrate, potassium nitrate, sodium sulphite, boric acid, chlorocresol, and formaldehyde for 4-6 months. They found that this process produces life-like cadavers, with full movement of joints and a preservation period of 3 years[6]. Another study by Lingbo et al., looked at the usefulness of Thiel cadavers for surgical training and anatomy[5]. They found that the improved flexibility and representation of fresh-frozen cadavers provided a valuable training asset for surgical procedures[5]. When looking at the biomechanical loading properties, it was found that this method of embalming produced significant differences in mechanical properties. Specifically, it was found that for biomechanical load to failure tests these embalmed cadavers had a significantly altered failure strain and plastic energy absorption[7].
While Thiel embalmed cadavers are often used in medical schools to teach gross anatomy, a cheaper alternative is plastination. In plastination, specimens are fixed in formalin, impregnated with a resin mixture, and cured in gas to become completely hard. This results in a plastic-like specimen that, while not biofidelic, is useful for educational purposes. [8]
Biofidelity of Preservation Methods
Various testing methods have been implemented in order to validate the biofidelity of tissues and skeletal components in biomechanics. These experiments often involve different preservation techniques, such as freezing, formalin embalming, fresh samples, and occasionally Thiel embalming. Each of these preservation techniques comes with their own set of advantages and disadvantages. The technique of freezing involves storing cadaver specimens at sub-zero temperatures to prevent decomposition and further tissue degradation after death. In comparison, formaldehyde is often injected into the arterial system of the specimen where it acts as a disinfectant and combatant to decomposition. Thiel Embalming is a newer technique that involves submerging the specimen in a preservation fluid, leading to increased soft tissue flexibility, as well as preservation of tissue colour. However, the biofidelity of Thiel embalmed specimens is still largely unknown, and requires further research.
Effects on Specific Body Parts
Bile Duct
Studies have been performed on different segments of the body to test preserved tissue performance in order to establish a baseline for post mortem human surrogate viability in injury biomechanics testing. One study looked at the behaviour of the bile duct wall of cadavers, and specifically how this affects the biomechanical attributes of the tissue[9]. The cadavers chosen for the experiment were grouped into fresh, frozen, and embalmed specimens. The embalmed cadavers were fixed using a formalin injection to the carotid artery, then preserved in a 4 degree Celsius room. The results from the experiment showed non linear strain hardening behaviour of the tissues, with there being a noticeable difference in the axial response of the tissues for the different cadavers.
| Axial | 1st load | 1st unload | Loading energy | Hysteresis energy | Ratio of hysteresis | ||
|---|---|---|---|---|---|---|---|
| 0-2% | 2-4% | 0-2% | 2-4% | ||||
| G1 (Frozen) | 6,03
(2,79) |
5,86
(3,75) |
2,27
(1,02) |
5,26
(2,77) |
0,60
(0,35) |
0,20
(0,08) |
33% |
| G2 (Embalmed) | 5,69
(2,33) |
6,21
(4,00) |
2,86
(2,07) |
5,59
(3,29) |
0,45
(0,25) |
0,12
(0,06) |
27% |
| G3 (Fresh) | 19,50
(14,78) |
37,46
(37,04) |
8,91
(6,57) |
28,58
(28,18) |
1,28
(0,68) |
0,49
(0,25) |
38% |
| p | 0,17 | 0,20 | 0,16 | 0,22 | |||
*Mean (standard deviation) (kPa), p: p-value, statistical significance if p<0.05
It was therefore concluded that the preservation process does have an important impact on tissue performance under loading. The results were summarized for this ratio of both frozen and embalmed to fresh specimen performance seen below.
| Slope of the curves | Hysteresis | |||
|---|---|---|---|---|
| Relative variation means | Relative variation
Standard deviations | |||
| Relative variation | Direction test | % | % | % |
| G1/G3 | Axial | 82,0 | 8,3 | 85,6 |
| Circumferential | 54,2 | 19,1 | 62,4 | |
| G2/G3 | Axial | 81,0 | 9,0 | 84,7 |
| Circumferential | 33,2 | 8,2 | 38,8 | |
ACL
A similar study looked at the tensile properties of human femur-ACL-tibial complexes, and the retention of biomechanical properties in tissues for male cadavers[10]. The specimens were split into three preservation techniques: 10% formalin injection, deep freezing at -20 degrees then thawing, and fresh cadavers. The results showed that the failure force for the fresh cadavers was highest while the frozen and formalin samples recorded around half the value. The elongation of the samples also varied, as well as the rupture point for where failure occurred.
The preservation technique used can also impact bone performance: one study looked specifically at how bone properties were affected by the post mortem processing technique[11]. In this study, four specimens were preserved at -20 degrees to specifically observe how thawing time after freezing preservation affected bone strength, density, and biofidelity. Screws were inserted into the femurs and rapidly removed from the bone to observe impact. The screws were pulled at 16, 50, or 90 hours at a rate of 5mm/min, with the 90 hour specimen designed to be reflective of 2-4 months of in vivo loading. In all three tests, bone failure did occur; however there was a decrease in screw pullout strength as drying time increased, showing a time-dependent difference in the mechanical properties of bones.
Feet
To examine how preservation method impacts the kinematics of the feet, one study mounted three fresh-frozen and three Thiel-embalmed feet[12]. The specimens were amputated 20cm above the medial malleolus, to an axial jig, and dropped them onto a pressure-mapping system using a range of weights and ankle positions. Using a six-camera optoelectronic motion capture system, the kinematic data of each specimen was recorded, including the relative angles of each foot segment to adjacent segments.
Data collected from the pressure-mapping system yielded the mean force difference, mean impulse, mean contact area, and mean peak pressure difference between the frozen and Thiel embalmed specimens. Both the kinetic and kinematic data showed no statistically significant difference between preservation methods in most of the categories, suggesting that Thiel-embalmed specimens could prove a viable alternative to fresh frozen specimens in kinetic and kinematic testing applications.
Biceps
To examine the material properties of frozen and embalmed tissues, another study performed tensile tests on fresh, fresh-frozen, formalin embalmed, and Thiel-preserved long heads of bicep tendons[13]. Tensile failure was found to occur at averages of 12N/mm² for fresh specimens, 40.1 N/mm² for fresh-frozen, 50.3 N/mm² for formalin-embalmed, and 52 N/mm² for Thiel-embalmed.
| Load to failure
N/SQMM |
SD | 95% CI | |
|---|---|---|---|
| Fresh | 12 | 3.8 | 8.5 - 15.5 |
| Fresh-frozen | 40.1 | 12.3 | 23.1 - 57.1 |
| Thiel | 52 | 13.5 | 37.8 - 66.2 |
| Formalin | 50.3 | 15.5 | 41.7 - 58.9 |
The Young’s modulus of each specimen was found to be 25.6 Pa for fresh, 55.3 Pa for fresh-frozen, 82.5 Pa for Thiel-embalmed, and 510.6 Pa for Formalin-embalmed.
| Young's modulus (Pa) | SD | 95% CI | |
|---|---|---|---|
| Fresh | 25.6 | 15.7 | 11 - 40.1 |
| Fresh-frozen | 55.3 | 28.4 | 31.6 - 79 |
| Thiel | 82.5 | 38.3 | 42.3 - 122.7 |
| Formalin | 510.6 | 187.8 | 406.6 - 614.6 |
This demonstrates remarkable similarity in the load to failure for fresh-frozen, formalin-embalmed, and Thiel-embalmed, suggesting that these could be used comparably in static tensile applications. However, the elastic modulus for all embalmed specimens were much higher than those of the fresh and fresh-frozen specimens, meaning that they would not prove viable alternatives in viscoelastic or dynamic load testing applications.
Ocular Tissue
In order to research ocular diseases, high quality RNA is required for gene expression analysis. However, in the death to preservation time (DP), the viability of RNA can deteriorate. In one study from Kim et al., 16 eyes were monitored to examine the degradation of the RNA integrity number (RIN) in different DP cases [14]. It was observed that trabecular tissues has a significantly higher RIN compared to the ciliary body for shorter DP. In addition, RIN values for non vascularized tissues were higher than vascularized at early DP times. Lastly, cornea RINs were significantly correlated to DP time, with tissues becoming less viable as the time between death and preservation increased. In regards to the retina, it was determined that it was superior in quality over post mortem irises. In summary, it was determined that ocular tissue biofidelity is linked to post mortem preservation time, which in turn affects RNA quality and effectiveness of analysis.
Abdominal Organs
Abdominal organs containing the liver, kidney, and spleen are some of the most commonly observed in automobile injuries. According to the National Automotive Sampling System (NASS), almost 19,000 adult occupants were involved in AIS 2+ abdominal injury incidents [15]. In order to determine the biofidelity of post mortem abdominal organs, studies from Lu et al. were conducted looking at the indentation and elastic properties of frozen and cooled specimens [15]. These specimens were compared to fresh harvested tissues to determine any change in stiffness. The results showed an increase in kidney stiffness for both cases, decreased stiffness of the spleen in both cases, and increased liver stiffness in cooling with little changes in freezing. One hypothesis for the behaviour of the liver was increased osmolality of extracellular fluid, leading to dehydration of cells in the cooling method. While the frozen liver may not demonstrate a significant change in stiffness, this does not indicate cellular damage that may affect other soft tissue failure. For the kidney, increased stiffness can be attributed to the thick renal capsule layer. This layer is composed of fibrous collagen and elastin. Elastin is previously known from other studies with cadaver toe regions to increase stiffness. Other abdominal organs such as the spleen which contain less elastic are potentially less stiff due to faster autolysis during cooling and freezing. Autolysis occurs when a cellular destruction occurs via it's own enzymes, softening the organ.
Brain Tissues
Brain tissues are one of the most essential for studying brain injuries, especially in motor vehicle safety applications. However, post mortem brain tissue deteriorates after death mainly due to microbial growth (fungi and bacteria) as well as change in acidity conditions from lack of oxygen [16]. In order to prevent significant degradation of the tissues, studies have looked into preservation solutions to maintain tissue integrity. One particular solution of antibiotic/anti-fungal and sodium bicarbonate was found to have the least tissue breakdown compared to fresh samples. In one test from Mallory et al., samples stored without any preservative were found to be much less stiff than fresh specimens; however, preserved tissue was found to be similar in mechanical performance[16]. In the solution, the antibiotic prevents microbial growth, while the sodium bicarbonate works as a buffer to decrease acidity which leads to autolysis.
Environmental Factors on Cadavers
Issues with cadaver testing can arise in adverse climates, or in countries were body donations are scarce. In India for example, it is less common for bodies to be donated to science so often medical schools will use unclaimed bodies, raising significant ethical concerns[17]. In addition, India has dry spells in winter and early summer, and humid spells in the later summer and monsoon season. The dryness can lead to brittle specimens, whereas the high humidity can increase the risk of decomposition. During dry spells, specimens can be covered in water and glycerol soaked cotton to prevent moisture loss. During the humid season, dry cotton can be applied to reduce moisture.
Climate and humidity may also affect decomposition of the cadaver into the primary mineral element, or on the contrary, towards the preservation of the cadaver for a period of time. In one study, a cadaver was exposed to warm, humid summer conditions[18]. These temperatures, combined with exposure to sunlight and minimal clothing, created ideal conditions for rapid putrefaction and intense insect activity. A second cadaver was exposed to a dry, enclosed, high-heat environment with low humidity and limited insect access. This led to natural mummification over three years, with excellent preservation of features like tattoos and facial structure. The study concluded that heat and humidity accelerate decomposition, while dry heat and dehydration can slow decay and result in long-term preservation.
Summary of Findings
From these test results, it is clear that the mechanical properties of various parts of the body are impacted by the preservation technique. Some samples can also be taken from the specimen during autopsy and stored for later testing. These come with a new set of issues though, as even trying to preserve and store samples can affect properties like composition and concentration. One example is postmortem methemoglobin (MetHB), which can be retrieved during autopsy from the femoral and cardigan blood supplies[19]. MetHB is a type of hemoglobin in the bloodstream that cannot bind to oxygen and lead to lethal anoxia. However, if stored in a freezer, the hemoglobin in the blood auto oxidizes in MetHB, requiring the addition of a cryoprotectant. Similar to cadavers, samples can be placed in refrigerated storage, however this is not suitable for long term preservation.
Looking specifically at the lungs, kidneys, heart, and liver of formalin embalmed cadavers, one study found that in general heart tissue was the best performing out of all the other organs[20]. In the study, cadavers were embalmed within 24 hours of death, and all testing was carried out within 36 months. In total, 76 kidneys, 39 hearts, 49 livers, and 96 lungs were examined and categorized into either ‘good’, ‘satisfactory’, or ‘poor’ cellular composition.
The heart tissue was reported to have the most ‘good’ results and the least ‘poor’. This could potentially be attributed to the proximity to the embalming injection. The heart receives fixative from both within the changers and from the coronary arteries. In comparison, to get to the lungs the fixative must travel through small sinuses that restrict flow. The ‘good’ ratings given were based on tissue samples that had strong cellular and nuclei definition. Satisfactory indicated some cellular definition, while poor indicated almost no definition at all.
Lesions most commonly found in the tissues included atherosclerosis, neoplasms, myocardial infarct, pneumonia, chronic obstructive lung disease, and interstitial fibrosis of the myocardium. The results of the pathologic conditions of the tissues were also reported, however there was no significant link between the pathologic state of the tissue and its previous ranking.
It was therefore concluded that similar to the previous studies discussed, the biomechanical properties of tissues after death can vary in their performance, however there was a >75% satisfactory level reached which indicates that as a source for testing, cadaver tissue is generally reliable.
Applications to Specific Fields
Biomechanical Modelling
Modelling provides a biofidelic testing alternative that eliminates the need for cadaveric specimens or live volunteers. However, to develop accurate and reliable models, high-quality test data is essential. Computational models often integrate empirical data from cadaveric studies, but the differences between preserved and fresh tissues must be accounted for to ensure accurate simulations of in vivo conditions. In the case of impact biomechanics, such as crash testing and sports injury research, these discrepancies can influence safety equipment design and injury prediction models.
Medical Training and Surgical Applications
Cadaveric specimens play a crucial role in medical training, especially in surgical education[21]. The preservation method used significantly influences specimen usability, as differences in tissue properties affect the realism of procedures like suturing, dissection, and orthopedic interventions. Identifying the most suitable preservation techniques for specific procedures requires analysis of how preservation alters tissue characteristics.
Medical Research
Preservation methods also impact biochemical analyses, such as drug metabolism studies, toxicology, and forensic pathology. The example of postmortem methemoglobin (MetHB) formation highlights how biochemical properties can change after death, complicating the interpretation of forensic evidence[19].
Problems and Controversies
One challenge surrounding post mortem human surrogates is public reluctance to donating ones body for scientific research [22]. However, many are unaware that donors often consult with the anatomical institutes prior to donation to set up legacy details, including specific body parts and length of stay at the institution. Additionally, many universities hold memorial celebrations for cadavers following dissection. Post mortem subjects are both consenting donors, and critical to biomechanical research fields, and can often identify potential injury not captured in ATDs. They also contribute to the improvement of computer models, and future ATD revisions [23].
There have been arguments about deceased people having a prima facie moral right to privacy in the context of health data research. After death, people are no longer considered as biological subjects, but still have informational entities which can be damaged. It was determined that post-mortem privacy should be recognized in the GDPR or in national laws, while ‘contextual exceptionalism’ requires that all studies are evaluated by research ethics committees. This would help protect data privacy and maintain public trust in research. [24]
Future Research
The study of preserved post-mortem human subjects presents numerous opportunities for advancing research, particularly through the standardization of testing protocols. The lack of standardized practices across various elements such as tissue selection, embalming, freezing or defrosting processes, and experimental conditions complicates the comparison of results across studies[9]. Different tissues may respond variably to preservation processes, leading to inconsistencies that hinder the drawing of reliable conclusions. To enhance the reproducibility and applicability of research findings, efforts should be made to establish and adhere to uniform protocols.
One possible direction for future research is the implementation of longitudinal studies and real-time data collection to monitor the biomechanical properties of tissues over time. Such studies would provide valuable insights into the long-term effects of different preservation methods, offering benefits beyond the scope of injury biomechanics. These insights are particularly relevant for fields requiring the extended use of preserved tissues, such as medical education and surgical training, where the fidelity of tissue properties is crucial.
However, challenges such as obtaining sufficient sample sizes persist, primarily due to the limitations associated with body donations. Despite these challenges, the accumulation of data over time is expected to gradually increase confidence in the research findings. The integration of empirical biomechanical data with advanced computational models could significantly enhance the predictive accuracy of studies, potentially reducing the reliance on cadaveric specimens. This integration would allow for more sophisticated simulations of tissue behaviour under various conditions, thereby improving the overall quality and applicability of biomechanical research.
By addressing these areas, future research in the biomechanics of preserved post-mortem human subjects could lead to significant advancements in injury biomechanics.
References
- ↑ Francisco J. Lopez-Valdes, Alberto Mascareñas Brito, Amanda M. Agnew, Peter Cripton, Jason Kerrigan, Spyros Masouros, Kai-Uwe Schmitt, Gunter Siegmund, The ethics, applications, and contributions of cadaver testing in injury prevention research, Traffic Injury Prevention, Volume 25, Issue 8, 2024, Pages 1115-1128, ISSN 1538-9588, https://doi.org/10.1080/15389588.2024.2376937.
- ↑ 2.0 2.1 Brenner, E. (2014). Human body preservation - old and new techniques. Journal of Anatomy, 224(3), 316–344. doi:10.1111/joa.12160
- ↑ E. Ottone, Nicolás (23 November 2023). "Brief Review of the Origins of Plastination". Advances in Plastination Techniques: 19.
- ↑ Chang, S. K., Lau, J. W., & Chui, C. K. (2014). Changes in mechanical, structural integrity and microbiological properties following cryopreservation of human cadaveric iliac arteries. Annals of the Academy of Medicine, Singapore, 43(10), 492–498.
- ↑ 5.0 5.1 5.2 Lingbo Y., Koki E., Takashige A., et al. Validation and motion analyses of laparoscopic radical nephrectomy with Thiel-embalmed cadavers. Current Problems in Surgery. 2024;61(10).
- ↑ 6.0 6.1 Munirama S, Eisma R, Columb M, Corner GA, McLeod GA. Physical properties and functional alignment of soft-embalmed Thiel human cadaver when used as a simulator for ultrasound-guided regional anaesthesia. Br J Anaesth. 2016 May;116(5):699-707. doi: 10.1093/bja/aev548. PMID: 27106974.
- ↑ Liao PY, Wang ZG. Thiel-embalming technique: investigation of possible modification in embalming tissue as evaluation model for radiofrequency ablation. J Biomed Res. 2019 Apr 8;33(4):280–8. doi: 10.7555/JBR.32.20160148. Epub ahead of print. PMID: 30956232; PMCID: PMC6813523.
- ↑ Cannas, M., & Fuda, P. (1991). "Plastination of Old Formalin-Fixed Specimens". The Journal of Plastination. 5: 15.CS1 maint: multiple names: authors list (link)
- ↑ 9.0 9.1 9.2 9.3 Girard, E., G. Chagnon, E. Gremen, M. Calvez, C. Masri, J. Boutonnat, B. Trilling, B. Nottelet, Biomechanical behaviour of human bile duct wall and impact of cadaveric preservation processes., Journal of the Mechanical Behavior of Biomedical Materials, Volume 98, 2019, Pages 291-300, ISSN 1751-6161, https://doi.org/10.1016/j.jmbbm.2019.07.001.
- ↑ Marieswaran M, Mansoori N, Digge VK, et al. Effect of preservation methods on tensile properties of human femur-ACL-tibial complex (FATC) - a cadaveric study on male subjects. Acta Bioeng Biomech. 2018;20(4):31-42.
- ↑ Cartner JL, Hartsell ZM, Ricci WM, Tornetta P 3rd. Can we trust ex vivo mechanical testing of fresh--frozen cadaveric specimens? The effect of postfreezing delays. J Orthop Trauma. . 2011;25(8):459-61. doi:10.1097/BOT.0b013e318225b875.
- ↑ Gatt A, Schembri-Wismayer P, Chockalingam N, Formosa C. Kinematic and Kinetic Comparison of Fresh Frozen and Thiel-Embalmed Human Feet for Suitability for Biomechanical Educational and Research Settings. J Am Podiatr Med Assoc. 2019 Mar;109(2):113-121. doi: 10.7547/16-130. PMID: 31135207.
- ↑ 13.0 13.1 13.2 Hohmann, E., Keough, Natalie, Glatt, Vaida, Tetsworth, Kevin, Putz, Reinhard, Imhoff, Andreas, The mechanical properties of fresh versus fresh-frozen and preserved (Thiel and formalin) long head of biceps tendons: a cadaveric investigation.Annals of Anatomy https://doi.org/10.1016/j.aanat.2018.05.002.
- ↑ 14.0 14.1 Kim BJ, Sprehe N, Morganti A, Wordinger RJ, Clark AF. The effect of postmortem time on the RNA quality of human ocular tissues. Mol Vis. 2013 Jun 11;19:1290-5. PMID: 23805035; PMCID: PMC3692406.
- ↑ 15.0 15.1 Lu Y-C, Untaroiu CD. Effect of storage methods on indentation-based material properties of abdominal organs. Proceedings of the Institution of Mechanical Engineers, Part H. 2012;227(3):293-301. doi:10.1177/0954411912468558
- ↑ 16.0 16.1 Mallory A, Wetli A, Neuroth LM, Rhule H, Moorhouse K, Satterfield K, Thomas C, Tesny A, Kang YS. Preservatives for postmortem brain tissue in biomechanical testing: A pilot study. J Anat. 2024 Sep;245(3):501-509. doi: 10.1111/joa.14069. Epub 2024 Jul 15. PMID: 39010676; PMCID: PMC11306769.
- ↑ Ghosh, S. K., & Sharma, S. (2015). Cadaveric preservation under adverse climatic conditions. Surgical and radiologic anatomy : SRA, 37(10), 1287–1288. https://doi.org/10.1007/s00276-015-1505-9
- ↑ Buhaș, C., Mihalache, G., Judea-Pusta, C., Buhaș, B., & Olsen, M. (2016). "The influence of the environmental factors on the human cadaver" (PDF). Analele Universităţii din Oradea, Fascicula: Ecotoxicologie, Zootehnie si Tehnologii de Industrie Alimentara. Vol. XV/B.CS1 maint: multiple names: authors list (link)
- ↑ 19.0 19.1 Varlet, V., Elenore Ryser, Marc Augsburger, Cristian Palmiere, Stability of postmortem methemoglobin: Artifactual changes caused by storage conditions, Forensic Science International, Volume 283, 2018, Pages 21-28, ISSN 0379-0738, https://doi.org/10.1016/j.forsciint.2017.12.009.
- ↑ Rae, G., Newman, W.P., III, McGoey, R., Donthamsetty, S., Karpinski, A.C. and Green, J. (2018), The histopathologic reliability of tissue taken from cadavers within the gross anatomy laboratory. American Association of Anatomists, 11: 207-214. https://doi.org/10.1002/ase.1743.
- ↑ Gilbody, J., Prasthofer, A. W., Ho, K., & Costa, M. L. (2011). The use and effectiveness of cadaveric workshops in higher surgical training: a systematic review. Annals of the Royal College of Surgeons of England, 93(5), 347–352. https://doi.org/10.1308/147870811X582954
- ↑ Hans Schnittler, Uwe Ortmann, Stefan Washausen, Wolfgang Knabe, Frank Wesemann, Stefan Triphaus, Bettina Schöne-Seifert, Holding donated human bodies in conservation: A novel interactive safe-keeping system meeting high ethical and safety standards, Annals of Anatomy - Anatomischer Anzeiger, Volume 225, 2019, Pages 11-16, ISSN 0940-9602, https://doi.org/10.1016/j.aanat.2019.05.007.
- ↑ Lopez-Valdes FJ, Mascareñas Brito A, Agnew AM, et al. The ethics, applications, and contributions of cadaver testing in injury prevention research. Traffic Inj Prev. 2024;25(8):1115-1128. doi:10.1080/15389588.2024.2376937
- ↑ Marieke A. R. Bak & Dick L. Willems (3 August 2022). "Contextual Exceptionalism After Death: An Information Ethics Approach to Post‑Mortem Privacy in Health Data Research" (PDF). Science and Engineering Ethics (2022). line feed character in
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