Legal medicine
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Malignant hyperthermia (MH) is a genetic disorder of skeletal muscle in susceptible individuals that is triggered by exposure to anesthetic agents, and can cause death. Mutations in the ryanodine receptor type 1 gene (RYR1) are associated with MH-susceptibility. MH is also triggered in susceptible individuals by severe exercise in hot conditions or by overheating in infants. ⋯ Postmortem mutation analysis revealed that the child possessed two distinct RYR1 mutations. Since each mutation had previously been identified in a separate MH-susceptible patient, MH-susceptibility with over-response to the environmental high temperature might have occurred in this child with RYR1 mutations. These findings suggest that a MH-susceptible case may have died with a presumed diagnosis of heat stroke at autopsy.
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The foremost task for scientific journals is the dissemination of knowledge and advancement of new ideas and theories, as science does not exist until it has been published. The first prerequisite for scientific information to become effective is determined by a favourable outcome in the publishing process after which the information is made available to the scientific community for affirmation or rejection. The world of scientific publishing has changed substantially during the past decade and these changes have affected all parties involved in the publishing process, as well as the readership. ⋯ As the scientific quality and the merit of a scientific publication is very difficult to assess by anyone other than other experts in the same field, peer review is the traditional method of assessing the quality of research. Bibliometrics have provided the scientific community with new and interesting parameters to analyze scientific literature. As human nature is prone to seek facile solutions, these parameters, such as the Impact Factor, have become very popular among university administrators and have been used as short cuts to "measure" scientific performance and quality, despite the well known limitations and unsuitability of citations as a measure of research quality.
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Modern medicine was first introduced into Taiwan by missionary hospitals in 1865. However, Japanese governors following Japan's medical reform applied modern medicine as the standard of practice in the year 1896. They also imported 150 doctors from Japan to promote public hygiene and control infectious diseases, such as malaria, plague, cholera, dysentery, etc. ⋯ The general environment for medical practice in Taiwan has changed greatly in the past 60years. It is time for us to look around the world to set up standards of negligence for both clinical and criminal cases as soon as possible. In the mean time, the Department of Health should consider adopting the Good Medical Practice guidelines from the United Kingdom to strengthen the administrative power to regulate physicians' behaviors.
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Ventricular tachycardia and fibrillation (VT/VF) complicating Brugada syndrome, a genetic disorder linked to SCN5A mutations, and VF complicating acute myocardial infarction (AMI) have both been linked to phase 2 reentry. Because of these mechanistic similarities in arrhythmogenesis, we examined the contribution of SCN5A mutations to VT/VF complicating AMI. Nineteen consecutive patients developing VF during AMI were enrolled. ⋯ We describe the first sodium channel mutation to be associated with the development of an arrhythmic storm during acute ischemia. These findings suggest that a loss of function in SCN5A may predispose to ischemia induced arrhythmic storm. These results could be very useful for forensic implications regarding genetic screening in relatives.
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Chronic kidney disease and elevated serum C-reactive protein (CRP) have been suggested as clinical risk factors for cardiac attacks. The present study investigated postmortem blood urea nitrogen (BUN), creatinine (Cr) and CRP levels in the peripheral blood of sudden cardiac death cases. Adult autopsy cases of ischemic heart diseases (n=153, >20 years of age), including acute myocardial infarction (AMI, n=71), recurrent myocardial infarction (RMI, n=47), acute ischemic heart disease without infarction (AIHD, n=27) and chronic ischemic heart disease (CIHD, n=8), were examined and compared with chronic congestive heart disease (CHD, n=24), spontaneous cerebral hemorrhage (SCH, n=17) and mechanical asphyxiation (n=32). ⋯ Heart weight was larger for all heart diseases and SCH than for asphyxiation, and was larger for RMI and CHD but lower for AIHD and CIHD among them. Body mass index (BMI) was slightly higher for AMI, RMI, AIHD and CHD, remaining within the reference interval in most cases, but was lower for CIHD. These findings suggest different risk factors or etiologies, including active atherosclerosis, latent renal failure, dehydration and cardiac hypertrophy, for sudden deaths due to these heart diseases.