Forensic Analysis of 33 Cases of Fatal Pulmonary Thromboembolism / 法医学杂志

OBJECTIVE@#To explore the related risk facts of pulmonary thromboembolism (PTE) and analyze the relation between PTE and the trauma or medical behavior by investigating the cases of PTE.@*METHODS@#Thirty-three cases were selected from Institute of Forensic Science (IFS) from 2000 to 2014.@*RESULTS@#In 33 cases, 16 decedents were male, 17 decedents were female; different degrees of dyspnea, chest tight- ness and syncope symptoms were the clinical manifestation of the deceased; the thrombus was mainly distributed in the left and right pulmonary arteries. The main source of embolism was the deep vein of lower limb and the left probability was higher. Trauma, limited position, operation and cardiovascular disease showed high-risk factors of PTE; D-Dimer test, hemolytic test and computer tomography pul- monary angiography were the diagnostic tools for PTE. In some cases, trauma and medical malpractice could be involved in the cause of death.@*CONCLUSION@#Non-typical clinical symptoms present in the most cases caused by PTE, and these cases always show many high-risk factors. The relation between PTE and injury or medical behavior should be considered carefully in the forensic pathological practice.

Uso de fibrinógeno humano en la generación de soportes para la obtención de equivalentes tisulares / Use of human fibrinogen in the generation of scaffold for obtaining Tissue equivalents

Desde sus orígenes, la Ingeniería de Tejidos ha buscado diversos materiales que puedan ser utilizados para la generación de soportes que sirvan para el anclaje, proliferación y diferenciación celular que conduzcan a la obtención de tejidos humanos. Muchos materiales de tipo cerámico, polimérico y metálico se han evaluado, pero hasta la fecha muchos de ellos han sido rechazados por diversas razones, entre otras su escasa biocompatibilidad y biodegradabilidad, la respuesta inmune generada, la baja resistencia mecánica o el riesgo de transmisión de virus o priones. El fibrinógeno es una proteína presente en el plasma sanguíneo que puede ser utilizada para la generación de soportes tridimensionales que favorezcan el crecimiento de células; se obtiene a partir del propio paciente, bancos de sangre o como proteína purificada (Tisseel® o Tissucol®, Laboratorios Baxter). El fibrinógeno evita el desencadenamiento de una respuesta inmunológica y el uso de productos xenogénicos. Debido a la estructura proteica, la adhesión y proliferación celular se ven favorecidas dando excelentes resultados en la generación de equivalentes de piel, cartílago, córnea y reemplazos cardiacos en aplicaciones in vitro e in vivo. Como desventajas presenta su rápida degradación y su baja resistencia mecánica; sin embargo, en los últimos años se han venido evaluando mezclas con algunos biopolímeros como ácido poliláctico (PLLA), ácido poli-glicólico (PGA) y alginato de sodio. Esta revisión presenta algunas de las principales aplicaciones del fibrinógeno en Ingeniería de Tejidos.

Since its origin, Tissue Engineering has sought various materials that can be used for generation of scaffolds that serve to anchor, proliferation and cell differentiation leading to the production of human tissues. Many materials such as ceramic, polymeric and metal type have been evaluated to date but many have been rejected for various reasons, including its limited biocompatibility and biodegradability, immune response generated, low mechanical strength or the risk of transmission of virus or prions. Fibrinogen is a protein present in blood plasma that can be used to generate three-dimensional scaffolds that favors growth of cells, it is obtained from the patient itself, bank of blood or purified protein (Tisseel® or Tissucol®, Laboratorios Baxter). Fibrinogen acts slowing or reversing the immune response and avoiding the use of xenogeneic materials. Because the protein structure, adhesion and cell proliferation is favored with excellent results in the generation of skin equivalents, cartilage, cornea and even heart replacements in vitro and in vivo. The disadvantages presented are the rapid degradation and low mechanical strength, but in recent years it has been evaluating some biopolymer mixtures as polylactic acid (PLLA), poly-glycolic acid (PGA) and sodium alginate. This review presents some of the main applications of fibrinogen in Tissue Engineering.

Novel thrombolytic therapy discovered from traditional oriental medicine using the earthworm.

Since a few thousand years ago, the earthworm has been used as a drug for various diseases in China and the Far East. However, modern scientific pharmacological studies have not so far been performed. We extracted a very strong fibrinolytic enzyme from the earthworm, Lumbricus rubellus. This enzyme was heat-stable and displayed a very broad optimal pH range. Purification of the enzyme was performed and three partially purified fractions were obtained. These three fractions were further subdivided, and six purified fractions (F-I-0, 1, 2, F-II, and F-III-1,2) were finally obtained. Based on results of their enzymatic activities against various substrates, the fraction I enzymes are thought to represent chymotrypsin-like enzymes and the fraction III enzymes to represent trypsin-like enzymes. The fraction II enzyme appears to be neither a trypsin-nor chymotrypsin-like enzyme nor an elastase. We therefore designed trials for in vivo experiments on human volunteers. 120 mg of lyophilized earthworm powder was administered orally to 7 healthy volunteers (aged 28-52 years old) three times after meals every day for 17 days. Blood was withdrawn once a day before and at 1, 2, 3, 8, 11 and 17 days after commencing the administration. The fibrin degradation products (FDP) value, tissue plasminogen activator (t-PA) antigen level and t-PA activities were measured in the blood. Before the administration, the t-PA antigen level was 5.6 +/- 0.38 ng/ml, and it gradually increased until the 17th day. The FDP level was increased on the 1st and 2nd day after the administration, but had decreased and normalized by the 17th day. The fibrinolytic activities also tended to show an increase during the experiment. These results suggest that earthworm powder represents a possible oral thrombolytic agent. The earthworm enzyme may thus be applicable for treating patients with thalassemia.