Death, Sudden ; epidemiology ; Emergency Service, Hospital ; statistics & numerical data ; Humans

OBJECTIVETo discuss the clustering of Yunnan unexplained sudden death (YUSD) in household and village.

METHODSFifty-two cases were found by YUSD surveillance system in 2005. Poisson distribution and beta-binomial distribution (BBD) were employed in studying the household distribution of the disease. Poisson distribution and negative binomial distribution (NBD) were employed in studying the village distribution of the disease.

RESULTSBBD were fitted household distribution of YUSD very well (chi(2) = 0.25, P = 0.62), while Poisson distribution was consistent with it (chi(2) = 46.01, P < 0.001). And NBD were fitted village distribution of YUSD very well (chi(2) = 0.05, P = 0.58), however the consistency in Poisson distribution was not observed (chi(2) = 110.57, P < 0.001).

CONCLUSIONHousehold and village clustering of YUSD does exist.

Bias ; Binomial Distribution ; Cause of Death ; China ; epidemiology ; Death, Sudden ; epidemiology ; Family ; Humans

Objective To explore the association of cardiac disease associated genetic variants and the high incidence of Yunnan sudden unexplained death （YNSUD） in Yi nationality. Methods The genomic DNA was extracted from peripheral blood samples collected from 205 Yi villagers from YNSUD aggregative villages （inpatient group） and 197 healthy Yi villagers from neighboring villages （control group）. Fifty-two single nucleotide variants （SNVs） of 25 cardiac disease associated genes were genotyped using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry （MALDI-TOF-MS）. The SPSS 17.0 was used to analyze data. The pathogenicities of variants with differences between the two groups that have statistical significance were predicted by protein function prediction software PolyPhen-2 and SIFT. All villagers from inpatient group were given electrocardiogram （ECG） examination using a 12-lead electrocardiograph. Results The allele frequency and the genotype frequency of missense mutation DSG2 （rs2278792, c.2318G>A, p.R773K） of pathogenic genes of arrhythmogenic right ventricular cardiomyopathy （ARVC） in inpatient group was higher than that in control group （P<0.05）. Abnormal ECG changes were detected in 71 individuals （34.6%） in the inpatient group, among which 54 individuals carried R773K mutation, including clockwise （counterclockwise） rotation, left （right） axis deviation, ST segment and T wave alteration and heart-blocking. Conclusion Definite pathogenic mutations have not been found in the 52 cardiac disease genes associated SNVs detected in Yi nationality in regions with high incidence of YNSUD. The cause of high incidence of YNSUD in Yi nationality needs further study.
Arrhythmogenic Right Ventricular Dysplasia ; China/epidemiology* ; Death, Sudden/etiology* ; Death, Sudden, Cardiac/etiology* ; Ethnicity/genetics* ; Humans ; Incidence ; Mutation

BACKGROUNDUnderlying diseases have a statistically significant positive correlation to sudden death. However, sudden unexplained death (SUD) is different from sudden death, as there is no clinical evidence to support the sudden death due to the original underlying disease, nor a lethal pathological basis to be found during autopsy. In addition, SUD are more common in young, previously healthy individuals, usually without any signs of disease, with no positive lesions found after autopsy. Therefore, a causal relationship between SUD and the underlying disease needs to be further explored. This study aimed to explore the role that common underlying diseases play in patients with SUD and to reveal the correlation between them.

METHODSThe medical records, history and case information of 208 patients with SUD were collected for the survey. All these SUD occurred in the emergency room of Peking University Third Hospital from January 2006 to December 2009. The patients were stratified by with and without common underlying diseases. To examine possible associations between the underlying diseases and the cause of unexplained sudden death, the chi-squared and Fisher's exact tests were used.

RESULTSAmong the 208 patients, 65 were diagnosed with common underlying diseases while 143 were not. Within these two groups, there were 45 patients for whom the clear cause of death was determined. However, there were no statistically significant differences or strong associations (χ(2) = 1.238, P > 0.05) between the 11 patients with (16.90%) and 34 without (23.78%) common underlying disease among these 45 patients. We also found that occurrence of the common underlying diseases, such as neurological system, cardiovascular and pulmonary system diseases, are not statistically significant (P > 0.05) in the diagnosis of the SUD.

CONCLUSIONCommon underlying diseases make no obvious contributions to SUD and are not useful in diagnosing the underlying reasons for death.

Adolescent ; Adult ; Aged ; Cause of Death ; Death, Sudden ; epidemiology ; etiology ; Female ; Humans ; Male ; Middle Aged ; Young Adult

BACKGROUNDThere is a yearly increase in the rate of sudden unexplained death (SUD), even through extensive physical examination and the testing of a large number of biomarkers, the cause of sudden death in patients previously in good health cannot be fully determined. During clinical practice, a spatial aggregation phenomenon has been observed in the incidence of sudden unexplained death. Previous research has shown that environmental factors, such as air pollution, weather conditions, etc., have a significant impact on human health. In the wake of the continuous environmental damage, the relationship between environmental factors and sudden unexplained death still needs to be studied. To study the relationship between sudden unexplained death and air quality and temperature, commonly used markers such as particulate matter of aerodynamic diameter < 10 µm (PM(10)), daily average concentration of the gaseous pollutants sulfur dioxide (SO2) and nitrogen dioxide (NO2), and the daily average temperature were investigated.

METHODSThe methods include collecting the data of sudden unexplained death; air quality monitoring; meteorological monitoring from January 1, 2005 to December 31, 2008; utilizing generalized additive models (GAM); controlling the influential factors such as secular trend, seasonal trend, and Sunday dummy variable; and analyzing the correlation between daily inhalable particle concentration, daily average temperature, and the number of daily SUD.

RESULTSThere was no statistical significance between the daily inhalable particle and daily incidence of sudden unexplained death. Incidence rate of sudden unexplained death had nonlinear positive correlation with daily temperature. When the temperature was 5°C above the daily average temperature, the daily incidence of sudden unexplained death went up with the rising temperature.

CONCLUSIONTemperature may be one of the key risk factor or precipitating factor of SUD.

Air Pollution ; analysis ; China ; epidemiology ; Death, Sudden ; epidemiology ; Humans ; Particulate Matter ; analysis ; Temperature

OBJECTIVETo understand the epidemiologic and clinical characteristics of the "Yunnan unknown-cause sudden cardiac death (YUSCD)".

METHODSCases of YUSCD occurred in 2002-2004 were investigated with cross-sectional study. Clinical manifestation was observed and analyzed.

RESULTSThe YUSCD areas were mountainous and most of the YUSCD cases appeared between June and August. Most of the YUSCD cases were young farmers and showed family/village clustering nature. Most of the patients died quickly with only few recovered. The overall incidence of YUSCD was 1.83% with mortality as 1.51%. The fatality rate of YUSCD appeared to be 78.1%.

CONCLUSIONThe YUSCD cases had a clustering feature along with time and area. The clinical manifestation of YUSCD could not be specifically identified, making the clinical diagnosis and treatment difficult when practicing in the fields that called for further studies on epidemiology, clinical work and etiology.

China ; epidemiology ; Cross-Sectional Studies ; Death, Sudden, Cardiac ; epidemiology ; Humans ; Seasons

OBJECTIVES: To study the epidemiological and pathological features of sudden death （SD） in Yunnan Province and to provide scientific evidence for prevention and forensic identification of sudden death. METHODS: Totally 363 SD cases were collected from the autopsies between 2009 and 2017 in the Forensic Centre of Kunming Medical University. The related factors such as etiology, age, inducing factor, time interval between the onset of disease and death, morbidity season and pathological change were retrospectively analysed. RESULTS: The incidence of SD in males was significantly higher than that of females. The peak age was ≥35-55 years. The mortality rate was relatively high within 6 h after the onset of disease. The season order with descending number of deaths was spring, summer, winter and autumn. The top ten causes of SD were coronary heart disease, sudden unexplained death （SUD）, cerebral hemorrhage, acute hemorrhagic necrotic pancreatitis, aortic dissection rupture, cardiomyopathy, pneumonia, pulmonary thromboembolism, amniotic fluid embolism and allergy. Exercise, infusion, surgery, medication and minor injury were the most common predisposing factors of sudden coronary death. Consciousness disorder or coma, chest pain or chest tightness, and abdominal pain were the most common premortem symptoms of sudden coronary death. CONCLUSIONS The SD is more common in middle-aged males, which is the key population for the prevention of SD. For the forensic identification and prevention of SD, the attention on SUD should be paid.
Adult ; Aortic Rupture ; Autopsy ; Cause of Death ; China/epidemiology* ; Death, Sudden/pathology* ; Death, Sudden, Cardiac/pathology* ; Female ; Forensic Pathology ; Humans ; Incidence ; Male ; Middle Aged ; Pulmonary Embolism ; Retrospective Studies ; Seasons

Commotio cordis （CC） is the acute death caused by the cardiac rhythm disorder after a sudden blunt external force to the precordium of a healthy person without previous heart disease. As one type of violent heart damage, CC is rare with relatively small external force and sudden death, therefore causing disputes. This paper reviews the epidemiology, mechanisms and the key points in forensic identification of CC, discusses the identification and antidiastole of CC, myocardial contusion, sudden cardiac death and death from inhibition, and provides assistance to forensic pathologists to identify such causes of death.
Commotio Cordis/epidemiology* ; Death, Sudden, Cardiac ; Forensic Pathology ; Heart ; Humans ; Wounds, Nonpenetrating

OBJECTIVETo analyze the causes of death in patients with heart failure.

METHODSA total of 133 heart failure patients died during hospitalization in our hospital between January 2005 and December 2008 were enrolled in this study. Patients were divided to two groups: sudden death (group A, n = 73, 54.9%), chronic end-stage pump failure (group B, n = 55, 41.4%). The remaining 5 cases died of other causes were excluded from the final analysis. Clinical data (medical history, blood pressure, clinical manifestation, NYHA cardiac function class, left ventricular diameter of diastole, left ventricular ejection fraction, ventricular arrhythmias, drug therapy) of group A and B were analyzed.

RESULTSThere were no significant differences in terms of medical history (including hypertension and diabetes), blood pressure, heart rate and the incidence of ventricular arrhythmia between the two groups. In group A, the NYHA functional class was mostly II or III grade, and LVEF value was significantly higher than that of group B. The incidence of angina pectoris was significantly higher in group A compared to group B. beta-blocker and angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use was also significantly higher in group A than in group B, however, the treatment dose was significantly lower and therapy duration was significantly shorter in group A than in group B. There were significantly less patients received statins and anti-platelet aggregation drugs in group A compared to group B.

CONCLUSIONIn our patient cohort, sudden cardiac death often occurred in heart failure patients with NYHA cardiac function II to III grade, angina pectoris, probably due to the unstable coronary plaque and less statins and anti-platelet drug use in these patients.

Adult ; Aged ; Cause of Death ; Death, Sudden, Cardiac ; epidemiology ; Female ; Heart Failure ; mortality ; Humans ; Male ; Middle Aged ; Prognosis ; Treatment Outcome

"Karoshi" originates from Japan's economic take-off period in the 1960s and 1970s. It is generally believed that overwork lead to the accumulation of fatigue, which triggers the outbreak of potential diseases, and results in sudden death. Karoshi causes great harm to both the community and families because it occurs primarily in 30 to 60 year old young adults. Japan put Karoshi into the category of industrial injury for the first time in 2001 and started to undertake a series of studies in the sociological and pathological fields. However, there is a tremendous gap in the forensic pathological diagnosis domain. In China, research on Karoshi started from the 1990s and is closely related to the reform and opening up policy as well as economic development. According to the incomplete statistics, 600 thousand people die from overwork each year in China, the highest in the world. Karoshi has become one of the most serious social problems in China at the present stage, thus a systematic study in the sociology and forensic pathology fields is urgently required. This paper summarizes the past and present status of Karoshi, and puts forward the problems that need attention during the judicial expertise of Karoshi from forensic pathology perspective.
Adult ; China ; Death, Sudden/etiology* ; Fatigue/epidemiology* ; Forensic Pathology ; Humans ; Middle Aged ; Occupational Stress/epidemiology* ; Risk Factors