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In the practice of forensic pathology, fat embolism is one of the common causes of death, which can be divided into two categories: traumatic and non-traumatic. Non-traumatic fat embolism refers to the blockage of small blood vessels by fat droplets in the circulatory blood flow caused by non-traumatic factors such as underlying diseases, stress, poisoning and lipid metabolism disorders. At present, it is believed that the production of non-traumatic fat embolism is related to the disturbance of lipid metabolism, C-reactive protein-related cascade reaction, the agglutination of chylomicron and very low-density lipoprotein. The forensic identification of the cause of death of non-traumatic fat embolism is mainly based on the case, systematic autopsy, HE staining and fat staining, but it is often missed or misdiagnosed by forensic examiners because of its unknown risk factors, hidden onset, the difficulty of HE staining observation and irregular implementation of fat staining. In view of the lack of attention to non-traumatic fat embolism in forensic identification, this paper reviews the concepts, pathophysiological mechanism, research progress, existing problems and countermeasures of non-traumatic fat embolism, providing reference for forensic scholars.
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Humans , Autopsy , Embolism, Fat/pathology , Forensic Medicine , Forensic Pathology , Pulmonary Embolism/pathologyABSTRACT
Objective:To compare the efficacy of anhydrous ethanol and lauromacrogol in the treatment of ovarian endometriosis cyst (OEC), and to provide evidence for more effective use of these two sclerotic drugs.Methods:Thirty-three cysts in 30 patients with OEC, who were admitted to Taizhou Hospital of Zhejiang Province from February 2017 to June 2018, were treated by ultrasound interventional therapy, followed by catheter aspiration, saline cavity cleaning, anhydrous ethanol rinsing and sclerotherapy, and lauromacrogol alcohol 1∶1 mixed solution retained in the capsule (mixed group). The therapeutic effects were observed 6 and 12 months after operation. A total of 30 OEC in 28 cases admitted to the same hospital from 2013 to 2015 were retrospectively analyzed after similar treatment steps, but the intracapsular retention fluid was anhydrous ethanol (ethanol group). A total of 28 OEC in 26 patients admitted to the same hospital from 2015 to 2017 were washed with normal saline, then washed with lauromacrogol and retained in the capsule with lauromacrogol (lauromacrogol group). The therapeutic effects of 6 and 12 months after treatment between the three groups were compared.Results:According to the classification of cure, marked effect and inefficacy, there was a weak correlation among the three groups. The mixed group did not tend to be ineffective, while the lauromacrogol group tended to be ineffective 6 and 12 months after treatmen.the difference was statistically significant (adjusted standardized residual >2). According to the total effective (cure+ markedly effective) and ineffective classification, the effective rate of the mixed group was significantly higher than that of the lauromacrogol group ( P<0.016 7). There was no significant difference for the effective rate between the mixed group and the ethanol group, and between the ethanol group and the lauromacrogol group ( P>0.0167). Conclusions:The retention of ethanol-lauromacrogol mixture in the capsule of sclerotic OEC, after pre-rinsing with anhydrous ethanol is helpful to improve the curative effect of OEC and give full play to the therapeutic effect of common sclerosing agents used in ultrasound intervention.
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Objective To predict the presence of impairment of right ventricular function in prediabetes using two-dimensional speckle tracking imaging. Methods From June 2012 to May 2016, a total of 110 patients from Zhejiang Taizhou Hospital of Taizhou Enze Medical Center (group) were recruited, including 40 controls, 33 prediabetes and 37 type 2 diabetes. The routine right ventricular parameters were measured. Longitudinal peak strain of right ventricular free wall (RVLPSF), ventricular septal (RVLPSS) and global longitudinal peak strain of right ventricle (RVLPSG) were measured with two-dimensional spekle tracking imaging, and global systolic strain rate (SRS), global early diastolic strain rate (SRE) and global late diastolic strain rate (SRL) of right ventricle were also measured. LVEDVI, LVESVI, LVEF, RVD, E/A, e/a, E/e, TAPSE, RVFAC, RVLPSF, RVLPSS, RVLPSG, SRS, SRE, and SRL in the above 3 groups were analyzed with LSD-t test. Results Compared with the controls: RVLPSF, RVLPSS, RVLPSG, SRS, and SRE were all statistically reduced in prediabetes[(-27.89±4.11)% vs(-21.78±3.62)%,(-20.08±4.11)% vs (-16.88±2.68)%, (-23.98±2.96)% vs (-19.33±2.13)%, -1.67±0.25 vs -1.18±0.24, and 1.84±0.23 vs 1.35±0.20,t=3.45,3.42,3.44,3.44,and 3.43,all P<0.01].RVLPSF,RVLPSS,RVLPSG,SRS,and SRE were all statistically reduced in diabetes[(-27.89±4.11)% vs(-20.97±3.88)%,(-20.08±4.11)% vs(-15.42±1.92)%, (-23.98±2.96)% vs(-18.19±2.29)%,-1.67±0.25 vs-1.08±0.23,and 1.84±0.23 vs 1.18±0.27,t=3.43,3.45,3.43, 3.42,and 3.42,all P<0.01].Compared the prediabetes:SRE was significantly reduced in diabetes(1.35±0.20 vs 1.18±0.27, t=3.45, P<0.01). Conclusions Diastolic and systolic function of right ventricle were already impaired in prediabetes, and speckle tracking imaging can quantitatively evaluate the impairment.
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Objective To assess the left ventricular global systolic function changes using ultrasonic three -dimensional speckle tracking imaging (3 D -STI )in patients with uremia undergoing high -flux hemodialysis (HFHD)treatment.Methods 86 patients with uremia and 59 healthy volunteers were selected.Participants of control group underwent plasma brain natrinuretic peptide(BNP)examinations before 3D -STI examinations.All the uremia patients received HFHD therapy,and underwent BNP and 3D -STI examinations before and after 4 weeks HFHD therapy.Parameters of left ventricular three dimensional global area strain(GAS),global circumferential strain (GCS),global longitudinal strain(GLS)and global radial strain(GRS)were measured in each group.The correlation between each 3D -STI parameters and BNP level were analyzed.Results Compared with the control group,GAS, GCS,GLS and GRS of left ventricular were significantly lower(t =7.564,6.866,7.946,5.477,all P <0.05)and BNP level in the control group were significantly higher in the uremia group[(60.75 ±17.22)ng/L vs.(792.68 ± 184.56)ng/L,t =30.876,P <0.05].After HFHD therapy 4 weeks,GAS,GCS,GLS and GRS of left ventricular were significantly higher(t =4.233,5.933,6.546,2.959,all P <0.05)and BNP level were lower(t =27.533,P <0.05) than before treatment in the uremia group.GAS,GCS,GLS and GRS of left ventricular were negatively correlated with BNP level(r =-0.51,0.64,-0.46,-0.43,all P <0.05).Conclusion 3D -STI can accurately evaluate the changes of left ventricular global systolic function in patients with uremia before and after hemodialysis,and provide reliable basis for clinical treatment and efficacy assessment.
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ObjectiveTo explore the value of three-dimensional speckle tracking (3DT-STI) technique for evaluating end-systolic three-dimensional longitudinal strain (3DLSe) of left ventricular myocardium in patients with left anterior descending coronary artery (LAD) lesions.MethodsSixty patients with pure LAD lesions diagnosed by coronary artery angiography (CAG) in Taizhou Hospital from June 2012 to December 2014 were enrolled, including 30 patients with acute anterior wall myocardial infarction (infarction group) and 30 patients without acute anterior wall myocardial infarction (non-infarction group). Sixty patients in the control group were enrolled in Department of cardiology in Taizhou Hospital in the same period. 3DLSe within LAD blood-supplied region, adjacent region and remote region were analyzed in all cases using 3DT-STI. The 3DLSe differences of 3 groups were compared by one-way analysis of variance, and the 3DLSe differences between two groups were compared by the LSD-t test. The inter-observer and intra-observer consistency of 3DLSe of left ventricular myocardium were analyzed by Bland-Altman drawing analysis method.Results3DLSe of all 7 segments within LAD blood-supplied region were lower in infarction group than those of non-infarction group and control group, and the differences were statistically significant (infarction groupvs. control group:t values were 6.96, 7.41, 8.94, 8.23, 8.94, 12.09 and 15.99, respectively,P values were all less than 0.01; infarction groupvs. non-infarction group:t values were 5.30, 5.50, 4.66, 4.32, 4.66, 7.66 and 10.11, respectively, P values were all less than 0.01); 3DLSe of middle anterior segment, middle anterior septal segment, apical anterior segment, apical septal segment and apex of heart within LAD blood-supplied region were lower in non-infarction group than those of control group, and the differences were statistically signiifcant (t values were 3.56, 3.23, 3.02, 3.25 and 4.36, respectively,P values were all less than 0.01), but 3DLSe of basal anterior segment and basal anterior septal segment had no statistically significant difference. 3DLSe of basal inferior septal segment within LAD adjacent region had no statistically significant difference in all 3 groups. 3DLSe of basal lateral segment, middle inferior septal segment, middle lateral segment, apical inferior segment and apical lateral segment within LAD adjacent region were lower in infarction group than those of non-infarction group and control group, and the differences were statistically signiifcant (infarction groupvs. control group:t values were 4.15, 4.79, 4.58, 9.24 and 12.07, respectively,P values were all less than 0.01; infarction groupvs. non-infarction group:t values were 2.66, 3.59, 4.29, 7.74 and 10.33, respectively,P values were all less than 0.01); but 3DLSe of basal lateral segment, middle inferior septal segment, middle lateral segment, apical inferior segment and apical lateral segment within LAD adjacent region had no statistically significant difference between non-infarction group and control group. 3DLSe of all 4 segments within remote region had no statistically significant difference. Bland-Altman drawing analysis method showed the mean inter-observer and intra-observer difference of 3DLSe of left ventricular myocardium were-0.3% and-0.2%, the 95% conifdence interval (CI) were in the range of (-5.6%, 5.0%) and (-8.2%, 7.7%), respectively. It was demonstrated that 3DLSe of left ventricular myocardium had good inter-observer and intra-observer consistency.Conclusions3DLSe of left ventricular myocardium can detect the subtle changes in myocardial systolic function and is more sensitive than the conventional echocardiography. It can localization and analyze quantitatively the range of myocardial ischemia or infarction and has good consistency.
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Objective To investigate the efficiency of radiofrequency ablation (RFA) and microwave ablation (MWA) in treating uterine leiomyoma.Methods The clinical data of thermal ablation with RFA and MWA were retrospectively analyzed in 42 patients.All patients were followed up at least 12 months to observe the therapeutic effects after the treatment.The changes of vital signs and the size of uterine leiomyoma,the score of uterine leiomyoma symptom and quality of Iife(UFS-QOL) were compared after RFA or MWA,the two thermal ablations techniques of clinic efficiency and influence on complications were analyzed.Results 23 patients received treatment of RFA and 19 patients received MWA,the visual analogue scale(VAS)during operation and postoperation were statistically significant differences between the two groups(P ＜0.05).The sizes of uterine leiomyoma were significantly reduced after the thermal ablation,the differences of volume within two groups in different time were statistics significance(P ＜0.05),but there were no statistics significance differences between two groups (P ＞0.05).The symptoms in two groups were improved significantly after treatment and the scores of UFS-QOL were no statistics significance differences between two groups (P ＞0.05).Conclusions Both of RFA and MWA have significant clinic efficiency in treating uterine leiomyoma.Compared with MWA,RFA with lower adverse reactions during operation and postoperation.