Death Caused by Toxic Epidermal Necrolysis (Lyell Syndrome)

Abstract: Toxic epidermal necrolysis (TEN) is characterized by fever, scalded appearance of the skin, and epidermolysis associated to blister formation and exfoliation, and it is caused by hypersensitivity reaction to a drug. The authors report two cases of death as a result of TEN; both referred to old aged women treated with a polytherapy including allopurinol. Both patients displayed erythematous skin lesions similar to scald burns and epidermolysis at the face, chest, and abdomen and died shortly after hospitalization. Autopsy findings and histological examinations revealed epidermal necrolysis and confirmed the clinical diagnosis. A strict time‐correlation between allopurinol administration and symptoms was evidenced. Because of its iatrogenic origin, TEN often arises suspicions of medical liability; however, because of its unpredictable nature, the occurrence of this syndrome cannot be ascribed to the medical staff whose main task is the rapid diagnosis and the correct management.     

Sickle Cell Trait Mimicking Multiple Inflicted Injuries in a 5-Year-Old Boy

Abstract:  Sickle cell disease (SCD) and sickle cell trait (SCT) can be associated with sudden unexpected death in the pediatric population, usually due to pulmonary complications occurring within the acute chest syndrome (ACS). Musculoskeletal complications can occur and are classically limited to bone infarcts. The occurrence of bone pathology centered upon the epiphyseal growth plate in SCD/SCT is extremely rare, and multiple such injuries in a single patient have not been previously reported. Herein, we describe a case of sudden unexpected death in a 5-year-old child with undiagnosed SCT due to the ACS, with widespread epiphyseal and periosteal bone lesions mimicking multiple inflicted injuries at autopsy. This case highlights the importance of clinicopathological correlation and is the first to describe SCT pathology as a mimic of nonaccidental injury.     

犊牛血清对高致病性猪繁殖与呼吸综合征病毒增殖及其活疫苗的影响

为了研究在同一培养条件下,不同含量犊牛血清(FCS)对高致病性猪繁殖与呼吸综合征病毒(HP-PRRSV)JXA1-R株病毒含量的影响,以及用其生产的疫苗质量、免疫效果的变化情况,采用4个不同含量的FCS对HP-PRRSV JXA1-R株进行了繁殖,并测定病毒毒价及疫苗样品的效价,监测免疫猪的体温变化,用ELISA方法检测免疫猪PRRSV特异性抗体水平。结果显示,用15～30mL/L犊牛血清培养的病毒的含量没有较大变化,但是随血清含量的增加而略有增高。样品疫苗的病毒含量没有明显变化,但是在免疫后测温过程中发现,血清含量高的样品疫苗在接种后第2～4天体温有短暂的高温波动,随后正常。采血检测抗体发现,血清含量高的样品疫苗产生的抗体也早3～5d。本试验结果可以为HP-PRRSV的培养及疫苗工艺的改进提供有效的参考数据。     

美国“其他保险条款”诉讼：现状与未来

其他保险条款诉讼是一个已经困扰了美国法院近四分之三个世纪的极其复杂的法律问题。美国各州在司法上对该问题的解决方式也存在差异。文章通过对美国有关其他保险条款冲突典型判例的分析,试图寻找美国法院在长期的判例实践中所形成的一些相对比较成熟的解决其他保险条款冲突问题的判例规则及其未来在解决该问题上所遵循的价值理念和解决思路,以此希望能为我国将来保险立法的进一步完善和对解决我国目前既无法可依又无章可循的其他保险条款诉讼提供可资借鉴的法律原则和价值理念。     

Cannabinoid Hyperemesis Syndrome: Reports of Fatal Cases

Cannabinoid hyperemesis syndrome (CHS) is one of the more clinically challenging effects of cannabis consumption. It is characterized by cyclic attacks of nausea and vomiting in chronic cannabinoid users and learned behavior of compulsive hot bathing. The deaths of a 27‐year‐old female, a 27‐year‐old male, and a 31‐year‐old male with a history of CHS are reported. The decedents had a history of cyclical nausea and vomiting, chronic cannabinoid use and negative laboratory, radiological and endoscopic findings. All presented to the emergency department with nausea and vomiting in the days preceding death and were treated symptomatically. Toxicological analysis revealed tetrahydrocannabinol in postmortem blood. The cause of death of two of the three cases was attributed to CHS. CHS was appreciated in the third case but was not the cause of death. These three cases demonstrate the importance of recognizing CHS as a potential cause or contributing factor to death in cannabinoid user.     

HCN4 Gene Variations in Sudden Unexplained Nocturnal Death Syndrome in the Southern Han Chinese Population,

Sudden unexplained nocturnal death syndrome (SUNDS) is widely considered to be related to hereditary fatal arrhythmias. Hyperpolarization‐activated cyclic nucleotide‐gated channel 4 (HCN4) channels are widely distributed in sinus myocytes and play a profound role in generating pacemaker electro‐activity in cardiomyocytes. In the present study, the potential correlation between HCN4 gene variations and the occurrence of SUNDS was investigated. Genomic DNA was extracted from blood samples of both 119 unrelated SUNDS patients and 184 healthy individuals and screened for candidate HCN4 gene variants. One missense heterozygous variant c.1578C>T (Ala195Val) and four synonymous heterozygous variants c.1552C>T, c.2833C>T, c.3823C>T, and c.4189C>A were discovered in the SUNDS cases. The missense variant c.1578C>T (Ala195Val) was absent in 163 recruited controls and 105 persons of the Southern Han Chinese population, had in‐silico prediction indications as damaging, and was reported prevalent in sudden infant death, and is thus likely to be involved in SUNDS.     

Unexpected Serotonin Syndrome,Epileptic Seizures,and Cerebral Edema Following 2,5‐dimethoxy‐4‐bromophenethylamine Ingestion

4‐bromo‐2,5‐dimethoxyphenethylamine (2C‐B) is a designer drug. In Europe, 2C‐B is easily obtained and used for recreational purposes. It is known for its stimulating effects similar to those of 3,4‐methylenedioxymethamphetamine, although in higher doses it has more hallucinogenic effects. Here, we report a case of 2C‐B ingestion, confirmed by liquid chromatography‐tandem mass spectrometry, in an 18‐year‐old man. The neurological consequences were severe, including the development of serotonin syndrome and severe brain edema. Supportive therapy resulted in a stable condition, although, after several months, the patient still suffered from severe neurological impairment due to the drug‐induced toxicity. This case showed that 2C‐B could not be identified with the drugs of abuse screening routinely used in Dutch hospitals. The use of 2C‐B carries many risks, with potentially profound neurological damage, that both consumers and healthcare physicians are unaware of.     

非公有制经济组织中的基层党组织建设问题

非公有制经济组织中的基层党组织建设也是党的基层组织建设十分重要的部分,在非公有制经济组织中建立党的组织,开展党的建设活动具有很强的思想基础、阶级基础和群众基础。     

PRRSV间接免疫荧光检测法的建立和应用

以猪生殖与呼吸综合征病毒(PRRSV) ATCC VR 2332 株人工单独感染3 头3 周龄仔猪,并用PRRSV ATCC VR 2332株和猪圆环病毒2型(PCV2)联合感染2 头3 周龄仔猪,每日检查试验猪体温、采食情况及临床表现,并用HerdChek IDEXX 试剂盒测其血清抗体。PRRSV PCV2联合感染猪分别在感染后1、3周剖杀,PRRSV单独感染猪和健康对照猪分别在感染后1、2和3周剖杀,对全部试验猪的肺组织进行灌洗处理以获得肺泡巨噬细胞(PAM),用PAM进行抹片,同时用肺组织直接进行触片做间接免疫荧光(IIF)检测。结果表明,用所获得的3 株单克隆抗体均检测到人工感染猪肺组织中的PRRSV抗原。另外,用IIF检测7 头临床疑似PRRS病猪的PAM抹片,其中沭阳县的2头猪呈现阳性反应;对这2头猪的肺组织进行病毒分离,在盲传到第4代时Marc 145细胞上产生明显的细胞病变,进一步证实用所获得的3株单克隆抗体检测临床样品的结果准确而可靠,且获得的3株单克隆抗体均可通过IIF用于检测猪肺组织中的PRRSV抗原。     

具有深远意义的两次重要判断

改革开放以来,我们党作过两次具有深远意义的重要判断,第一次是十一届六中全会关于我国社会主义处于初级阶段的科学判断,第二次是"三个代表"重要思想对我们党所处历史方位的科学判断。两次科学判断具有深刻的启示作用。