Peripherin: A proposed biomarker of traumatic axonal injury triggered by mechanical force.

Traumatic axonal injury (TAI) is one of the most common pathological features of severe traumatic brain injury (TBI). Our previous study using proteomics suggested that peripherin (PRPH) should be a potential candidate as a biomarker for TAI diagnosis. This study is to further elucidate the role and association of PRPH with TAI. In the animal study, we performed immunohistochemistry, ELISA and morphological analysis to evaluate PRPH level and distribution following a severe impact. PRPH-positive regions were widely distributed in the axonal tract throughout the whole brain. Axonal injuries with PRPH inclusion were observed post-TBI. Besides, PRPH was significantly increased in both cerebral spinal fluid and plasma at the early phase post-TBI. Colocalization analysis based on microscopy revealed that PRPH represents an immunohistological biomarker in the neuropathological diagnosis of TAI. Brain samples from patients with TBI were included to further test whether PRPH is feasible in the real practice of neuropathology. Immunohistochemistry of PRPH, NFH, APP and NFL on human brain tissues further confirmed PRPH as an immunohistological biomarker that could be applied in practice. Collectively, we conclude that PRPH mirrors the cytoskeleton injury of axons and could represent a neuropathological biomarker for TAI.

Role of integrin and its potential as a novel postmortem biomarker in traumatic axonal injury.

Traumatic axonal injury (TAI) accounts for a large proportion of the mortality of traumatic brain injury (TBI). The diagnosis of TAI is currently of limited use for medicolegal purposes. It is known that axons in TAI are diffusely damaged by secondary processes other than direct head injury. However, the physiopathological mechanism of TAI is still elusive. The present study used RGD peptide, an antagonist of the mechanotransduction protein integrin, to explore the role of integrin-transmitted mechanical signalling in the pathogenesis of rat TAI. The rats were subjected to a linearly accelerating load, and changes in beta-amyloid precursor protein (ß-APP) expression, skeleton ultrastructure, skeleton protein neurofilament light (NF-L), and α-tubulin in the brainstem were observed, indicating that RGD could relieve the severity of axonal injury in TAI rats. In addition, the expression of ß-integrin was stronger and centralized in the brainstem of the deceased died from TAI compared to other nonviolent causes. This study examined the pathophysiology and biomechanics of TAI and assessed the role of integrin in the injury of microtubules and neurofilaments in TAI. Thus, we propose that integrin-mediated cytoskeletal injury plays an important role in TAI and that integrin has the potential as a biomarker for TAI.

Alveolar regeneration following viral infection is independent of tuft cells

Severe injuries following viral infection cause lung epithelial destruction with the presence of ectopic basal progenitor cells (EBCs), although the exact function of EBCs remains controversial. We and others previously showed the presence of ectopic tuft cells in the disrupted alveolar region following severe influenza infection. Here, we further revealed that the ectopic tuft cells are derived from EBCs. This process is amplified by Wnt signaling inhibition but suppressed by Notch inhibition. Further analysis revealed that p63-CreER labeled population de novo arising during regeneration includes alveolar epithelial cells when Tamoxifen was administrated after viral infection. The generation of the p63-CreER labeled alveolar cells is independent of tuft cells, demonstrating segregated differentiation paths of EBCs in lung repair. EBCs and ectopic tuft cells can also be found in the lung parenchyma post SARS-CoV-2 infection, suggesting a similar response to severe injuries in humans.

Evaluation of brain injury caused by stick type blunt instruments based on convolutional neural network and finite element method / 生物医学工程学杂志

The finite element method is a new method to study the mechanism of brain injury caused by blunt instruments. But it is not easy to be applied because of its technology barrier of time-consuming and strong professionalism. In this study, a rapid and quantitative evaluation method was investigated to analyze the craniocerebral injury induced by blunt sticks based on convolutional neural network and finite element method. The velocity curve of stick struck and the maximum principal strain of brain tissue (cerebrum, corpus callosum, cerebellum and brainstem) from the finite element simulation were used as the input and output parameters of the convolutional neural network The convolutional neural network was trained and optimized by using the 10-fold cross-validation method. The Mean Absolute Error (MAE), Mean Square Error (MSE), and Goodness of Fit ( R 2) of the finally selected convolutional neural network model for the prediction of the maximum principal strain of the cerebrum were 0.084, 0.014, and 0.92, respectively. The predicted results of the maximum principal strain of the corpus callosum were 0.062, 0.007, 0.90, respectively. The predicted results of the maximum principal strain of the cerebellum and brainstem were 0.075, 0.011, and 0.94, respectively. These results show that the research and development of the deep convolutional neural network can quickly and accurately assess the local brain injury caused by the sticks blow, and have important application value for understanding the quantitative evaluation and the brain injury caused by the sticks struck. At the same time, this technology improves the computational efficiency and can provide a basis reference for transforming the current acceleration-based brain injury research into a focus on local brain injury research.

Fatal cervix rupture due to intraplacental choriocarcinoma triggered by sexual intercourse.

A 27-year-old woman, gravida 1 para 0, died 30 min after intercourse at the 16th week of gestation. The prenatal medical history indicated the placental implantation position at the cervix. The autopsy revealed massive hemoperitoneum and a tumor in the placenta and myometrium on the anterior right side of the cervix. A transmural perforation was found from the tumor to the serosal surface of the cervix. The autopsy, histopathology, and medical history indicated that her death was ascribed to the rupture of the cervix due to intraplacental choriocarcinoma (IC) after intercourse. The case indicated that placental implantation and tumor invasion might lead to the rupture of the uterus triggered by external forces in daily life. This case study might increase the awareness and recognition of IC.

Progress in functional magnetic resonance imaging of emotion dysregulation due to traumatic brain injury / 中华行为医学与脑科学杂志

Patients with brain injury are often accompanied by emotional disorders, which can cause a variety of mental disorders, and mental disorders will continue to exist after rehabilitation, seriously affecting the ability of patients to adapt and integrate into society, greatly reducing the quality of life.Therefore, the research on the mechanism of emotional disorders after brain injury is of great significance to the clinical prevention and treatment of mental disorders related to emotional disorders.Functional magnetic resonance imaging (fMRI) provides a more intuitive and accurate research method for the study of emotional regulation, so many scholars have conducted in-depth research on emotional disorders after craniocerebral injury from different perspectives.In this paper, the functional MRI studies of emotional disorders were reviewed after craniocerebral injury in the past decade and most of the resting MRI studies showed that the mechanism of emotional disorders after craniocerebral injury is related to the imbalance of interaction among the resting default network, executive network and salience network, while the task MRI studies found that the amygdala, dorsolateral prefrontal lobe and anterior Cingulate gyrus and right inferior frontal gyrus played an important role in attention distribution, cognitive reappraisal, expression inhibition and other emotional regulation strategies, and the damage of these brain regions will cause corresponding emotional regulation disorders.In this paper, the neural mechanism and research progress of emotional disorders after brain injury were systematically reviewed, summarize the existing problems, and propose possible solutions from the perspective of resting and task state functional MRI.

Discussion on the management of fever clinic during the epidemic period of corona virus disease 2019 / 中华急诊医学杂志

Objective:To investigate the role of epidemiological history in the screening of corona virus disease 2019 (COVID-19) in fever clinic, to improve the efficiency in fever clinic and reduce the incidence of cross infection.Methods:This is a retrospective study. Patients who were admitted to the Fever Clinic in West China Hospital of Sichuan University from January 23th, 2020 to February 11th, 2020 were included in the study. According to epidemiological history, the patients were divided into the epidemiological history group (experimental group) and no epidemiological history group (control group). The two groups of patients were admitted and treated separately. The clinical data, NEWS score, etiology results, viral pneumonia showed on CT, time of visit, COVID-19 patient ratio, and admission composition ratio were compared between the two groups. The measurement data were presented as the mean ± standard deviation (SD), and the numeration data were expressed as ratio or constituent ratio. The measurement data of normal distribution between the two groups were compared by independent sample t test. The measurement data of skewed distribution were expressed by the median (interquartile range), and the comparison between the two groups was tested by non-parameter. The differences between enumeration data were assessed by chi-square test. A P<0.05 was considered statistically significant. Results:A total of 2423 patients were included, including 927 patients in the experimental group and 1296 patients in the control group. There were no significant differences in gender, NEWS score and clinical symptoms between the two groups ( P> 0.05). The age (35.00 ± 12.80 vs 38.13 ± 15.57 years) , the proportion of fever patients (28.80% vs 32.75%) and waiting time (31.72 vs 58.08 min) of the experimental group were lower than those of the control group, and the difference was statistically significant (P <0.05). The CT examination ratio (37.54% vs 20.39%), viral pneumonia ratio shown on CT (9.77% vs 2.95%), ratio of examined COVID-19 nucleic acid test (85.44% vs 56.75%), and the admission ratio (16.72% vs 9.63%) of the experimental group were higher than those of the control group, and the differences were statistically significant (P <0.05). There was no significant difference in the positive rates of influenza virus and rhinovirus between the two groups ( P> 0.05). Conclusion:It is necessary to adjust the management mode of fever clinic during the corona virus disease 2019, and to manage the patients according to the epidemiological history which can improve the screening efficiency and reduce the risk of cross infection.

Discussion on the Management of Fever Clinic during the Epidemic Period of Corona Virus Disease 2019 / 中华急诊医学杂志

Objective@#To investigate the role of epidemiological history in the screening of Corona Virus Disease 2019 (COVID-19) in fever clinic, to improve the efficiency in fever clinic and reduce the incidence of cross infection.@*Methods@#This is a retrospective study. Patients who were admitted to the fever clinic in West China Hospital of Sichuan University from January 23th, 2020 to February 11th, 2020 included the study. According to epidemiological history, the patients were divided into epidemiological history group (the experimental group) and no epidemiological history group (the control group). The two groups of patients were admitted and treated separately. The clinical data, NEWS score, etiology results, viral pneumonia showed on CT, time of visit, COVID-19 patient ratio, and admission composition ratio were compared between the two groups. The measurement data were presented as the mean ± standard deviation (SD), and the numeration data were expressed as ratio or constituent ratio. The measurement data of normal distribution between the two groups were compared by independent sample t test. The measurement data of skewed distribution are expressed by the median (interquartile range), and the comparison between the two groups is tested by non-parameter. The differences between enumeration data were assessed by chi-square test. A P<0.05 was considered statistically significant.@*Results@#A total of 2423 patients were included, including 927 patients in the experimental group and 1296 patients in the control group. There were no significant differences in gender, NEWS score and clinical symptoms between the two groups (P> 0.05). The age (35.00 ± 12.80 vs 38.13 ± 15.57 years) , the proportion of fever patients (28.80% vs 32.75%) and waiting time (31.72 vs 58.08 min) of the experimental group were lower than the control group, the difference was statistically significant (P <0.05). The CT examination ratio (37.54% vs 20.39%), viral pneumonia ratio showed on CT (9.77% vs 2.95%), ratio of examined COVID-19 nucleic acid test (85.44% vs 56.75%), and the admission ratio (16.72% vs 9.63%) of the experimental group were higher than the control group, and the differences were statistically significant (P <0.05); There was no significant difference in the positive rates of influenza virus and rhinovirus between the two groups (P> 0.05).@*Conclusion@#It is necessary to adjust the management mode of fever clinic during the Corona Virus Disease 2019, and to manage the patients according to the epidemiological history which can improve the screening efficiency and reduce the risk of cross infection.

Advance of Forensic Research in Insulin Poisoning / 法医学杂志

Insulin as a com m on clinical hypoglycem ic agent can effectively control serves to low er the concentration of blood glucose. H ow ever, insulin overdose can lead to death. In the w hole fatal cases of insulin overdose, m edical accident is the m ost com m on, follow ed by suicide. T hough insulin hom icide is extrem ely rare, it deserves great attention. T hough there are som e researches about insulin poisoning on forensic toxicology and pathology, it is still a difficult task in forensic practice. In this paper, the m ech-anism of death, pathological changes, detection m ethods and diagnose criteria of insulin overdose w ill be discussed in the view of forensic toxicology and pathology. W e hope that this paper could enhance rela-tive know ledges of insulin poisoning for m edical exam iners.

Research advance of apolipoprotein J in brain injury / 中国法医学杂志

Apolipoprotein J plays an important role in neuroprotection and neurological restoration after brain injury. It shows spatiotemporal dynamic expression at varying times after brain injury. Thus, it will be of great importance in the clinical treatment of brain injury, as well as in post-injury intervals estimation in forensic pathology. In this paper, we will review relevant research advance of it in brain injury.

Progress in the research of diagnosis of amniotic lfuid embolism based on the methodologies in forensic medicine / 中国法医学杂志

Amniotic lfuid embolism refers to the accessible amniotic lfuid component of maternal circulation leading to a series of severe symptoms, such as pulmonary embolism, shock or even death. Up till now, AFE is a diagnosis of exclusion. The sensitivity and specificity of these methods were poor. With the increasing maternal mortality caused by AFE in forensic medicine, it is important to seeking for more precise diagnosis method. This review intends to provide methodological reference for forensic identification through the research progress of the diagnosis of AFE.

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.

Pharmacokinetic characteristics of ferulic acid in patients with different syndromes of deficiency of spleen qi, stagnation of liver qi and spleen deficiency, and excess of stomach heat / 中西医结合学报

To investigate the nature of syndrome of traditional Chinese medicine by means of pharmacokinetic (PK) method.

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.

Simultaneous determination of lidocaine and bupivacaine in human spinal cord pretreated with formaldehyde by high performance liquid chromatography / 中国法医学杂志

Objective For purpose of meeting the requirement of forensic toxicological investigation, a RPHPLC method was established for simultaneous determining lidocaine and bupivacaine in human spinal cord pretreated with formaldehyde. Method Analytical column was YWG-C18 (4.6mm?150mm) and a per column. Mobile phase was CH3OH:0.015M NaH2PO4 =75:25 (v/v) pH = 7.2. The wavelength of detection was 210 nm. The pretreatment method of sample, detection condition, linear range, precision and recorery of the method were systematically investigated by using blank spinal cord spiked with standard lidocaine and bupivacaine. Results The linear range was 0.5 ~ 10.0?g.g-1 (lidocaine: r=0.9999; bupivacaine: r = 0.9998). The detection limit of lidocaine was 15ng and of bupivacaine 20ng (S/N≥3). The intra and inter day precision of assay of lidocaine and bupivacaine were less than 4.3% (n=5). Both lidocaine and bupivacaine have been detected in a forensic toxicological analysis case by using this method and the result was correct. Conclusion Lidocaine and bupivacaine can determined in human spinal cord pretreat-edwith formaldehyde by HPLC. The method is simple, useful and accurate. It can be applied in the forensic toxicological analysis investigation and other medical studies.

Pathological study on 18 cases of forensic re-autopsy and histopathological re-examination / 中国法医学杂志

Eighteen cases of forensic re autopsy and histopathological re examination were analyzed retrospectively. The manner and the impression of original autopsy,times of autopsy,the reason and manner of forensic re autopsy,the interval betwwen the original autopsy and the re autopsy as well as the last conclusions were analyzed.It was found that the forensic re autopsy always occured in cases of medical disputes(3 cases,16 7%) and death related to the police investigation(4 cases,22 2%).Only external examination and incomplete forensic autopsy were done originally in 13 out of 18 cases(72 2%).The conclusions of re autopsy were completely different from that of the original autopsy in 5 cases.Attension must be paid and prevention measures for re autopsy must be adopted were also discussed.

An immunohistochemical study on COX-1 and COX-2 following traumatic brain Injury in rats / 中国法医学杂志

Objective The time-dependent changes of COX-1 and COX-2 following the experimental brain contusion were studied for the purpose of extrapolation of the molecular mechanism and timing of brain contusion.Methods Male SD rats were divided into normal control,sham-operated control and contusion groups.The animal model of cerebral contusion was established by impact to the parietal lobe with a free fall weight.The time-dependent changes of COX-1 and COX-2 were detected at 1d,3d,5d,7d,14d post-injury by immunohistochemical SP method.Results In comparison with the control,COX-1 and COX-2 were faintly expressed in the brain of the control groups.Expression of COX-1 was gradually elevated in the cortex of the brain from 1d to 5d after contusion,which was sustained at a high level up to 14d postinjury.Expression of COX-2 was gradually increased in the cortex of the brain from 1d to 3d after injury,which peaked in the hippocampus at 1d after contusion.Conclusion It is suggested that brain contusion may induce the expressions of the COX-1 and COX-2,and the time-dependent changes of COX-1 and COX-2 may be applicable to the wound age estimation of cerebral contusion in forensic practice.

Mechanism of proliferation migration and differentiation of neural stem cells / 中国法医学杂志

Recent researches have showed that neural stem cells be isolated not only in the embryonic nervous system but also in adult nervous system. Neural stem cells have some capacity for self-renewal, migration and can differentiate into neurons, astrocyte and oligodendrocyte. This provides a basis in therapy of degenerative diseases and functional recovery of the central nervous system injury. Also helps in the study of determining the postmortem interval ( PMI) and postmortem injury. Distribution, biological characteristic, identification and the factors effecting the proliferation, differentiation and migration with reference to therapy of neural stem cells and applications in forensic pathology are reviewed.

The timing expression of apo E following experimental traumatic brain injury in the rat / 中国法医学杂志

Objective To Study the expression of apo E protein changed in different wound age and position of the experimental traumatic brain injury(TBI) in rat. Methods The animal model of cerebral contusion was established by impact to the parietal lobe with a free fall weight,observed the changes of apo E in different wound age (0.5h、2h、6h、12h、24h、3d、7d、14d). The results were measured quantitatively with computer imaging analysis system. Results In cortex apo E-positive neurons definitely detected in 0.5h after brain injury, reaching the peak in 3d, then it shows the gradual decrease from 3d to 14d; In hippocampus apo E-positive neurons definitely detected in 0.5h after brain injury, reaching the peak in 3d in CA1 section and 24h in CA2～CA4. Then it shows the gradual decrease. We found the expression of apo E protein in CA1 section is stronger than others. Conclusion The location and intersity of the immunoreactivity of apo E protein changed at the different stages after TBI. These changes observed in the present study might be used for determination of injury time,early diagnosis and distinguish antemortem and postmortem brain injury in forensic medicine.