A cross-sectional survey of patients ' compliance of endoscopic surveillance after endoscopic submucosal dissection / 中华消化内镜杂志

Objective:To investigate patients' compliance of endoscopic surveillance after endoscopic submucosal dissection (ESD) and the influencing factors.Methods:This study was a cross-sectional survey. The data of patients who underwent ESD in Xijing Digestive Hospital of Air Force Military Medical University from January 2014 to December 2015 were collected through questionnaire and telephone call. The questionnaire survey was conducted from May 1, 2019 to July 31, 2020. Patients' compliance for endoscopic surveillance and influencing factors were evaluated. Logistic regression model was used for multivariate analysis to determine independent risk factors affecting compliance of endoscopic surveillance.Results:A total of 413 questionnaires were collected, of which 331 (80.1%) patients were well complied with endoscopic surveillance, and 82 (19.9%) were not. Univariate analysis showed that gender ( χ2=4.68, P=0.034), lesion type ( χ2=10.10, P=0.002), educational background ( χ2=4.00, P=0.049), disposable income ( χ2=7.00, P=0.009), employment ( χ2=11.29, P=0.004) and medical insurance ( χ2=13.59, P=0.001) affected patients' endoscopic surveillance compliance. Logistic regression analysis indicated that patients with submucosal lesions were less likely to be compliant than patients with mucosal lesions with the same type of medical insurance ( P<0.001, OR=0.383, 95% CI: 0.227-0.644); and with the same lesion type, patients with urban medical insurance were more likely to be compliant than those with rural cooperative medical insurance ( P<0.001, OR=2.938, 95% CI: 1.696-5.090). Conclusion:The endoscopic surveillance compliance for post-ESD patients is related to the lesion type, the type of medical insurance, and the awareness of the disease. More attention should be paid to those with submucosal lesions and rural cooperative medical insurance due to their poor compliance. And it is necessary to improve health education on the disease for better surveillance compliance.

Reflections on the aconitine poisoning.

Aconitine is a natural toxic substance belonging to the family of aconitum alkaloids, which is used in small doses by Traditional Chinese practitioners. We present a case of accidental death due to acute aconitine poisoning. A 65-year-old Chinese man presented to a medical clinic with fever and shoulder pain. Soon after administration of intravenous ceftriaxone, a bottle of Chinese medicinal wine was administered. The man rapidly experienced headache, hearing loss and tinnitus, nausea, diarrhea, numbness of the lips, tongue, face, and the upper and lower extremities, cold sweat, fall of blood pressure, and discomfort of the entire body, and he died on the same day. Postmortem examination showed cyanosis of the nail beds, severe congestion in lungs and other organs, bilateral pleural effusions, and infiltration of basophils in the intestinal submucosa. No significant increase of IgE was found in the blood. Toxicological analysis detected aconitine in the medicinal wine, blood, and stomach contents by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Aconitine was quantified in cardiac blood as 16.4 ng/ml, and in stomach contents (63.8 ng/ml) and wine sample (10.1 ug/ml). The cause of death was aconitine poisoning. This case report highlights the danger of aconitine. LC-MS/MS has the advantages of high analytic speed, sensitivity, and accuracy. It would be desirable for the government to control the use of aconitine-containing herbal extracts.

The preoperative scoring system for high-risk gastric stromal tumors / 中华消化内镜杂志

Objective:To explore a scoring system of preoperative evaluation for high-risk gastric stromal tumors.Methods:A total of 275 consecutive patients with gastric stromal tumors of diameter ≤5 cm who underwent surgical or endoscopic resection at Xijing Hospital between 2008 and 2018 were retrospectively enrolled in the study. Multivariate logistic regression analysis was performed to investigate independent risk factors for high-risk gastric stromal tumors.Weighted points was proportionally assigned based on β regression coefficient value to establish the scoring system. The receiver operator characteristic (ROC) curve was plotted, the scoring system as the test variable, and the area under curve (AUC) was calculated.Results:Multivariate analysis revealed tumor size>1.75 cm ( OR=6.474, 95% CI: 2.335-17.948), irregular tumor shape ( OR=3.548, 95% CI: 1.745-7.216) and mucosal ulceration ( OR=2.412, 95% CI: 1.154-5.041) were independent risk factors for high-risk gastric stromal tumors of diameter ≤5 cm ( P<0.05). These risk factors for high-risk gastric stromal tumors were weighted with value: one point for mucosal ulceration, two points for irregular tumor shape and three points for tumor size>1.75 cm. The AUC value of the scoring system was 0.781, of which the cut-off value was 4. According to the cut-off value, 0-3 points was categorized as the low risk group and 4-6 points as the high risk group for gastric stromal tumors. The incidence of high-risk gastric stromal tumors of the low risk group and the high risk group were 13.3% (26/196) and 48.1% (38/79), respectively, with significant difference ( χ2=38.266, P<0.001). Conclusion:Tumor size larger than 1.75 cm, irregular tumor shape and mucosal ulceration can be applied to establish a preoperative scoring system to predict high-risk gastric stromal tumors of diameter ≤5 cm.

Fatal barium chloride poisoning: four cases report and literature review.

Barium is an alkaline earth metal which has a variety of uses including in the manufacturing industry and in medicine. However, adverse health effects and fatalities occur due to absorption of soluble barium compounds, notably the chloride, nitrate, and hydroxide, which are toxic to humans. Although rare, accidental and suicidal modes of poisoning are sporadically reported in the literature.We describe 4 cases of poisoning due to barium chloride in China. In witnessed cases, severe gastrointestinal symptoms, hypokalemia leading to muscle weakness, cardiac arrhythmias, and respiratory failure were noted. Autopsy showed some nonspecific but common findings, such as subendocardial hemorrhage in the ventricles, visceral petechiae, and fatty changes in the liver. Interestingly, microscopic examination showed degenerative changes and amorphous, flocculent foamy materials in the renal tubules. Toxicology was relevant for barium in blood and tissues. Three of the cases were accidental and 1 homicidal in nature. A round-up of relevant literature on fatal barium compounds poisoning is also provided. Forensic pathologists should be aware of the clinical presentations of barium compound poisoning and especially look for any evidence of hypokalemia. Still, postmortem toxicological and histological studies are essential for an accurate identification of the cause of death.

Value and prospects of constructing digital slides data of forensic medicine / 中华医学教育探索杂志

As a rising histological specimen carrier,digital slide has advantages of easy search and fast browse.By digital scanning and stitching of traditional slides and uploading traditional slides as well as pathological information to network servers,the construction of digital slides data can take its own superiority to assist forensic medicine teaching.Combined with our research and teaching experience,this article discussed the application prospects of digital slide technology and digital slides data so as to provide references for the improvement and reformation of forensic medicine education.

Role of neuropeptide Y and peroxisome proliferator-activated receptor γ coactivator-1α in stress cardiomyopathy / 华中科技大学学报（医学）（英德文版）

Death following situations of intense emotional stress has been linked to the cardiac pathology described as stress cardiomyopathy, whose pathomechanism is still not clear. In this study, we sought to determine, via an animal model, whether the transcriptional coactivator peroxisome proliferator-activated receptor γ coactivator-1alpha (PGC-1α) and the amino peptide neuropeptide Y (NPY) play a role in the pathogenesis of this cardiac entity. Male Sprague-Dawley rats in the experimental group were subjected to immobilization in a plexy glass box for 1 h, which was followed by low voltage electric foot shock for about 1 h at 10 s intervals in a cage fitted with metallic rods. After 25 days the rats were sacrificed and sections of their hearts were processed. Hematoxylin-eosin staining of cardiac tissues revealed the characteristic cardiac lesions of stress cardiomyopathy such as contraction band necrosis, inflammatory cell infiltration and fibrosis. The semi-quantitative RT-PCR analysis for PGC-1α mRNA expression showed significant overexpression of PGC1-α in the stress-subjected rats (P<0.05). Fluorescence immunohistochemistry revealed a higher production of NPY in the stress-subjected rats as compared to the control rats (P=0.0027). Thus, we are led to conclude that following periods of intense stress, an increased expression of PGC1-α in the heart and an overflow of NPY may lead to stress cardiomyopathy and even death in susceptible victims. Moreover, these markers can be used to identify stress cardiomyopathy as the cause of sudden death in specific cases.

Reform and exploration on forensic toxicology teaching / 中华医学教育探索杂志

As a core curriculum of forensic medicine,it is of great importance to improve the quality of forensic toxicological education for cultivating high-quality forensic professionals.Basing on the rich experiences of forensic teaching and expertise,well teaching effects were achieved by the reform and explorations in teaching contents and methods,development of curriculum and teachers as well as other aspects aimed to improving the quality of forensic toxicological teaching.

Role of neuropeptide Y and peroxisome proliferator-activated receptor γ coactivator-1α in stress cardiomyopathy / 华中科技大学学报（医学）（英德文版）

Death following situations of intense emotional stress has been linked to the cardiac pathology described as stress cardiomyopathy, whose pathomechanism is still not clear. In this study, we sought to determine, via an animal model, whether the transcriptional coactivator peroxisome proliferator-activated receptor γ coactivator-1alpha (PGC-1α) and the amino peptide neuropeptide Y (NPY) play a role in the pathogenesis of this cardiac entity. Male Sprague-Dawley rats in the experimental group were subjected to immobilization in a plexy glass box for 1 h, which was followed by low voltage electric foot shock for about 1 h at 10 s intervals in a cage fitted with metallic rods. After 25 days the rats were sacrificed and sections of their hearts were processed. Hematoxylin-eosin staining of cardiac tissues revealed the characteristic cardiac lesions of stress cardiomyopathy such as contraction band necrosis, inflammatory cell infiltration and fibrosis. The semi-quantitative RT-PCR analysis for PGC-1α mRNA expression showed significant overexpression of PGC1-α in the stress-subjected rats (P<0.05). Fluorescence immunohistochemistry revealed a higher production of NPY in the stress-subjected rats as compared to the control rats (P=0.0027). Thus, we are led to conclude that following periods of intense stress, an increased expression of PGC1-α in the heart and an overflow of NPY may lead to stress cardiomyopathy and even death in susceptible victims. Moreover, these markers can be used to identify stress cardiomyopathy as the cause of sudden death in specific cases.

HIV-negative drug addict diagnosed with AIDS and tuberculosis at autopsy: a case report and brief review of literature.

Human Immunodeficiency Virus (HIV) infection is a true plague and a major health concern globally. It is one of the most significant pandemics in recorded history. Despite worldwide efforts to fight the pandemic, and now with the re-emergence of tuberculosis, those clinicians, personnel performing autopsies and medical caregivers are again at risk in the work place, especially in developing countries. We describe a case where a drug abuser, whose addiction was concealed by his parents, died in hospital. He was tested HIV-negative there. A medical tangle ensued and forensic autopsy was carried out. Autopsy confirmed he was an intravenous drug addict and had tuberculosis. Post-mortem blood was positive for HIV antibodies and he was diagnosed with AIDS. Due to social stigmas, lack of knowledge or inefficient medical laboratory procedures etc, such type of cases can become a hazard to those attending the sick and to autopsy pathologists alike. We provide the case description, autopsy findings and review of pertinent literature.

Unexpected death of a young woman: is myocardial bridging significant?--A case report and review of literature.

Myocardial bridging (MB) refers to a congenital condition where a segment of a major coronary artery courses within the myocardium for a variable distance, and has been reported as an incidental finding in many cases. However, in some situations it has been shown to be associated with acute coronary syndromes, arrhythmias, myocardial ischemia and sudden death. We present the case of a 26-year-old Chinese woman with no previous history of disease who died unexpectedly in hospital. She had a 'common cold' with its associated symptoms. Autopsy revealed the presence of MB of the left anterior descending artery and microscopic examination showed associated cardiac lesions such as contraction band necrosis and interstitial fibrosis in the region supplied by the embedded artery. The coronaries were otherwise patent. Gross and microscopic examination of other organs was unremarkable. Toxicological analysis of body fluids and stomach content excluded death due to either drug intoxication or known poisonous substances. MB could have been responsible for death, but the disparate attitudes towards this phenomenon made this assumption open to discussion. We provide the case description and a short review of the literature on fatal and near- fatal cases involving MB.

Application of PBL teaching in the training of forensic medical talents with creative ability / 中华医学教育探索杂志

Forensic medical talents with creative ability should have ability to find.analyze and solve problems from complex cases.According to teaching practice on the basis of PBL this article illustrates application methods of PBL teaching characters in the training of forensic medical talents with creative ability.

Fatal renal failure due to the Chinese herb "GuanMu Tong" (Aristolochia manshuriensis): autopsy findings and review of literature.

Herbal remedies have been used since ancient times and it is now known that they are not completely free of adverse effects. We present the case of a 41-year-old Chinese man, who died in renal failure because he consumed a herbal preparation called "Fen Qing Wu Lin Wan", having GuanMu Tong as main ingredient, for about 1 month. GuanMu Tong is derived from the plant Aristolochia manshuriensis which contains aristolochic acid. Aristolochic acid is being reported as the causative agent of what is now called aristolochic acid nephropathy (AAN) which includes Chinese herb nephropathy (CHN) and Balkan endemic nephropathy (BEN), all having renal impairment as hallmark for the disease. The gross autopsy showed multiple punctate hemorrhages over the limbs, pleural effusion, and edematous lungs with consolidation, mild myocardial hypertrophy and normal-looking kidneys. Microscopic renal tissue examination showed severe degeneration, necrosis and desquamation of renal tubular epithelial cells, presence of protein cast and a widened, edematous interstitium with interstitial fibrosis. We also provide the clinical presentation of the deceased as reported in the medical records and briefly review the literature pertinent to similar cases.

Image analysis on corneal opacity: A novel method to estimate postmortem interval in rabbits / 华中科技大学学报（医学）（英德文版）

Corneal opacity is one of the most commonly used parameters for estimating postmortem interval (PMI). This paper proposes a new method to study the relationship between changes of corneal opacity and PMI by processing and analyzing cornea images. Corneal regions were extracted from images of rabbits' eyes and described by color-based and texture-based features, which could represent the changes of cornea at different PMI. A KNN classifier was used to reveal the association of image features and PMI. The result of the classification showed that the new method was reliable and effective.

Image Analysis on Corneal Opacity: A Novel Method to Estimate Postmortem Interval in Rabbits / 华中科技大学学报（医学）（英德文版）

Corneal opacity is one of the most commonly used parameters for estimating postmortem interval(PMI).This paper proposes a new method to study the relationship between changes of corneal opacity and PMI by processing and analyzing cornea images.Corneal regions were extracted from images of rabbits' eyes and described by color-based and texture-based features,which could represent the changes of cornea at different PMI.A KNN classifier was used to reveal the association of image features and PMI.The result of the classification showed that the new method was reliable and effective.

Long-time fulvic acid supplementation modulates hydroxylysyl glycosylation of collagen in mice / 华中科技大学学报（医学）（英德文版）

In order to investigate the impact of fulvic acid (FA) on the hydroxylysyl glycosylation in collagen bio-synthesis, 40 NMRI mice were divided into two groups (n = 20 in each group, consisting 10 females and 10 males). The animal was maintained for two generations by different diets: control group with normal water and food and study group with water containing 30 mg/L FA and normal food. The second generation of the animal was slaughtered, and the biochemical parameters of collagen content and the degree of collagen hydroxylysyl glycosylation in skin, rib and tibia were detected by biochemical methods. The mean value of collagen in the study group was increased slightly, and no significant difference between study group and control group was found (P > 0.05), but the content of glucose-glactose-hydroxylysine (GGH) was significantly decreased in the study group in comparison with the control group (P<0.01). It was suggested that through the decrease of GGH 30 mg/L FA could inhibit the activity of galactosyl-hydroxylysylglucosyl-transferase and further disturb the post-translational modification of collagen intracellularly.

Long-time fulvic acid supplementation modulates hydroxylysyl glycosylation of collagen in mice / 华中科技大学学报（医学）（英德文版）

In order to investigate the impact of fulvic acid (FA) on the hydroxylysyl glycosylation in collagen bio-synthesis, 40 NMRI mice were divided into two groups (n = 20 in each group, consisting 10 females and 10 males). The animal was maintained for two generations by different diets: control group with normal water and food and study group with water containing 30 mg/L FA and normal food. The second generation of the animal was slaughtered, and the biochemical parameters of collagen content and the degree of collagen hydroxylysyl glycosylation in skin, rib and tibia were detected by biochemical methods. The mean value of collagen in the study group was increased slightly, and no significant difference between study group and control group was found (P > 0.05), but the content of glucose-glactose-hydroxylysine (GGH) was significantly decreased in the study group in comparison with the control group (P<0.01). It was suggested that through the decrease of GGH 30 mg/L FA could inhibit the activity of galactosyl-hydroxylysylglucosyl-transferase and further disturb the post-translational modification of collagen intracellularly.

An immunohistochemical study on the time-dependent expression of IL-10 and IL-4 during skin incised wound healing in mice / 中国法医学杂志

Objective To explore the temporal expressions of interleukin-10(IL-10)and interleukin-4(IL-4)and their relationship with the wound age during skin incised wound healing in mice.Methods Immunohistochemical and image-analysis techniques were employed in vital skin wounds 0.5h～168h after incision and postmortem incision 0.5h～6h after death.Results Weak expression of IL-10 was detected at 0.5h after incision,which increased subsequently,and peaked at 3h post-injury.Then decreased to the pre-incision level at 24h,but peaked again at 72h after injury.Immunostaining revealed that epidermal cells and infiltrating mononuclear cells were the major source of IL-10.IL-4-positive cells were observed in the dermis at 24h,and reached the maximum level at 96h,which maintained until 168h post-injury.IL-4 was mainly expressed in the fibroblast-like cells of the granulation tissue and dermis.In addition,faint IL-10-positive cells were merely identified in the epidermal cells in the postmortem incision skin within 1～3h after incision.No IL-4-postitive cells were found in the postmortem incision skin.Conclusion The time-dependent expressions of IL-10 and IL-4 during cutaneous wound healing may be used for the estimation of wound age.

An ultrastructural observation of corneal collagen matrix of rabbit in the different time after death / 中国法医学杂志

Objective To study the relationship between the ultrastructural changes of corneal matrix collagen fibrils diameter and the postmortem interval.Methods Twenty-eight rabbits were killed by the method of air embolism and the samples of cornea were separately cut down in 0,6,12,18,24,48 and 72h after death.The ultrastructure of the collagen diameter was observed by transmission electro microscopy(TEM)and the 4 parameters of area(Y1),perimeter(Y2),average-diameter(Y3)and mean-diameter(Y4)were measured by a computer image technique and analyzed by Excel 2000 and SPSS 10.0 software.Results The 4 parameters of Y1,Y2,Y3 and Y4 were respectively increased from 1 131?53nm to 1 628?26nm,from 132.8?23nm to167.5nm,from 38nm to 45nm and from 37.71?6nm to 44.89?5nm within 72 hours after the death.Conclusion The corneal matrix collagen diameter increase regularly with the postmortem interval in 72h after death,and the parameters of Y1,Y2,Y3 and Y4 could be used as a new reference mark for timing the postmortem interval after death.

Ryanodine receptor and its significance on forensic medicine / 中国法医学杂志

Ryanodine receptor is a Ca2+ release channel in cadiocyte.It is reported recently to the obvious change of its function and quantity in such pathological process as the myocardial ischemia and cardiac hypertrophy.These changes will affect the ability of cadiocytes processing intracellular calcium or lead to the calcium overload in the myocardial cells and then induces fatal ventricular arrhythmia,even sudden cardiac death.