Eosinophilic myocarditis from a forensic histopathological perspective

Eosinophilic myocarditis (EM) is a rare and potentially fatal form of myocarditis characterized by infiltration of the myocardium with eosinophil leukocytes, often accompanied by eosinophilia. Although the exact underlying cause remains unknown, it has been shown to be associated with hypersensitivity reactions, immune-mediated disorders, infections, or cancer. Due to the differences in symptomatology, it is often diagnosed by postmortem histopathological examination. We aimed to retrospectively examine the histopathological findings of rare cases of EM and to detect accompanying cardiac and other organ pathologies. The histopathological findings of the cases that underwent autopsies between 2012 and 2020 and were diagnosed with EM were assessed. Demographic features, symptoms, causes of death, macroscopical findings at autopsy, toxicologic and microbiological analysis results, accompanying cardiac pathologies, and histopathological findings in other organs were evaluated. Myocarditis was detected on histopathologic examination in 558 (1.1%) of 49,612 forensic autopsies. There were 12 (2.3%) EM cases. There were nine males and four females. The mean age was 42.3 (3–83) years. Heart weights ranged from 82 to 564 g. The most common finding on macroscopic examination was the mottled discoloration and scarring in the myocardium. Microscopic examination revealed perivascular and interstitial infiltration of eosinophils in all of the cases accompanied by myocyte necrosis in four of them. EM was reported as the cause of death in four cases. EM remains a challenging heart disease with its obscure etiopathogenesis and varying clinical presentation and a rare entity diagnosed by postmortem histopathological examination in sudden and unexpected deaths.     

Fatality involving complications of bupivacaine toxicity and hypersensitivity reaction

This case represents unusual findings of elevated bupivacaine and tryptase concentrations following local anesthetic, bupivacaine, administered as a scalene nerve block for elective rotator cuff repair surgery. Following bupivacaine injection, the patient exhibited almost immediate seizure activity, bradycardia, and cardiac arrest. Resuscitative efforts including cardiopulmonary bypass restored a cardiac rhythm. However, the clinical medical status of the patient progressively declined and he died 7 h following administration of the local anesthetic. Autopsy revealed several abnormalities of the heart including cardiomegaly, myocardial bridging, and lipomatous hypertrophy of the intraatrial septum, which may have contributed to bradycardia and arrhythmia. Postmortem toxicology results revealed elevated bupivacaine and tryptase concentrations. Elevated postmortem bupivacaine concentrations 7 h following administration and abrupt onset of seizures indicate unintentional intravascular injection instead of nerve and tissue infiltration. An elevated postmortem tryptase concentration points to the possibility of a hypersensitivity reaction to bupivacaine.     

猪脾转移因子微囊的制备及其活性检测

为了提高转移因子的稳定性,以壳聚糖和海藻酸钠为囊材,采用乳化外部凝胶法制备猪脾转移因子微囊,并检测了其粒径大小、包封率、载药量等性质;通过小鼠腹腔巨噬细胞吞噬试验和迟发型超敏反应试验检测转移因子微囊的药理活性。结果显示,转移因子微囊呈类圆形,平均粒径为11.05μm,包封率为60.8%,载药量11.60mg/g;转移因子微囊能增强小鼠腹腔巨噬细胞的吞噬功能,提高迟发型超敏反应的能力,效果优于转移因子。结果表明,该制备工艺简单,转移因子微囊具有较好的发展前景。     

牛膝不同提取部位抗炎镇痛及抗迟发型超敏反应的作用

目的 观察牛膝不同提取部位的抗炎镇痛及抗迟发型超敏反应的作用。方法 采用二甲苯致小鼠耳肿胀实验、热板实验及醋酸诱导小鼠扭体实验,观察牛膝不同提取部位的抗炎镇痛作用;采用2,4-二硝基氯苯（2,4-dinitrochlorobenzene, DNCB）诱导的小鼠迟发型超敏反应来观察牛膝不同提取部位的抗迟发型超敏反应作用。结果 牛膝的正丁醇提取部位能显著减轻二甲苯所致小鼠耳肿胀（P<0.05),显著延长小鼠在热板上的舔足时间以及减少醋酸诱导的小鼠扭体次数（P<0.05）,明显降低DNCB诱导的迟发型超敏反应小鼠的耳肿胀度、胸腺指数及脾指数（P<0.05）;石油醚提取部位和乙酸乙酯提取部位对二甲苯诱导的炎症、热板和醋酸诱导的疼痛及DNCB诱导的迟发型超敏反应之部分指标有明显抑制作用（P<0.05)。结论 牛膝的正丁醇提取部位具有显著的抗炎镇痛以及抗迟发型超敏反应作用。     

类胰蛋白酶和IgE测定在过敏性猝死诊断中的应用研究

目的探讨过敏性猝死法医学鉴定的诊断方法和指标。方法采取10例正常人、9例过敏性猝死和19例其他死因（排除过敏反应、冠心病）尸体的静脉血，采用荧光酶联免疫法（Pharmacia UniCAP100过敏原定量分析仪）和酶联免疫吸附试验ELISA法分别测定血清肥大细胞类胰蛋白酶和]gE含量，采用免疫组化方法观察过敏性猝死和其他死因的肺组织中的肥大细胞类胰蛋白酶免疫组化染色。结果过敏性猝死者的血清类胰蛋白酶和IgE含量升高，与其他死因之间的差异具有显著性意义（P〈0．01），其他死因和正常人之间的差异无统计学意义（P〉0．05）；与其它死因相比，过敏性猝死肺组织中的肥大细胞类胰蛋白酶免疫组化阳性染色增强（P〈0．01）。结论过敏性猝死者血清IgE和肥大细胞类胰蛋白酶含量显著升高；过敏性猝死者肺组织中肥大细胞类胰蛋白酶染色增强。     

基于NF-κB/AHR通路探讨电针“足三里”和“内关”对肠易激综合征大鼠内脏高敏感的调节机制

目的 观察电针“足三里”和“内关”穴对肠易激综合征（irritable bowel syndrome,IBS）大鼠内脏高敏感的调节机制。方法 将40只新生SD大鼠随机分为模型制备组（n=32）和空白组（n=8）,采用“母婴分离结合醋酸灌肠”复制内脏高敏感大鼠模型,将模型复制成功的内脏高敏感大鼠随机分为模型组、假刺激组、电针组,每组8只。假刺激组大鼠仅电刺激非经非穴部位,空白组及模型组大鼠仅抓取,不做其他干预;电针组大鼠给予电针同侧足三里和内关穴,每次30 min,隔日1次,共4周。观察各组大鼠一般情况,体质量,粪便性状评分,内脏痛阈值,血清白细胞介素-17A（interleukin-17A,IL-17A）水平,结肠组织中芳香烃受体（aryl hydrocarbon receptor,AHR)、细胞色素P1（cytochrome P1,CYP1)、核因子-κB（nuclear factor-κB,NF-κB) P65蛋白表达水平。结果 与空白组比较,模型组大鼠粪便性状评分显著增加（P＜0.05）,体质量显著下降（P＜0.05）,内脏痛阈值显著降低（P＜0.05）,血清IL-17A水平显著升高（P＜0.05）,结肠组织AhR、CYP1、NF-κB P65蛋白表达水平均显著降低（P＜0.05）;与模型组比较,电针组大鼠粪便性状评分显著减少（P＜0.05）,体质量显著增加（P＜0.05）,内脏痛阈值显著增加（P＜0.05）,血清IL-17A水平显著降低（P＜0.05）,结肠组织AHR、CYP1、NF-κB P65蛋白表达水平显著上升（P＜0.05）。结论 电针“足三里”和“内关”穴能降低IBS大鼠的内脏高敏感,其作用机制可能通过激活NF-κB/AHR通路,上调AHR、CYP1、NF-κB P65蛋白的表达而实现的。     

电针四白穴预处理对内脏痛大鼠的镇痛作用

目的 探讨电针四白穴对内脏痛大鼠的镇痛作用及其机制.方法 将成年SD大鼠30只,随机分为空白组(组I)、内脏痛组(组Ⅱ)、电针四白穴组(组Ⅲ)、电针非穴位+内脏痛组(组Ⅳ)、电针四白穴位+内脏痛组(组V).采用腹腔注射乙酸复制内脏痛模型.组Ⅲ、组Ⅳ和组Ⅴ分别电针刺激双侧四白穴及四白穴外侧旁开1 cm处20 min;电针结束后,分别腹腔注射9.0 g/L氯化钠注射液和乙酸.观察各组大鼠的扭体反应以及孤柬核(nucleus of tractus solitarii,NTS)内c-fos表达水平.结果 组Ⅰ和组Ⅲ未观察到大鼠的扭体反应;组Ⅱ大鼠出现显著的扭体反应;组Ⅳ和组Ⅴ大鼠扭体反应次数显著低于组Ⅱ(P<0.05,或P<0.01).组Ⅰ大鼠NTS内c-fos低水平表达;组Ⅱ大鼠NTS内c-fos表达水平显著高于组Ⅰ(P<0.01);与组Ⅱ比较,组Ⅲ、组Ⅳ和组Ⅴ大鼠NTS内c-fos表达水平显著降低(P<0.05,或P<0.01).结论 电针四白穴对大鼠内脏痛有显著的镇痛作用,面口部穴位的躯体感觉传入在孤束核对内脏感觉传入的抑制作用可能是电针四白穴对内脏痛产生镇痛效应的基础.     

Peace building with the body: resonance and reflexivity in Colombia’s Legion del Afecto

ABSTRACT

Youth in Medellín, Colombia have been recognized as potential peacebuilders through initiatives for urban peace and non-violence, including the initiative Legión del Afecto. This paper explores the development of the Legión del Afecto in order to ask questions about the peace building potential of specific frames (e.g. coexistence) and specific strategies of mobilization (e.g. embodied). We describe how differences between the earlier and later years of the Legión have come to highlight tensions between affective versus market-based relationships in motivating youth. These tensions may be productive, but without serious attention to reflexivity, may also derail peacebuilding efforts.     

TNFα检测在药物过敏性休克死因鉴定中的价值

目的分析某些药物过敏性休克致死者血清中肿瘤坏死因子α（tumor necrosis factor-alpha,TNFα）检测水平的变化,探讨TNFα检测在药物过敏性休克死因鉴定中的应用价值。方法采用双抗体夹心酶联免疫吸附试验法（ELISA）检测尸体心血中TNFα的水平。结果实验组TNFα检测值为（131.6±9.4）pg/mL,感染性疾病对照组TNFα检测值为（87.3±6.4）pg/mL,正常对照组TNFα检测值为（17.2±4.5）pg/mL,各组间差异有统计学意义（P〈0.05）。结论血清TNFα检测可以作为高度怀疑药物过敏性休克案例的死因鉴定的指标之一。     

多发性软组织挫伤后对肺及其他脏器的影响

目的观察多发性软组织挫伤后短时间内死亡案例的脏器病理学改变。方法应用常规组织学及免疫组织化学染色技术进行光学显微镜检查。结果光镜检查见肺组织毛细血管扩张充血，白细胞集聚，肺组织散在片状出血、灶状坏死及透明膜形成；心脏间质血管扩张充血，点灶状纤维溶解；脑组织充血水肿，肝脾充血。免疫组化发现肺泡腔及部分血管内纤维蛋白染色阳性，部分脾脏血管内及肾髓质集合管中肌红蛋白染色阳性。结论本研究结果提示多发性软组织挫伤后短时间内死亡的死因为成人呼吸窘迫综合征（ARDS）合并多脏器功能衰竭。