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Forensic Sciences Research 2019年第3期4卷 247-256页

作者： Thomas Hadberg Lynge Trine Skov Nielsen Bo Gregers Winkel Jacob Tfelt-Hansen Jytte Banner Department of Cardiology RigshospitaletDenmarkSection of Forensic PathologyAarhus UniversityAarhusDenmark Department of Forensic Medicine Section of Forensic PathologyAarhus UniversityAarhusDenmark Department of Forensic Medicine Section of Forensic PathologyCopenhagen UniversityCopenhagenDenmark

Myocarditis is associated with an increased risk of sudden cardiac death (SCD) in the ***,Information on nationwide burden of SCD caused by myocarditis (SCD-myocarditis) is *** this study all deaths among persons in Denmark aged 1-35years in 2000-2009 and 36-49years in 2007-2009 (27.1 million person-years) were *** reports,death certificates,discharge summaries,and nationwide registries were used to identify all cases of *** the 10-year study period,there were 14294 deaths,of which we identified 1 363 (10%) *** autopsied SCD (n=753,55%),cause of death was myocarditis in 42 (6%) cases corresponding to an SCD-myocarditis incidence of 0.16 (95%CI: 0.11-0.21) per 100000 *** had significantly higher incidence rates of SCD-myocarditis compared to females with an incidence rate ratio of 2.2 (95%CI:1.1-4.1).Myocarditis was not registered as cause of death In any of the non-autopsied SCD (n=610,45%).In conclusion,after nationwide unselected Inclusion of 14294 deaths,we found that 6% of all autopsied SCD was caused by *** cases of SCD-myocarditis were reported in the non-autopsied SCD,which could reflect underdiagnosing of myocarditis in non-autopsied ***,our data suggest a female protection towards SCDmyocarditis.

关键词： Forensic sciences sudden cardiac death myocarditis autopsy epidemiology gender children young adults

sudden cardiac death in anabolic androgenic steroids abuse: case report and literature review

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Forensic Sciences Research 2019年第3期4卷 267-273页

作者： Ana Isabel Hernández-Guerra Javier Tapia Luis Manuel Menéndez-Quintanal Joaquín S.Lucena Histopathology Service National Institute of Toxicology and Forensic Sciences(NITFS)Canary Islands DepartmentTenerifeSpain Forensic Pathology Service Institute of Legal Medicine and Forensic Sciences(ILMFS)Las Palmas de Gran CanariaSpain Chemistry Service NITFSCanary Islands DepartmentTenerifeSpain Forensic Pathology Service ILMFSSevilleSpain

Anabolic androgenic steroids (AAS) have several adverse effects on the cardiovascular system that may lead to a sudden cardiac death (SCD).We herein report a case involving a 24-year-old male,AAS abuser with intramuscular delivery in the 6 months before,who suffered a cardiorespiratory arrest at home's bathtub when returning from New Year's party.A forensic autopsy was performed according to the guidelines of the Association for European Cardiovascular Pathology (AECVP).The body showed hypertrophy of skeletal musculature,with low amount of subcutaneous fat and no signs of injury (body mass index,BMh 26.8 kg/m^(2)).On internal examination,there were multiorgan congestion,acute pulmonary edema,and cardiomegaly (420 g) with severe coronary atherosclerosis and superimposed acute occlusive thrombosis at the left main trunk and left anterior *** of scarring were located at the intersection between the posterior wall and the posterior third of the septum (postero-septal).At histology,acute myocardial infarction at the anterior third of the septum and the anterior wall,and subacute myocardial infarction at apical septum and apical posterior wall were *** findings were small intramyocardial vessel disease and myocytes *** analysis in blood showed ethanol ((0.90 ±0.05) g/L),stanazolol (11.31 μg/L),nandrolone (2.05μg/L) and testosterone (sudden death in a young athlete we must pay attention to the physical phenotype that may suggest AAS abuse and perform a detailed examination of the *** analysis is a key to establish the relationship between SCD and AAS abuse.

关键词： Forensic sciences forensic pathology anabolic androgenic steroids(AAS) sudden cardiac death autopsy cardiac pathology toxicology

sudden cardiac death of Duchenne muscular dystrophy with NT-proBNP in pericardial fluid as a useful biomarker for diagnosis of the cause of death: a case report

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Forensic Sciences Research 2020年第2期5卷 165-169页

作者： Mengzhou Zhang Rui Zhao Tianshui Yu Jiaoyong Li Miao Zhang Shukun Jiang Linlin Wang Guohua Zhang Rubo Li Baoli Zhu Dawei Guan Department of Forensic Pathology China Medical University School of Forensic MedicineShenyangChina Remote Forensic Consultation Center Collaborative Innovation Center of Judicial CivilizationChina University of Political Science and LawBeijingChina

Duchenne muscular dystrophy(DMD)is one of the most common and severest muscular *** it can be a cause of death when associated with cardiac muscle and/or respiratory muscles,no cases of sudden deaths in the setting of undiagnosed DMD with cardiac involvement have been reported in the *** studies showed that N-terminal-proBNP(NT-proBNP)was a robust laboratory biomarker to diagnose and monitor cardiac failure in clinical situations,suggesting that it may be used as an auxiliary indicator for diagnosis on left ventricular dysfunction in sudden cardiac deaths in forensic ***,we reported a case of 29-year-old man who died *** revealed that muscles of the body were almost replaced by fatty and fibrotic *** heart was enlarged with disarray and degeneration of cardiomyocytes in cardiac *** absence of dystrophin was detected by immunohistochemical staining,which confirmed *** biochemical test of pericardial fluid revealed a high level of NT-proBNP,indicating dysfunction of the left ventricle before *** cause of death was certified as an early dilated cardiomyopathy(DCM)/dysfunction of the left ventricle secondary to DMD,suggesting that sudden cardiac death with cardiac dysfunction could be identified by immunohistochemical method in combination with pericardial fluid NT-proBNP determination after systemic autopsy.

关键词： Forensic sciences forensic medicine NT-proBNP sudden cardiac death Duchenne muscular dystrophy left ventricular dysfunction

sudden cardiac death and cardiac Sodium Channel Diseases

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Journal of Forensic Science and Medicine 2022年第4期8卷 179-185页

作者： Wenzhao Wei Ying Fang Nan Zhou Qiuping Wu Qianhao Zhao Jianding Cheng Department of Forensic Pathology Zhongshan School of MedicineSun Yat‑sen UniversityGuangzhouChina

sudden cardiac death(SCD),accounting for a substantial part of the forensic autopsy,is a leading cause of mortality *** arrhythmia due to sodium channel diseases is recognized as one of the most prevalent etiologies of *** these disorders,defective cardiomyocytes,including the pacemaker and the working cardiomyocytes,would manifest as abnormal electrical activity and morphology,thereby predisposing individuals to *** is always a problem for forensic pathologists to adjudicate a sudden death caused by sodium channel diseases since structural changes in those cases are often *** the advent of the molecular autopsy,forensic pathologists can conduct targeted gene testing to identify the risk of SCD for family members of the *** review aims to discuss the relationship between SCD and sodium channel diseases,clarify the underlying mechanisms,and provide prophylactic suggestions for the relatives of SCD patients at risk.

关键词： Brugada syndrome dilated cardiomyopathy long QT syndrome progressive cardiac conduction disorder sodium channel disease sudden cardiac death

sudden cardiac death Due to Long QT Syndrome

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Journal of Forensic Science and Medicine 2022年第4期8卷 190-193页

作者： Jiayi Wu Wei Tang Kai Zhang Kai Li Jianwen Wang Youjia Yu Feng Chen Department of Forensic Medicine Nanjing Medical UniversityNanjingChina Department of Forensic Medicine Forensic Expertise Institute of Nanjing Medical UniversityNanjingChina Key Laboratory of Targeted Intervention of Cardiovascular Disease Collaborative Innovation Center for Cardiovascular Disease Translational MedicineNanjing Medical UniversityNanjingChina

Identification of sudden cardiac death(SCD)with a structurally normal heart remains an important challenge in forensic *** QT syndrome(LQTS)is known as an inherited or acquired channelopathy,which is characterized with prolonged QT interval,and is likely to cause SCD in young *** this circumstance,no specific pathological change in the heart can be found anatomically or histologically in the LQTS ***,postmortem LQTS diagnosis is mainly based on clinical manifestations and genetic ***,we reported a 26‑year‑old woman who was found dead at home with a history of unexplained *** clinical records and an electrocardiograph(ECG)obtained 3 months before her death showed a QTc interval of 539 ms which implicates the diagnosis of *** the autopsy and pathological examination findings lacked specificity,we noticed enhanced lipofuscin accumulation in cardiomyocytes,which might be related to *** excluding potential diseases and injuries,we made the postmortem diagnosis as LQTS according to ECG,clinical history,and forensic postmortem *** conclusion,we provided clinical and pathological features of an SCD case due to LQTS,which might enrich the understanding of forensic postmortem SCD diagnosis with nonstructural cardiac diseases.

关键词： Electrocardiograph long QT syndrome QT interval sudden cardiac death

Spontaneous type 1 pattern, ventricular arrhythmias and sudden cardiac death in Brugada Syndrome： an updated systematic review and meta-analysis

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Journal of Geriatric Cardiology 2017年第10期14卷 639-643页

作者： Ahmed Bayoumy Meng-Qi GONG Ka Hou Christien Li Sunny Hei Wong William KK Wu Guang-Ping LI George Bazoukis Konstantinos P Letsas Wing Tak Wong Yun-Long XIA Tong LIU Gary Tse Department of Medicine and Therapeutics Faculty of Medicine Chinese University of Hong Kong Hong Kong China Li Ka Shing Institute of Health Sciences Faculty of Medicine Chinese University of Hong Kong Hong Kong China Faculty of Medicine University of Amsterdam The Netherlands Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of Cardiology Tianjin Institute of Cardiology Second Hospitalof Tianjin Medical University Tianjin China Faculty of Medicine Newcastle University United Kingdom Department of Anaesthesia and Intensive Care Faculty of Medicine Chinese University of Hong Kong Hong Kong China Second Department of Cardiology Evangelismos General Hospital of Athens Athens Greece School of Life Sciences Chinese University of Hong Kong Hong Kong China Department of Cardiology First Affiliated Hospital of Dalian Medical University Dalian China

Brugada syndrome （BrS） is primary electrical disorder characterized by ST segment elevation with right bundle branch block morphology in patients with apparent structurally normal hearts, It predisposes affected individuals to ventricular tachycardia/fibrillation （VT/VF） and sudden cardiac death （SCD）.A number of studies have identified risk factors that are associated with a more malignant course of disease. These include male gender, syncope, a spontaneous type 1 ECG pattern, family history of SCD, family history of Brugada syndrome,

关键词： Brugada syndrome Risk stratification Spontaneous type 1 sudden cardiac death Ventricular arrhythmia

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Forensic Sciences Research 2019年第3期4卷 257-266页

作者： Benito Morentin M.Paz Suárez-Mier Ana Monzó Pilar Molina Joaquín S.Lucena Section of Forensic Pathology Basque Institute of Legal MedicineBilbaoSpain Histopathology Service Department of MadridNational Institute of Toxicology and Forensic SciencesSpain Forensic Pathology Service Institute of Legal Medicine and Forensic SciencesValenciaSpain Forensic Pathology Service Institute of Legal Medicine and Forensic SciencesSevilleSpain

This is a multicentre forensic study that identifies all sports-related sudden deaths (SRSDs) in young people,due to myocardial diseases (MDs) that occurred in a large area of *** aim of the study is to assess the epidemiology,causes of death,and sport activities associated with these *** is a retrospective study based on forensic autopsies performed in the provinces of Biscay,Seville,Valencia and in the jurisdiction covered by the National Institute of Toxicology and Forensic Sciences in Madrid (Spain).The retrospective study encompasses from 2010 to *** sudden cardiac deaths (SCDs) in persons 1-35years old were *** total number of SCDs were divided into death occurred during exercise (SRSD) and death during rest,sleep or normal activities (non-SRSD).Each of these two groups was subdivided according to the cause of death into MD (primary cardiomyopathies and myocarditis) and ***-pathological,toxicological and genetic characteristics of SRSD due to MD were *** the 8-year study period,we identified 645 cases of SCD in the young: 75 SRSD (11.6%) and 570 non-SRSD (88.4%).MD was diagnosed in 33 (44.0%) of the SRSD and in 112 (19.6%) of the non-SRSD *** cases of SRSD due to MD were males (mean age (24.0±7.6) years) practicing recreational sports (85%).SRSDs were more frequent in arrhythmogenic cardiomyopathy (ACM) (37%) and hypertrophic cardiomyopathy (HCM) (24%),followed by myocarditis (15%) and idiopathic left ventricular hypertrophy (ILVH) (9%).Only in five cases of SRSD the MD responsible of death (HCM) had been diagnosed in *** symptoms related to the disease were present in other seven patients (six of them with ACM).Postmortem genetic studies were performed in 15/28 (54%) primary cardiomyopathies with positive results in 12 (80%) *** most frequent sports disciplines were football (49%) followed by gymnastics (15%) and running (12%).In Spain,SRSD in young people due to MDs occurs in mal

关键词： Forensic sciences forensic pathology sudden cardiac death sports myocardial diseases autopsy young

Regulatory variation within 3’UTR of STAT5A correlates with sudden cardiac death in Chinese populations

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Forensic Sciences Research 2022年第4期7卷 726-735页

作者： Huan Yu Yadong Guo Zhenzhen Yang Qing Zhang Jiabin Xu Qi Yang Yiling Qu Rui Tan Lijuan Li Yan He Chengtao Li Suhua Zhang Bin Luo Yuzhen Gao Department of Forensic Medicine Medical College of Soochow UniversitySuzhouChina Department of Forensic Science School of Basic Medical SciencesCentral South UniversityChangshaChina Public Security Bureau of Taixing TaizhouChina Department of Epidemiology Medical College of Soochow UniversitySuzhouChina Shanghai Key Laboratory of Forensic Medicine Academy of Forensic ScienceShanghaiChina Faculty of Forensic Medicine Zhongshan School of MedicineSun Yat-sen UniversityGuangzhouChina

Definitive diagnosis to sudden cardiac death(SCD)is often challenging since the postmortem examination on SCD victims could hardly demonstrate an adequate cause of *** is therefore important to uncover the inherited risk component to *** transducer and activators of transcription 5 A(STAT5A)is a member of the STAT family and a transcription factor that is activated by many cell ligands and associated with various cardiovascular *** this study,we performed a systematic variant screening on the STAT5A to filter potential functional genetic *** on the screening results,an insertion/deletion polymorphism(rs3833144)in 3’UTR of STAT5A was selected as the candidate variant.A total of 159 SCD cases and 668 SCD matched healthy controls was enrolled to perform a case-control study and evaluate the association between rs3833144 and SCD susceptibility in Chinese *** regression analysis showed that the deletion allele of rs3833144 had significantly increased the SCD risk(odds ratio(OR)=1.54;95%confidence interval(CI)=1.18-2.01;P=0.000955).Further genotype-expression eQTL analysis showed that samples with deletion allele appeared to lower expression of STAT5A,and in silico prediction suggested the local 3 D structure changes of STAT5A mRNA caused by the *** the other hand,the bioinformatic analysis presented that promoters of RARA and PTGES3L-AARSD1 could interact with rs3833144,and eQTL analysis showed the higher expression of both genes in samples with deletion ***-luciferase activity assays also suggested the significant regulatory role of rs3833144 in gene *** current data thus suggested a possible involvement of rs3833144 to SCD predisposition in Chinese populations and rs3833144 with potential function roles may become a candidate marker for SCD diagnosis and prevention.

关键词： Forensic sciences forensic genetics STAT5A 3’UTR rs3833144 sudden cardiac death indel polymorphism

Evaluation of cardiac hypertrophy in the setting of sudden cardiac death

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Forensic Sciences Research 2019年第3期4卷 223-240页

作者： Kristopher S.Cunningham Danna A.Spears Melanie Care Department of Laboratory Medicine and Pathobiology Ontario Forensic Pathology ServiceUniversity of TorontoTorontoCanada University Health Network Division of Cardiology-ElectrophysiologyUniversity of TorontoTorontoCanada Fred A.Litwin Family Centre in Genetic Medicine and Inherited Arrhythmia Clinic University Health Network&Mount Sinai HospitalUniversity of TorontoTorontoCanada

Ventricular hypertrophy is a common pathological finding at autopsy that can act as a substrate for *** grapple with the significance of ventricular hypertrophy when assessing the sudden and unexpected deaths of young people and what it could mean for surviving family *** pathological spectrum of left ventricular hypertrophy (LVH) is reviewed *** article is oriented to the practiring autopsy pathologist to help make sense of various patterns of increased heart musde,particularly those that are not clearly cardiomyopathic,yet present in the setting of sudden cardiac *** article also reviews factors influencing arrhythmogenesis as well as genetic mutations most commonly associated with ventricular hypertrophy,especially those associated with hypertrophic cardiomyopathy (HCM).

关键词： Forensic sciences forensic pathology ventricular hypertrophy arrhythmia sudden cardiac death genetics

Analyses of N‑Terminal Pro‑Brain Natriuretic Peptide,cardiac Troponin T,and Creatine Kinase MB in Pericardial Fluid in sudden cardiac death Caused by Ischemic Heart Disease

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Journal of Forensic Science and Medicine 2022年第4期8卷 135-141页

作者： Zhipeng Cao Tianqi Wang Shao‑Huang Wu Zihan Liao Baoli Zhu Rui Zhao Department of Forensic Pathology School of Forensic MedicineChina Medical UniversityShenyangChina2Liaoning Province Key Laboratory of Forensic Bio‑Evidence SciencesShenyangChina3Center of Forensic InvestigationChina Medical UniversityShenyangChina

Background:Biochemical analyses of N‑terminal pro‑brain natriuretic peptide(NT‑proBNP),cardiac troponin T(cTnT),and creatine kinase MB(CK‑MB)have been reported to be valuable for the auxiliary diagnosis of sudden cardiac death(SCD)in previous forensic *** and Objectives:The present study aimed to evaluate the diagnostic efficiency of combined analyses of NT‑proBNP,cTnT and CK‑MB in the pericardial fluid for forensic diagnosis of SCD caused by ischemic heart *** and Methods:Levels of NT‑proBNP,cTnT,and CK‑MB in the pericardial fluid of 132 medicolegal autopsy cases were obtained through electrochemiluminescence ***:NT‑proBNP,cTnT,and CK‑MB levels were significantly elevated in SCD cases(P<0.05).Receiver‑operating characteristics(ROC)analysis showed that NT‑proBNP,cTnT,and CK‑MB have diagnostic value for the diagnosis of SCD:NT‑proBNP,cutoff value of 2236 pg/ml;cTnT,cutoff value of 199.51 ng/ml;CK‑MB:cutoff value of 2742.5 ng/ml,and the combined analyses of these three biomarkers have better diagnostic efficiency than each single biomarker ***,the causes of SCD were sub‑divided into acute ischemic heart disease,acute myocardial infarction(AMI),and recurrent myocardial infarction subgroups for further analysis,which revealed that the ratio of cTnT/CK‑MB could be used to distinguish AMI with the cutoff value of 0.1085 estimated by ROC ***:These observations suggested that the postmortem biochemical analyses of NT‑proBNP,cTnT,and CK‑MB in the pericardial fluid may assist to diagnose SCD in forensic practice,and the combined analyses of multiple biomarkers have better diagnostic efficiency than each single biomarker *** the basis of the postmortem biochemical analyses of NT‑proBNP,cTnT and CK‑MB,combining the ratio of cTnT/CK‑MB could be used to distinguish AMI.

关键词： cardiac troponin T creatine kinase MB ischemic heart disease N‑terminal pro‑brain natriuretic peptide pericardial fluid postmortem biochemistry sudden cardiac death