Forensic Analysis of 43 Medical Disputes Caused by Death after Cardiac Surgery / 法医学杂志

Objective To explore the causes and characteristics of medical disputes caused by death after cardiac surgery and to analyze the pathological changes after cardiac surgery and the key points of forensic anatomy, thus to provide pathological evidence for clinical diagnosis and treatment of cardiac surgery and judicial appraisal as well as reference for the prevention of medical disputes in such cases. Methods Forensic pathological cases of medical disputes caused by death after cardiac surgery which were accepted by the Center for Medicolegal Expertise of Sun Yat-Sen University from 2013 to 2018 were analyzed retrospectively from aspects such as causes of death, pathological diagnosis, surgery condition, medical misconduct, and so on. Results The causes of death after cardiac surgery of 43 patients were abnormal operation, low cardiac output syndrome, postoperative infection, postoperative thrombosis, and other diseases. Among the 43 cases, there were 18 cases without medical fault while 25 cases had medical fault. Conclusion The medical disputes caused by death after cardiac surgery are closely related to the operative technique and postoperative complications. The causes of medical faults include defects in diagnosis and treatment technique, as well as unfulfillment of duty of care.

Exploration on molecular mechanism of hot herb Aconitum carmichaelii for therapeutic action based on metabolomics / 中草药

Objective: To observe the effects of Aconitum carmichaelii on serum metabolites in mice by metabolomics technology, and to explore biomarkers and metabolic pathways and targets related to its treatment of various ailments such as cardiovascular diseases, in order to uncover its molecular mechanism of efficacy. Methods: Twenty male mice were randomly divided into two groups, and A. carmichaelii decoction and distilled water were orally administered with the dose of 15 mL/(kg∙d) for consecutive 4 d respectively. Collected blood samples of each group were analyzed using UPLC-MS/MS technology, and data pattern recognition was performed using PCA, PLS-DA and other analytical methods. Meanwhile, differential metabolites were screened out based on VIP greater than 1 and manual integral calculation. The differential metabolites were used for pathway analysis. Network modular analysis and targets screening were performed by Cytoscape and MetScape. Results: When performing data pattern recognition, the aconite group and the control group could be completely separated. A total of 18 differential metabolites were screened out, and their contents were up-regulated. Pathway analysis was performed to obtain five related pathways, namely linoleic acid metabolism, arachidonic acid metabolism, starch and sucrose metabolism, nicotinate and nicotinamide metabolism, and inositol phosphate metabolism. Fourteen modules were obtained using the network analysis, the largest two of which were arachidonic acid metabolism pathway and linoleic acid metabolism pathway. The degree of arachidonic acid (59), linoleic acid (55), nicotinamide (26), and palmitic acid (11) were greater than the mean value (8.010) in the network, and the related pathways were arachidonic acid metabolism, linoleic acid metabolism, nicotinate and nicotinamide metabolism, and saturated fatty acid beta-oxidation pathway respectively. A total of 26 genes were screened out, all of which belonged to the cytochrome P450 enzyme system. Conclusion: A. carmichaelii may affect arachidonic acid metabolism by acting on CYP450, thereby improving the body's energy metabolism and producing therapeutic effects.