Review of pathologic findings in remnant hearts following valve donation

The failure of medical examiners/coroners (ME/C) to allow heart valve donation is a major problem encountered by tissue agencies. Even though many ME/C favor tissue donation they remain responsible for determination of cause and manner of death. In 2001, the Jesse E. Edwards Registry of Cardiovascular Disease was approached by one of the nation's largest tissue procurement agencies (The American Red Cross--ARC) for the purpose of performing cardiovascular pathologic examinations following valve donation. The affiliation existed from October 2001 to January 2005. This study was undertaken to review all 593 postvalve recovery heart remnants received during that time period to tabulate the abnormalities identified and to determine whether donation interfered with the determination of cause of death. For each case, a preliminary cause of death was provided by the ARC. The decedent's body height and weight were also provided. Using the preliminary cause of death, the 593 cases were divided into natural and nonnatural manner of death groups. This division of the cases resulted in 106 cases placed in the natural manner of death group and 487 cases in the nonnatural manner of death group. For each case, all cardiac findings including significant conditions, additional findings, incidental findings, and congenital abnormalities were tabulated. Within the natural manner of death group, 15 cases had a noncardiac cause of death and 91 cases had a cause of death suspected to be cardiac related. In the 91 cases, a total of 132 significant cardiac findings were identified and there were six structurally normal hearts including two infants. In the nonnatural manner of death group, 214 significant cardiac findings were identified and 222 cases had a structurally normal heart. In both natural and nonnatural groups, the most common cardiac abnormality was atherosclerotic coronary artery disease. Other frequently encountered conditions were also identified including 11 cases with acute angle of origin of a coronary artery (five cases natural group; six cases nonnatural group). An important feature of this review was the recognition of potentially inheritable conditions that were diagnosed in both natural and nonnatural manner of death groups. There were three cases of hypertrophic cardiomyopathy (one natural; two nonnatural), three cases of arrhythmogenic right ventricular cardiomyopathy (one natural; two nonnatural), and one case of mitral valve prolapse (natural). In reviewing these cases, we did not feel that valve donation severely impaired cardiac pathologic examination. The benefits of cardiovascular pathologic examination by a cardiac pathologist include the identification of significant and incidental findings and recognition of potentially inheritable conditions.     

Interpreting Injury Mechanisms of Blunt Force Trauma from Butterfly Fracture Formation

According to biomechanics of fracture production during blunt impact, tubular bones are subject to compressive (impact site) and tensile (opposite impact site) forces; this causes bones to break in tension before compression, producing Y-shaped fracture patterns with breakaway (butterfly) fragments. In current forensic models, the side of the bone exhibiting the breakaway fragment is designated the impact side, with initial breakage occurring opposite. Fracture production and patterning of blunt impacts to 255 sheep femora were analyzed. Contra the existing model, only 60% of complete butterfly fractures exhibited impact side breakaway fragments. Although fractures initiated on the tension, nonimpact side, butterfly fragments formed on either compression or tension sides. Using newly defined breakaway fragment shape criteria, impact side was estimated with 98% accuracy for both complete and partial butterfly fractures. Furthermore, the results suggest that the impact site is the located on one of the Y-fracture's arms, not the butterfly fragment's center, as previously modeled.     

Sudden death in infancy due to bicuspid aortic valve

Symptoms of bicuspid aortic valve usually occur in the age group of 50-70 years, but rarely, it can also lead to sudden unexpected death in infancy and early childhood. The autopsy of a 2-month-old baby boy, found dead in his cot, revealed the heart weight as 25 g, and the macroscopic examination showed the circumference of the aortic valve consisting of two leaflets as 8 mm. The thickness of the left ventricle, right ventricle, and septum was measured as 8, 7, and 10 mm, respectively. Microscopically, the heart revealed hypertrophic changes of myocytes. Subendocardial areas displayed necrosis of myocytes, and severe and diffuse ischemic changes characterized by loss of myofibers and vacuolization. Interstitial pneumonia was identified in the lungs. Death occurred as a result of a congenital bicuspid aortic valve obstructing the left ventricular outflow tract complicated by lung infection. As there are only a few reported cases in infancy, and congenital bicuspid aortic valve can lead to sudden unexpected death, this case is presented to the forensic community.     

Floppy aortic valve presenting as sudden death

A previously healthy 34-year-old Dutch immigrant to Australia died unexpectedly in his sleep. At autopsy the only significant finding was a floppy aortic valve (FAV). Histologic, histochemical and electron microscopic studies corroborated the macroscopic diagnosis. Previously described associations of the FAV include the floppy mitral valve, Marfan's syndrome, aortic root dilatation and aortic cystic medial necrosis. None of these features were found in the present case which is the first recorded example of isolated FAV presenting as sudden death. The mechanism of death is obscure, and while it is presumed to be dysrhythmic, a detailed histological examination of the cardiac conducting system revealed no anatomic abnormality.     

报道家庭暴力:新闻专业主义给中国媒体的借鉴与思考

在中国反对家庭暴力行动兴起的背景下,如何对中国家暴进行合理有效的新闻报道是动员全社会投入反家暴的瓶颈之一,也是新兴的研究课题。在家暴问题的报道方式上,本文对西方新闻专业主义旗舰《纽约时报》、《华盛顿邮报》和跨文化地区香港《南华早报》的相关实践作出分析,同时对中国内地媒体提出了本土化报道家庭暴力的策略建议。     

Ebstein Anomaly and Sudden Childhood Death

A 13‐year‐old girl is reported who died suddenly and unexpectedly in her sleep from previously undiagnosed Ebstein anomaly. At autopsy, there was dilatation of the right atrium with marked dilatation of the right auricle and apical displacement of the tricuspid valve into the right ventricular cavity with atrialization of the upper portion of the right ventricle. There were also prominent dysplastic changes in both the septal and posterior leaflets of the tricuspid valve with thickening of the valve and fusion of leaflets to the wall of the ventricle. Histology of the myocardium showed focal, minor microscopic areas of interstitial fibrosis with marked fibrous dysplasia and thickening of the tricuspid valve. Lethal arrhythmias occur in this condition because of the geographical relationship of the conduction system to the abnormal anatomical structures. As adolescents who died suddenly are often minimally symptomatic, cases will rarely present de novo to forensic autopsy.     

行政冲突的价值分析--公共管理新模式探索

公共领域的冲突或危机管理模式是价值观、信仰以及稀少的地位、权力和资源分配上的斗争,具有一定的负功能;关注公共领域中的冲突管理或危机管理并不是涉及双方行政关系的基础,不是核心价值的冲突,而是民主性质的公共规则控制下的冲突,是公共领域可以承受,并对公共管理结构的整合提供动力的冲突,使人们能够运用冲突的危机探索并接近解决的可能性的冲突,因而是具有正功能的冲突.认为,虽然冲突管理或危机管理也具有反功能,有一定风险,但影响是有限的,因此,危机管理或冲突管理的正功能成为研究的重点.     

社会转型与社会冲突调适机制的构建

转型期是利益诉求集中和社会矛盾增多的一个特殊历史阶段,调节社会冲突,化解社会矛盾,构建长效持久的社会冲突调适机制是各级领导干部在转型期的重要职责和任务。各级领导干部要在坚持＂最大限度地消除不和谐因素,最大限度地创造和谐因素＂原则的前提下,着力推进构建科学的社会风险预警机制、社会安全阀机制和社会矛盾调节机制,增强社会冲突调适的针对性、时效性和可操作性,促进社会的稳定与和谐。     

Assessing Impact Direction in 3‐point Bending of Human Femora: Incomplete Butterfly Fractures and Fracture Surfaces,,

Current literature associates bending failure with butterfly fracture, in which fracture initiates transversely at the tensile surface of a bent bone and branches as it propagates toward the impact surface. The orientation of the resulting wedge fragment is often considered diagnostic of impact direction. However, experimental studies indicate bending does not always produce complete butterfly fractures or produces wedge fragments variably in tension or compression, precluding their use in interpreting directionality. This study reports results of experimental 3‐point bending tests on thirteen unembalmed human femora. Complete fracture patterns varied following bending failure, but incomplete fractures and fracture surface characteristics were observed in all impacted specimens. A flat, billowy fracture surface was observed in tension, while jagged, angular peaks were observed in compression. Impact direction was accurately reconstructed using incomplete tension wedge butterfly fractures and tension and compression fracture surface criteria in all thirteen specimens.     

社区服务:现代社会的"安全阀"

经济全球化给各国特别是发展中国家带来社会不稳定因素,随着人重新"回归社区",也把不稳定因素带入了社区.社区服务多元化和服务水平的提升,能增强社区人的认同感、归属感,是社会稳定、发展的"安全阀".在现代社区服务中要增强社区助老、就业、文化、信息服务功能,并倡导志愿者精神和社会中间组织.