A retrospective study of poisoning deaths from forensic autopsy cases in northeast China (Liaoning).

Acute poisoning is a public health threat that leads to morbidity and mortality worldwide. In this retrospective study, we evaluated autopsies from deaths caused by acute poisoning from 2008 to 2017 at the School of Forensic Medicine, China Medical University (SFMCMU) in the Liaoning Province, northeast China. A total of 140 poisoning deaths were investigated and the demographic characteristics, causes and manner of death, toxics category were analyzed. The number of poisoning deaths gradually increased during the study period. The majority of poisoning deaths were accidents (66.43%), followed by suicides (27.86%), and homicides (3.57%). Of the 140 cases, 47 (33.57%) were caused by drugs, 38 (27.14%) by agrochemicals (mainly organophosphate pesticides, n = 16), 37 (26.43%) by respiratory dysfunction toxics (mainly carbon monoxide, n = 21), and 9 (6.43%) by poisonous plants and animals. Alcohol/methanol (5, 3.57%) and other chemicals (4, 2.86%) accounted for the remaining cases. The present study provides poisoning distribution in the Liaoning province and highlights implications for public health policy and prevention efforts in northeast China.

[Progress on Hypoxic-ischemic Brain Damage Associated with CCR2 and CCL2].

Hypoxic-ischemic brain damage (HIBD) is referred to a common type of cerebral damage, which is caused by injury, leading to shallow bleeding in the cortex with intact cerebral pia mater. In recent years, studies show that a various kinds of immune cells and immune cellular factors are involved in the occurrence of HIBD. CC chemokine receptor 2 (CCR2) is a representative of CC chemokine receptor, and is widely distributed in cerebral neuron, astrocyte, and microglial cells, and is the main chemo-tactic factor receptor in brain tissue. CC chemokine ligand 2 (CCL2) is a kind of basophilic protein and the ligand of CCR2, and plays an important role in inflammation. In order to provide evidence for correlational studies in HIBD, this review will introduce the biological characteristics of CCR2 and CCL2, and illustrate the relationship between the immunoreactivity and HIBD.

[Progress on Correlation between the Expression of CDK5 and Brain Injury Time].

Cyclin-dependent kinase 5 (CDK5) is a member of cyclin-dependent kinase family, which does not directly regulate cell cycle. Through phosphorylation of target protein, CDK5 plays an irreplaceable role in the development, reparation and degeneration of neurons. Brain injury refers to the organic injury of brain tissue caused by external force hit on the head. Owing to the stress and repair system activated by our body itself after injury, various proteins and enzymes of the brain tissues are changed quantitatively, which can be used as indicators for estimating the time of injury. This review summarizes the progress on the distribution, the activity mechanism and the physiological effects of CDK5 after brain injury and its corresponding potential served as a marker for brain injury determination.

[Expression of p35 and p25 after Focal Cerebral Contusion in Rat].

OBJECTIVE: To study the expression of p35 and p25 in rat after focal cerebral contusion and to provide experimental data for estimating brain injury time. METHODS: Fifty adult male SD rats were randomly divided into 0 h, 6 h, 12 h, 24 h, 3 d, 5 d, 7 d, 10 d after focal cerebral contusion, control and sham-operated groups (5 rats each group). The focal cerebral contusion rat model was established. The expression of p35 and p25 protein of the damage peripheral zone in brain were detected by HE staining, immunohistochemistry and Western blotting at different injury time. RESULTS: A large number of p35 protein and a small amount of p25 protein were expressed in control group and sham-operated group. After focal cerebral contusion, p35 presented unimodal change with time and p25 presented bimodal changes with time. CONCLUSION: Expression of p35 and p25 showed different regularity with good time correlation, which could help to estimate the brain injury time.

[Progress of the recovery mechanism of brain injury associated with the gene polymorphism of apolipoproteins E].

Brain injury is a kind of wound by violence on head, which is a mechanical distortion of skull, meninx, cerebral vascular and brain tissue due to outside force acting on head. Apolipoproteins E (ApoE) is a major kind of apolipoproteins, participating in the metabolism of lipid and regulating balance of cholesterol. Some recent investigations show that gene polymorphism of ApoE is associated with various kinds of diseases. Also its immunoreactivity is changed regularly with brain injury. In addition, ApoE has remarkable effect in neurological normal growth and reparative process after brain injury. This article reviews the biological characteristics and mechanism of ApoE in the repair of brain injury and application prospect in forensic medicine, which may be able to provide new ideas for estimation of the brain injury time and related experimental research.

[Metallothionein-I/II in brain injury repair mechanism and its application in forensic medicine].

Metallothionein (MT) is a kind of metal binding protein. As an important member in metallothionein family, MT-I/II regulates metabolism and detoxication of brain metal ion and scavenges free radicals. It is capable of anti-inflammatory response and anti-oxidative stress so as to protect the brain tissue. During the repair process of brain injury, the latest study showed that MT-I/II could stimulate brain anti-inflammatory factors, growth factors, neurotrophic factors and the expression of the receptor, and promote the extension of axon of neuron, which makes contribution to the regeneration of neuron and has important effect on the recovery of brain injury. Based on the findings, this article reviews the structure, expression, distribution, adjustion, function, mechanism in the repair of brain injury of MT-I/II and its application prospect in forensic medicine. It could provide a new approach for the design and manufacture of brain injury drugs as well as for age estimation of the brain injury.

[Twenty autopsy cases of anaphylactic shock induced by cephalosporins].

OBJECTIVE: To explore the characteristics of autopsy cases of anaphylactic shock induced by cephalosporins and provide the evidences in forensic medicine. METHODS: Twenty cases of anaphylactic shock induced by cephalosporins were collected from April 2005 to August 2009 in judicial expertise center of China Medical University, and the characteristics of the cases were analyzed retrospectively. RESULTS: The age of decedents ranged from 40 to 60 years. Ninety percent of cases were from local medical centers and private clinics. The symptoms of the shock appeared 30 s-150 min after the administration of the drug, and death occurred 10 min-210 min after the appearance of the shock symptoms. In all cases, various degrees of eosinophil infiltration were observed in trachea and the lungs. Serum IgE detected by ELISA method was normal value in 14 cases. CONCLUSION: In fatal anaphylactic cases, little specific findings are detected during postmortem and microscope examination. For this reason, the determination of cause of death in these cases requires comprehensive analysis combined with clinic information and excludes other diseases leading to the sudden death.

[Homer protein expression after focal brain contusion in rats].

OBJECTIVE: To investigate Homer protein expression after focal brain contusion and explore the relationship between expression and injury time. METHODS: Focal brain contusion in rats was established and Homer protein expression in brain at different injury intervals after contusion was detected by immunohistochemistry and Western blotting. RESULTS: A small amount of Homer positive expression cells were detected in control group, sham operated group and experimental group (0.5 h after contusion). The amount of Homer positive expression cells increased after 3 h and reached peak 12 h after contusion. The amount of positive cells continued to decrease 1 d after contusion and to the base level 7 d after contusion. Homer protein expression based on immunohistochemistry and Western blotting had statistical difference among adjacent groups. CONCLUSION: Expression of Homer protein near the focal contusion area shows time dependence after brain contusion in rats.

Fatal acute compartment syndrome in patients after surgical treatment: 2 case reports.

This report describes 2 cases died from acute compartment syndrome after surgical treatment. Case 1 was a 30-year-old man suffered from upper arm fracture, who complicated with the acute compartment syndrome at the following day after surgical fixation, and died 6 days later. Case 2 was a 9-year-old woman sustained medial malleolus sprain, who experienced plaster cast immobilization and died 7 days after management. At autopsy, swollen and necrotized skeletal muscles with edema were detected in the involved region in both cases. Histopathologically, hemorrhage and infiltration of neutrophils were observed in the skeletal muscles. Intensive positive immunoreactivity of myoglobin was detected in granular casts in distal convoluted tubules by immunohistochemical staining. Marked elevation in serum urea nitrogen uric acid, creatinine and C-reactive protein levels was demonstrated by serological tests. The pathological findings and postmortem biochemical measurements indicated that both victims died due to myoglobinuric renal failure.

Death from accidental poisoning of methamphetamine by leaking into alimentary tract in drug traffic: a case report.

A case of acute mathamphetamine (MA) poisoning death was occasionally found in autopsy by leaking into alimentary tract from package in drug traffic. A Korean man (39-year-old) was found dead in his apartment in Shenyang and 158 columned-shaped packages (390 g) of MA were found in his alimentary tract by autopsy, in which four packages were found in the esophagus, 118 in the stomach and 36 in the lower part of small intestine. The packages were wrapped with tinfoil and plastic film, from which one package in the stomach was empty and ruptured. Extreme pulmonary edema, congestion and hemorrhage as well as moderate edema, congestion and petechial hemorrhage in the other viscera were observed at autopsy and microscopically. Simultaneously AMP (amphatamine) in urine was tested positive by Trige DOA kit. Quantitative analysis was performed by gas chromatography/mass spectrometry. Extremely high concentrations of MA were found in the cardiac blood (24.8 microg/mL), the urine (191 microg/mL), the liver (116 microg/mL) and the gastric contents (1045 microg/mL), and no alcohol and other conventional drugs or poisons were detected in the same samples. The poisoning dosage is 5 microg/mL in the plasma and lethal dosage is 10-40 microg/mL in the plasma according the report. This high concentrations of MA in blood indicated that the cause of death was result from acute MA poisoning due to MA leaking into stomach. Much attention must be paid in the body packer of drugs in illegal drug traffic.

[Expression of matrix metalloproteinase-3 after brain contusion in rats].

OBJECTIVE: To investigate the expression of matrix metalloproteinase-3 after brain contusion and its applicability for estimating the age of brain contusion. METHODS: Rats had been divided into three groups: control group, sham operation group and brain contusion group. The expression of matrix metalloproteinase-3 at different time was detected by immunohistochemistry and Western blot. RESULTS: By the immunohistochemistry, no staining was observed in control and sham operation groups. The positive staining of MMP-3 appeared 6 hours after contusion, increased gradually in 24 hours and peaked 5 days after contusion, then started to decrease, 14 days after contusion still could be observed. By the Western blot analysis, no expression of MMP-3 was detected in control and sham groups. The positive staining of MMP-3 appeared 6 hours after contusion, increased gradually and maximized 5 days after contusion, then started to decrease, 14 days after contusion still could be found. CONCLUSION: Time-order expression of MMP-3 could be used for estimating the age of brain contusion in forensic pathology.

Diagnostic aspects for epidemic hemorrhagic fever in legal medical autopsy: report of 2 cases and review.

Epidemic hemorrhagic fever (EHF) is known also as hemorrhagic fever with renal syndrome (HFRS). Hantaviruses, a notorious cause of EHF is spreaded by rodents or biting insects, can cause epidemic hemorrhagic fever. This report describes two rare medico-legal autopsy cases died from epidemic hemorrhagic fever. The victims were two male individuals aged 34 years and 29 years. The medico-legal autopsies were requested for alleged medical negligence. In both cases, autopsy reveals lesions to kidneys and lungs with multiple organ hemorrhage and edema, indicative of the generalized capillary damage. On admission to hospital, both patients had the symptom of fever, lumbago, renal failure and recent outdoor activities. The laboratory diagnosis results indicating multiple organ dysfunction syndrome are also important for certificating of EHF. Though the ELISA-based detection of virus-specific IgM antibody which has the highest titers between 8 and 25d after onset of disease is positive in the 34-year-old case and negative in 29-year-old case, the pathological findings and clinical laboratory analysis suggested the both victims died of EHF. In addition, immunohistochemistry analysis for Hantavirus antigen in lung or in tubular cells and PCR having been used increasingly in recent years contribute to the diagnosis of Hantavirus infection.

Study on changes of MMP-3 expression after brain contusion in rats.

To investigate the mechanism and to explore the applicability of MMP-3 (matrix metalloproteinase-3) to determine the age of brain contusion, expression of MMP-3 was studied by immunochemistry and Western blot techniques on model of brain contusion in rats. Brain contusion was performed by falling weight in adult male Sprague-Dawley rats after anesthetized with diethyl ether, then maintained with 2% pentobarbital sodium (30 mg/kg). Samples were collected at 6 and 12 h, 1, 3, 5, 7, 10 and 14 days after the contusion. Histopathological examination and immunostaining of MMP-3 were conducted using paraffin sections. Protein of MMP-3 bands was visualized by ECL kit in Western blot. Result showed that: No staining in control and sham operation group. The staining of MMP-3 positive appeared 6 h after contusion, and it becomes stronger 24 h after contusion, the staining reached the maximum at 5 days post-contusion, then it decrease, positive staining could still be observed at 14 days after contusion. No MMP-3 expression was detected in control and sham group by Western blot analysis. Brain contusion caused the appearance of a band of 45 ku molecular weight, which corresponds to an active form of MMP-3. Conclusions were drew that there is no expression of MMP-3 in normal brain, that the expression of MMP-3 appears 6h after TBI, and that there is a relationship between the expression of MMP-3 and the time course after TBI, and MMP-3 would be used as an indicator for estimating the age of traumatic brain contusion in forensic pathology.