Objective To explore the value of mast cell tryptase and brain natriuretic peptide(BNP)in the differential diagnostic of sudden death due to hypersensitivity and coronary atherosclerotic heart dis-ease.Methods Totally 30 myocardial samples were collected from the autopsy cases in the Department of Forensic Pathology, Shanxi Medical University during 2010—2015. All samples were divided into three groups:death of craniocerebral injury group, sudden death of hypersensitivity group and sudden death of coronary atherosclerotic heart disease group, 10 cases in each group. Mast cell tryptase and BNP in myocardium were detected by immunofluorescence staining and Western Blotting.Results Immunofluo-rescence staining showed that the positive staining mast cell tryptase appeared in myocardium of sudden death of hypersensitivity group and coronary atherosclerotic heart disease group. Among the three groups, the expression of mast cell tryptase showed significantly differences through pairwise comparison(P<0.05); The expression level of BNP in sudden death of coronary atherosclerotic heart disease group were significantly higher than the sudden death of hypersensitivity group and death of craniocerebral injury group(P<0.05). The difference of the expression level of BNP between the sudden death of hypersensitivity group and the death of craniocerebral injury group had no statistical significance(P>0.05).Conclusion The combined detection of the mast cell tryptase and BNP in myocardium is expected to provide help for the forensic differential diagnosis of sudden death due to hypersensitivity and coronary atherosclerotic heart disease.

Objective:To evaluate the effects of different position interventions in patients with acute respiratory distress syndrome (ARDS) undergoing mechanical ventilation from the aspects of effectiveness and safety using the method of network Meta-analysis.Methods:Randomized clinical trials (RCTs) related to the therapeutic effect of position interventions in adult ARDS patients undergoing mechanical ventilation were retrieved in PubMed, Embase, Cochrane Library, Web of Science, CINAHL, China Biomedical Literature Database, China National Knowledge Infrastructure, VIP and WanFang Data. The search time limit was from the establishment of the database to January 2021. According to the literature inclusion and exclusion criteria, literature was screened and the quality evaluation and data extraction were carried out. StataSE 15 and Addis 1.16.6 were used for network Meta-analysis.Results:A total of 31 RCTs were included, involving5 positions of prone, semi-recumbent, side-recumbent, supine and sitting, and 3 738 patients. The prone position compared with the semi-recumbent position, the semi-recumbent position compared with the supine position could reduce the 28-day all-cause mortality of the patient, and the difference was statistically significant ( P<0.05) . Compared with the semi-recumbent position and the supine position, the prone position could reduce the length of time the patient stayed in the ICU, and the difference was statistically significant ( P<0.05) . The prone position could increase the oxygenation index of patients compared with the supine position, and the difference was statistically significant ( P<0.05) . For the total incidence of adverse events and adverse reactions, there was no statistically significant difference between any two positions ( P>0.05) . The network Meta probability ranking of all the outcome indicators showed that the prone position and the side-recumbent position had advantages, and the supine position and the semi-recumbent position had no obvious advantages. Conclusions:Current evidence shows that the prone and side-recumbent position interventions are effective and safe for the treatment of ARDS patients undergoing mechanical ventilation, and are good choices among several positions.

Objective:To investigate the interfering factors in the determination of creatinine(Cr) using the American Clinical Laboratory Standards Association (CLSI) EP7-A3 document.Methods:According to the CLSI EP7-A3 document, fresh serum (no hemolysis, lipemia, and jaundice) was used on the day of the experiment and confirmed the interfering substances through the pairing difference experiment and the point-to-point analysis method was used in the dose effect experiment to clarify the difference of interfering substances.Results:Triglyceride (16.94 mmol/L), dobutamine hydrochloride (4.01 μmol/L), ascorbic acid (298 μmol/L) did not interfere with the determination of Cr. Free bilirubin (684 μmol/L), conjugated bilirubin (684 μmol/L), calcium hydroxybenzene sulfonate (144 μmol/L) and hemoglobin (10 g/L) were used as the maximum concentrations of interferences for the dose effect test, the results showed that the above interferences had negative interference on the determination of Cr.Conclusion:According to EP7-A3, it is valuable to evaluate the interference factors of creatinine determination.