High prevalence of hepatic steatosis and vascular thrombosis in COVID-19:A systematic review and meta-analysis of autopsy data

BACKGROUND Coronavirus disease 2019(COVID-19)disease can frequently affect the liver.Data on hepatic histopathological findings in COVID-19 is scarce.AIM To characterize hepatic pathological findings in patients with COVID-19.METHODS We conducted a systematic review with meta-analysis registered on PROSPERO(CRD42020192813),following PRISMA guidelines.Eligible trials were those including patients of any age and COVID-19 diagnosis based on a molecular test.Histopathological reports from deceased COVID-19 patients undergoing autopsy or liver biopsy were reviewed.Articles including less than ten patients were excluded.Proportions were pooled using random-effects models.Q statistic and I2 were used to assess heterogeneity and levels of evidence,respectively.RESULTS We identified 18 studies from 7 countries;all were case reports and case series from autopsies.All the patients were over 15 years old,and 67.2%were male.We performed a meta-analysis of 5 studies,including 116 patients.Pooled prevalence estimates of liver histopathological findings were hepatic steatosis 55.1%[95%confidence interval(CI):46.2-63.8],congestion of hepatic sinuses 34.7%(95%CI:7.9-68.4),vascular thrombosis 29.4%(95%CI:0.4-87.2),fibrosis 20.5%(95%CI:0.6-57.9),Kupffer cell hyperplasia 13.5%(95%CI:0.6-54.3),portal inflammation 13.2%(95%CI:0.1-48.8),and lobular inflammation 11.6%(95%CI:0.3-35.7).We also identified the presence of venous outflow obstruction,phlebosclerosis of the portal vein,herniated portal vein,periportal abnormal vessels,hemophagocytosis,and necrosis.CONCLUSION We found a high prevalence of hepatic steatosis and vascular thrombosis as major histological liver features.Other frequent findings included portal and lobular inflammation and Kupffer cell hyperplasia or proliferation.Further studies are needed to establish the mechanisms and implications of these findings.

Assessment of a Sudden Death Case due to Coronary Artery Disease Based on the PMCT and Forensic Autopsy

It is never an easy thing to diagnose heart vascular disease only depending on the unenhanced postmortem computed tomography(PMCT).This article reported a case of sudden natural death after the complaint of anterior chest pain in which coronary artery calcification(CAC) was clearly displayed using PMCT scan.The entire coronary artery system was almost reconstructed via multiplanar reformation(MPR) and volume-rendering reconstruction(VR),and the total calcium score of the coronary arteries was obtained with CaScoring automatic analysis software.The results showed that CAC was conspicuous;the total calcium score was 640.3,considerably higher than 400.The pulmonary ground-glass opacity(GGO) and small amount of fluid both in the subglottic trachea and main bronchi were also found.The imaging results confirmed those of autopsy.In addition,the results concluded that PMCT might serve as an invaluable adjunct to the classic autopsy procedure.

Comparative Analysis of CT Virtual Autopsy and Traditional Autopsy:A report of 3 Cases

The objective of the study is to compare the results of virtual autopsy and traditional autopsy and then to analyze the advantages and disadvantages of them.three cases with postmortem computed tomography(CT)examination and autopsy were selected.The CT images were sent to radiologists for interpretation and were compared with autopsy results.In the cases of death in traffic accidents,the two examination conclusions are relatively consistent;in the cases of sudden cardiac death,the information provided by virtual autopsy is limited;virtual autopsy has more strength on showing some lesions such as pneumatosis and fracture.Virtual autopsy has high application value in traffic accident cases,while its application in some sudden death cases remains to be improved.

Risk Identification and Protection during High-Risk Forensic Autopsy

"High-risk"autopsies are those in which the anatomical examination of a corpse entails a substantial risk of contracting a serious infectious disease.Herein,we discuss the risks of infection associated with high-risk autopsies and factors pertaining to risk identification in high-risk autopsies,and we suggest potentially preventative measures focused on anatomy room protection and virtual imaging.

Diagnostic imaging, preautopsy imaging and autopsy findings of 8 AIDS cases： a comparative study

Background Aquired immune deficiency syndrome （AIDS） presents a challenge to medical researchers because of its unique pathological and clinical picture. The clinical data, particularly autopsy evidence, from China have failed to provide enough pathological and etiological evidence for AIDS diagnosis, which impairs the reliability of the diagnosis and our full understanding of the occurrence and development of AIDS complications. The purpose of this study was to investigate the imaging and pathologic characteristics of AIDS. Methods Autopsy, imaging and pathological data from 8 cases of AIDS were retrospectively analyzed. Routine CT scanning of different body parts was performed during their periods of hospitalization. Transverse CT scanning was conducted from the skull to the pelvis immediately after the occurrence of death. After routine formalin fixing, 7 cardevers were cross sectioned for autopsy in freezing state and 1 for gross autopsy. Tissues were obtained from each section and organs for pathological examinations. Results The autopsy data indicated the presence of parasitic infections, bacterial infections, fungal infections, and virus infections in AIDS patients. Pneumocystis pneumonia, pulmonary tuberculosis, coccobacteria pneumonia, Aspergillus pneumonia, cytomegaJovirus pneumonia, toxoplasma encephalitis, lymphoma and cerebrovascular diseases were found in these patients. Conclusions During the course of AIDS progression, the concurrent multiple infections as well as tumor development may resuJt in multiple organ pathological changes and clinically complex symptoms that further complicate the imaging and pathological manifestations, thus resulting in difficult differential diagnosis. A combination of imaging data and autopsy data can help to clarify the diagnosis.

Fluctuations in the rate of autopsy in China

Autopsy has played a unique role in the progression of clinical medicine, medical education, epidemiology, and public health. However, the autopsy rate has been decreasing during the past several decades worldwide, and its necessity is frequently argued. Autopsy-based research in China, a country with the world＇s largest population, is very important for studying the spectrum and epidemiology of diseases as well as for discovering new diseases. This article summarizes the brief history of autopsy in China and analyzes the cause of its decline in recent decades by reviewing previously published papers, review articles, self-collected materials, and private correspondence. Since the first officially permitted autopsy in 1913, China witnessed the highest autopsy rate between 1950 and 1970, and since then the autopsy rate began to decline as it in other parts of the world. The main reasons for the reduction in autopsy rates in China include negligence by hospital administrators and relevant government authorities, unmotivated clinicians, helpless pathologists, unenforceable regulations and laws, and local cultures and customs.

Gastrointestinal tuberculosis:An autopsy-based study

Background:Tuberculosis is a disease of great relevance since it is one of the leading causes of morbidity and mortality worldwide.Gastrointestinal tuberculosis is an unusual presentation.It is defined as the involvement of any segment of the digestive tract,associated viscera,and peritoneum.The study’s main objective is to collect information from autopsies of patients diagnosed with gastrointestinal tuberculosis in a Pathology reference center in Colombia.Methods:This is a retrospective and descriptive study of autopsy reports.A total of 4,500 autopsies were performed between January 2004 and December 2020.The inclusion criteria were authorization of a family member following local law regulations and a final autopsy diagnosis of gastrointestinal tuberculosis using microscopic visualization.Results:Forty-eight patients with gastrointestinal tuberculosis autopsies were included in our study.Most of the patients were male(n=35,72.9%)with a median age of 40.5 years old.Human immunodeficiency virus infection history was reported in 28 cases(58.33%).The most affected gastrointestinal tract site was the terminal ileum.Ulcers and thickened epithelium were common autopsies macroscopic findings.Tuberculosis multiorgan compromise was a relevant finding in patients with gastrointestinal tuberculosis.Conclusions:Gastrointestinal tuberculosis is a disease of great importance,being its diagnosis a clinical challenge.Underdiagnosis can be reported in a high percentage of cases,so autopsy diagnosis can help reveal more accurate data about this condition.

Forensic Pathological Expertise of Medical Tangle Analysis of 139 Autopsy Cases

In this article , we report 139 autopsy cases of medical tangle , which were examined by the Department of Forensic Pathology, Faculty of Medicine, Tongji Medical University from Jan. 1972 to Dec. 1992.The emphasis is put on analyses of the status of medical tangle autopsy in forensic pathology, involved medical departments , distribution of victim's age and sex , differences between clinical diagnosis and autoptical conclusion, the composition and causes of medical tangle. The associated problems in forensic pathological autopsy are also discussed.

Perspectives on the Construction of Forensic Autopsy Laboratories Designed to Handle Infectious Diseases

Coronavirus disease 2019 has already infected tens of thousands of people in China.The existing autopsy laboratories are not qualified to perform autopsies on individuals confirmed or suspected to have died from an infectious disease.When dealing with corpses with uncertain health conditions or unknown contact with a pathogen,the forensic medical practitioners face severe risks of being infected.To meet the requirements of performing autopsies on such bodies,ensure the health and safety of forensic medical practitioners,and study the pathophysiological changes of infected patients,it is necessary to improve the construction requirements and regulations for forensic autopsy laboratories.

104例产前死胎原因的临床分析与探讨

目的:分析产前死胎原因的临床资料,以增加对死胎原因的认识。方法:收集2018年1月至2022年12月在南京大学医学院附属鼓楼医院终止妊娠的产前死胎病例,分析其临床资料的分布特征及死胎原因分布,采用美国死胎协作网络(SCRN)开发的标准进行死因归类,并分为死因明确组和死因不明组,比较分析两组人群的不同特征。结果:研究期间共有产前死胎210例,符合纳入标准者共104例。其中有尸检结果的为33例(31.7%),39例(37.5%)有遗传学结果,具有胎盘病理学检查的有75例(72.1%)。经SCRN标准归类分级后,死因归入很可能有关者55例(52.9%),可能有关者33例(31.7%),可能无关者13例(12.5%),还有3例(2.9%)不能归因,即死因明确组占84.6%(88例),死因不明组占15.4%(16例)。死因明确组与死因不明组相比,前者胎盘病理学检查率显著增高(78.4%)。死因分类中,胎盘病理性改变占比最多,占26.9%(28例),其次是妊娠合并症占比25.0%(26例),有15.4%的死胎原因仍是不明原因。结论:胎盘病理学检查对明确死胎原因有重要意义,采用SCRN的死胎病因分类分级法具有可行性,胎盘病理性改变在死胎原因分类中占比较高,建议每一例死胎胎盘都要进行病理学检查。

强化法医病理工作规范,提高尸检鉴定质量

法医病理检案鉴定工作的主要任务是查明死因及其相关问题,除理论知识外,其技术方法主要包括案情调查、现场尸体检验勘查、尸体解剖、病理检验、组织病理学检查、毒物化验和硅藻检验等辅助检查,检验过程中形成的相关记录和图照等也是鉴定文书的重要组成部分。在科技发展日新月异、新技术层出不穷,各行各业都要求高质量发展的今天,需强化相关规范和夯实专业基本功。

21例致死性肺动脉血栓栓塞的高危因素及临床病理分析

目的:探讨致死性肺动脉血栓栓塞的高危因素及其临床病理特点,为临床预防及治疗致死性肺栓塞提供帮助。方法:对北京大学基础医学院病理学系2002年1月1日至2008年9月30日完成的162例成人医疗纠纷尸检病例进行回顾性分析,用限制性长度多态性(RFLP)的方法对致死性肺栓塞病例(21例)及随机对照成人病例(6例)进行FⅤ(factorⅤ)Leiden突变和FⅡ(factorⅡ)G20210A突变检测。结果:有21例致死性肺动脉血栓栓塞病例,占病例总数的12.96%(21/162)。每例均至少存在1项已知的高危因素,多数病例存在2项以上的高危因素。主要的获得性高危因素包括:手术、创伤骨折、恶性肿瘤、妊娠及产褥期、老年人、高血压、糖尿病、感染等。21例致死性肺栓塞病例及6例对照病例均未检测出FⅤLeiden突变与FⅡG20210A突变。21例患者中,只有6例生前进行了D-二聚体检查,6例均明显升高;只有1例患者使用药物进行预防性抗凝。结论:致死性肺动脉血栓栓塞是临床科室尤其是手术科室引起纠纷的重要原因。中国人发生致死性肺栓塞主要与创伤骨折、手术等获得性因素有关,遗传性因素FⅤLeiden突变和FⅡG20210A突变不是中国人发生致死性肺栓塞的主要原因。对存在肺栓塞高危因素(尤其是创伤骨折及手术)的患者,合理评估患者的危险因素,做好预防性措施,并尽可能的早期诊断与处理或可减少致死性肺栓塞的发生。

影像学技术与尸体解剖在致伤方式鉴定中的应用比较

目的探讨影像学技术在法医学死因鉴定、致伤方式分析研究中的应用范围。方法以真实高坠死亡案例为研究对象,分别运用多层螺旋CT平扫、三维重建和磁共振成像技术对尸体进行全面检查,随后即行系统尸体解剖,分别比较影像学技术与尸体解剖在关键信息和细节信息获取方面的优点和不足。结果对于损伤死亡案例,影像学技术可以收集损伤、骨折、出血等关键信息,且具有预先探知、显示非常规解剖部位微小损伤等优点,对于细节问题显示尚存在不足,某些技术的法医学应用尚需进一步磨合。结论影像学技术应用可在致伤方式鉴定中作为法医尸体解剖的指导和补充,在特定情况下可起到一定的替代作用。

云南地方性暴发性心肌炎尸检病理学观察

目的探讨云南地方性暴发性心肌炎死亡的原因。方法在云南地方性暴发性心肌炎发病点区争取到3例死亡病例及1例病区猝死鸡的尸体解剖,对尸体解剖标本进行病理学研究。结果心脏大小及重量基本在正常范围,光镜检查主要改变是心肌间质水肿,内有淋巴细胞浸润,心肌纤维粗颗粒变性、空泡变性、小灶状肌溶性坏死并累及传导系统。结论观察的3例死亡病例及1例病区猝死鸡的病理学变化与文献报道的病毒性心肌炎的病理学变化基本相同。在云南地方性暴发性心肌炎暴发流行时,在疫区的野生动物或家畜家禽间是否存在相似的疾病流行,有待研究。

90例医疗纠纷尸检分析

目的分析、讨论医疗纠纷中法医病理学尸体解剖的重要性。方法收集温州医学院法医学系2001—2008年涉及医疗纠纷尸体解剖案例90例,按照死者年龄、性别、死亡原因及临床诊断和法医病理诊断等要素进行分类整理和分析。结果死者年龄从新生儿至72岁,男女比例为1∶1,医院级别以县级医院较多(30例,33.33%),临床诊断与法医病理死因诊断符合率为33.33%。结论尸体解剖对涉及死亡的医疗纠纷的正确处理和防范有重要作用。

虚拟现实技术在法医病理学中的应用

对虚拟现实技术的概况及其在法医病理中的运用、发展前景进行了综述。文献资料表明:随着手术导航系统、虚拟尸检、显微影像技术等虚拟现实技术的产生发展,这必将对法医病理学的教学、实验、科研及其实际运用产生深远的影响,并将极大推动本学科的发展。但由于软硬条件、成本、费用等的限制,这一技术要真正进入实践运用还需要进一步改进、完善。

雷公藤中毒的尸检病理变化--附4例尸检报告

中药雷公藤制剂已广泛用于治疗类风湿关节炎、红斑性狼疮等多种自身免疫性疾病,并已取得明显疗效而引起关注。但本品具有一定毒性,其有效治疗量与最小中毒量比较接近。为提供临床安全用药参考,本研究报告了4例因雷公藤中毒的尸检病理报告。其中2例是因心脏损害引起心源性休克死亡,其心肌细胞可见水变性、甚至心乳头肌收缩带坏死明显;2例因重度急性中毒性肾病死于急性肾功能衰竭;4例均见脑水肿及胃肠炎等病变。提示,用药剂量十分关键;应废弃直接用雷公藤生药治疗疾病,要采用正规药厂生产的雷公藤制剂,以预防今后类似中毒死亡案例的发生。

死后CT血管造影对冠状动脉粥样硬化的诊断价值

目的探讨死后CT血管造影技术在冠状动脉粥样硬化血管狭窄程度诊断中的应用价值。方法基于前期实验研究结果,对人死后离体心脏CT造影装置进行改良,选取不同冠状动脉粥样硬化病变程度猝死的检案案例,于心脏解剖前完整取出心脏并立即行CT冠状动脉造影,并将CT血管造影结果与组织病理学所见进行比较;同时比较改良前后造影装置的优、缺点。结果改良的离体心脏造影装置可以获得更好的成像效果;死后CT血管造影技术在冠状动脉粥样硬化血管狭窄程度诊断上与解剖和组织病理学所见具有较高的一致性,同时还可以通过三维重建技术将冠状动脉病变更客观、形象地展现出来。但CT血管造影技术只能对病变血管进行检查,在死因的诊断上存在一定的局限性。结论死后CT血管造影技术在冠状动脉粥样硬化血管狭窄程度案件中可以作为传统尸体解剖的辅助手段。

不同年龄实验恒河猴自然死亡的肝脏病变谱分析

目的观察人工饲养条件下实验恒河猴肝脏病理改变,探讨肝脏疾病分布规律和病理改变特点,丰富实验猴自发病变基本研究资料。方法对1998～2008年云南地区饲养的自然死亡的155只恒河猴(年龄2～20岁)的肝脏进行病理检查,按年龄分为幼年组、成年组、老年组,并对观察结果进行统计学分析。结果 155例恒河猴中88例检出肝脏病变,有肝细胞变性、肝细胞坏死、炎细胞浸润、吞噬细胞增生、肝淤血、纤维组织增生、肝脓肿、寄生虫共八种主要病变,出现率最高的为肝细胞水样变性(34.19%)。除肝脓肿外,幼年组、成年组、老年组八种病变均有检出。卡方检验显示:肝细胞水样变性成年组病变率明显高于幼年组;肝细胞脂肪变性老年组明显高于成年组和幼年组;轻度炎细胞浸润病变老年组明显高于成年组;纤维组织增生老年组明显高于幼年组(P<0.05)。结论人工饲养条件下死亡实验猴肝脏病变检出率较高,实验猴肝脏病理改变随年龄增长而病变加重,提示在进行实验猴肝脏研究时,应注意对自发性病变的判别,药物安全性评价实验应避免选择老年猴做为研究对象。死亡实验猴肝脏病变谱研究,对实验猴的质量控制和相关动物实验有重要指导价值。

120例围生期妇女、婴儿死亡导致医疗纠纷案例分析报告

目的:比较分析各相关因素对围生期妇女、婴儿死亡的影响,对引起死亡及导致医疗纠纷的原因进行总结。方法:回顾分析重庆医科大学法医教研室2000～2009年解剖医疗纠纷案例中围生期死亡妇女、婴儿共120例,其中妇女72例,婴儿48例。统计内容包括:尸检数量、死亡原因、死亡时间、医院级别、分娩方式、产前疾病、临床诊断与尸检诊断符合情况等。结果:①围生期妇女、婴儿死亡导致医疗纠纷主要集中在一级医院和二级医院;②各级医院围生儿组的平均误诊率为77.1%,远高于妇女组的误诊率:40.3%;③发生医疗纠纷的围生期死亡妇女年龄偏高,平均年龄30.5岁,大于28岁的占65.3%;④发生医疗纠纷的围生期死亡妇女职业主要为农民和无业,分别占62%和17%;⑤75%的死亡妇女为高危妊娠,其高危因素的前3位依次是:妊娠合并症、妊娠异常和分娩异常;⑥发生医疗纠纷的围生期妇女死亡原因前5位依次是:产后大出血、羊水栓塞、严重感染、肺动静脉血栓形成、急性坏死性胰腺炎,死亡时间的3个高峰期为:进入产程～分娩结束、分娩结束～产后6h、产后12h～产后24h;⑦发生医疗纠纷的围生期婴儿死亡原因前4位依次为:肺部因素、脐带因素、胎盘因素和产程因素,其中进入产程～出生48h是婴儿死亡的高峰期,占婴儿总死亡例数的77.1%。结论:医疗条件、高危妊娠、治疗抢救是否及时有效是影响围生期妇女、婴儿死亡的重要因素。提高一级医院和二级医院的医疗条件,增强其处理围生期妇女高危妊娠、产后大出血、羊水栓塞、围生儿肺部因素和脐带因素的能力,是降低重庆地区围生期妇女、婴儿死亡率及其导致的医疗纠纷发生率的关键。