Active surveillance (AS) is currently accepted as a good management option for men with low-risk prostate cancer (PCa). Moreover, given the grade migration following the 2005 International Society of Urologic Pathology consensus conference, AS may be appropriate for men presenting with favorable intermediate-risk PCa. Three contemporary experiences of AS for men with intermediate-risk features suggest that although these men are at higher risk for radical treatment, most of them are not significantly compromising chances for long-term cure. From the long-term randomized ProtectT trial, 10-year outcomes after active monitoring, surgery, or radiotherapy for localized PCa revealed that PCa specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Multiparametric magnetic resonance imaging, molecular biomarkers, and new Gleason grading system could enhance diagnostic accuracy and decrease the demerits of current AS protocols. Particularly, uniform recording of the percentage pattern 4 in Gleason 7 cancers will enable better understanding of prognostic risks and consideration of careful expansion of AS to populations with minimal Gleason pattern 4 disease.
Biomarkers ; Clothing ; Consensus ; Humans ; Magnetic Resonance Imaging ; Male ; Mortality ; Neoplasm Grading ; Passive Cutaneous Anaphylaxis ; Pathology ; Prostate* ; Prostatic Neoplasms* ; Radiotherapy

OBJECTIVES: 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 disease. 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: Immunofluorescence 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）. CONCLUSIONS 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.
Anaphylaxis ; Autopsy ; Blotting, Western ; Case-Control Studies ; Coronary Artery Disease/complications* ; Death, Sudden, Cardiac/etiology* ; Diagnosis, Differential ; Fluorescent Antibody Technique ; Forensic Pathology ; Humans ; Male ; Myocardial Infarction ; Myocardium/metabolism* ; Natriuretic Peptide, Brain/metabolism* ; Tryptases/metabolism*

Postmortem chemistry is becoming more and more essential in routine forensic pathology and has made considerable progress over the past years. Biochemical analyses of vitreous humor, blood, urine and cerebrospinal fluid may provide important information in determining the cause of death or in elucidating forensic issues. Postmortem chemistry may be essential for the determination of cause of death when morphological methods (diabetes mellitus, alcoholic ketoacidosis and electrolytic disorders) cannot detect the pathophysiological changes involved in the death process. It can also provide many information in other forensic situations, including myocardial ischemia, sepsis, inflammation, infection, anaphylaxis and hormonal disturbances. The most recent relevant research advances on glucose metabolism, liver function, cardiac function, renal function, sepsis, inflammation, infection, anaphylaxis and hormonal aspect are hereby reviewed.
Anaphylaxis ; Autopsy/trends* ; Biomarkers/analysis* ; Body Fluids/chemistry* ; Death ; Diabetes Mellitus ; Forensic Pathology/methods* ; Humans ; Postmortem Changes ; Sepsis ; Vitreous Body

OBJECTIVE: To explore the forensic pathological features of death caused by anaphylactic shock. METHODS: One hundred and forty-two death cases of anaphylactic shock were retrospectively analyzed. The IgE level in the serum of anaphylactic shock cases were statistically compared with that of 62 non-anaphylactic shock cases. RESULTS: Most cases (77.46%) of anaphylactic shock death occurred in the medical institutes, with intravenous drug administration accounting for 53.53% of anaphylactic shock death. β-Lactam antibiotics, glucocorticoid and herbal medications were responsible for a significant proportion of such cases. Although characteristic histopathological changes were absent in vast majority of these anaphylactic shock cases, the differences of IgE levels in the serum between anaphylactic shock group and non-anaphylactic shock group were statistically significant (P<0.05). CONCLUSION Combined information including clinical data, autopsy results, IgE level, and other specific test results should be evaluated together in the forensic pathological diagnosis of anaphylactic shock.
Anaphylaxis ; Autopsy ; Cause of Death ; Forensic Pathology ; Humans ; Infusions, Intravenous ; Retrospective Studies ; Serum

OBJECTIVE: To explore the application value of serum total IgE, tryptase and chymase in the identification of death caused by drug anaphylactic shock. METHODS: The general information from 235 cases of non-drug anaphylactic shock and 32 cases of drug anaphylactic shock were analyzed. The serum IgE level had been detected in the cases. Ten cases caused by coronary disease and 10 cases caused by sudden manhood death syndrome were selected from non-drug anaphylactic shock cases for the control group. Expressions of tryptase and chymase in the lung and heart were detected using immunohistochemistry method. The number and IOD of positive mast cells were counted. RESULTS: In the drug anaphylactic shock group, the IgE value of 18 samples (56.25%) was significantly higher than the normal upper limit of 120 IU/mL. In the non-drug anaphylactic shock group, the IgE value of 67 samples (28.51%) was higher than 120 IU/mL. The expressions of tryptase and chymase were significantly increased in lung and myocardial tissue in drug anaphylactic shock group (P < 0.05). CONCLUSION Tryptase and chymase are more superior than that of the serum total IgE in the diagnosis of death caused by drug anaphylactic shock, and are more suitable in forensic practice.
Adolescent ; Adult ; Aged ; Anaphylaxis/pathology* ; Autopsy ; Case-Control Studies ; Cause of Death ; Child ; Child, Preschool ; Chymases/metabolism* ; Death, Sudden, Cardiac/pathology* ; Drug Hypersensitivity ; Female ; Forensic Pathology ; Humans ; Immunoglobulin E/blood* ; Immunohistochemistry ; Infant ; Lung/pathology* ; Male ; Middle Aged ; Myocardium/pathology* ; Tryptases/metabolism* ; Young Adult

OBJECTIVE: To explore the value of flow cytometry in anaphylactic shock diagnosis by CD63 expression being detected using flow cytometry to conform the activation of basophils. METHODS: Sixteen rats were randomly divided into two groups: control group and anaphylactic shock group. The model of anaphylactic shock rat with ovalbumin injection was established. CD63, CD45 and CD203c antibody combination, flow cytometry was employed to detected blood basophil CD63 expression. Immunofluorescence method was employed to observe the CD63 immunofluorescence staining in the rat lung tissue. RESULTS: (1) Pure basophils were obtained by CD45 and CD203c gating. (2) The percentages of basophils CD63 were (17.34 +/- 2.04)% and (1.52 +/- 0.35)% in the experimental and control group, respectively. The differences between two groups were statistically significant (P < 0.01). (3) Compared with the control group, the expression of CD63 in basophils increased in anaphylactic shock lung tissue. CONCLUSION The detection of CD63 by flow cytometry could be the supplement of vivo allergic reactions and have good clinical value.
Anaphylaxis/metabolism* ; Animals ; Basophil Degranulation Test/methods* ; Basophils/metabolism* ; Biomarkers/analysis* ; Disease Models, Animal ; Female ; Flow Cytometry ; Lung/pathology* ; Male ; Ovalbumin/administration & dosage* ; Phosphoric Diester Hydrolases/immunology* ; Pyrophosphatases/immunology* ; Random Allocation ; Rats ; Rats, Wistar ; Tetraspanin 30/metabolism*

OBJECTIVE: To detect the changes of leukotriene E4(LTE4), prostaglandin D2(PGD2), carboxypeptidase A3(CPA3) and platelet activating factor (PAF) in guinea pigs died from anaphylactic shock. METHODS: Guinea pigs were used for establishing anaphylactic shock models. The levels of LTE4, PGD2 and CPA3, and PAF were detected in urine, plasma, and brain tissues with ELISA kit, respectively. The significant biomarkers were selected comparing with control group. The changes of PGD2, CPA3 and PAF in the guinea pigs at time zero, 12 and 24 hours after death were observed and compared respectively. The effect of platelet activating factor acetylhydrolase (PAF-AH) to PAF in guinea pig brain was examined and compared. RESULTS: There were no statistically differences of LTE4 levels in urine observed between experimental group and control group. The levels of CPA3, PGD2 and PAF in the experimental group were significantly higher than that in the control group at 0 h. The levels of PAF at 12 and 24 hours after anaphylactic shock were significantly higher than that in the control group. The levels of PAF decreased significantly after pretreatment with PAF-AH. CONCLUSION LTE4 in urine cannot be selected as a biomarker to determine the anaphylactic shock. PGD2 and CPA3 in plasma, and PAF in brain tissue may be used as biomarkers to determine the anaphylactic shock. PAF-AH may be potentially useful for clinical treatment of anaphylactic shock.
1-Alkyl-2-acetylglycerophosphocholine Esterase/pharmacology* ; Anaphylaxis/prevention & control* ; Animals ; Brain/pathology* ; Carboxypeptidases/blood* ; Case-Control Studies ; Disease Models, Animal ; Egg Proteins/administration & dosage* ; Enzyme-Linked Immunosorbent Assay ; Female ; Guinea Pigs ; Leukotriene E4/urine* ; Male ; Mice ; Platelet Activating Factor/metabolism* ; Prostaglandin D2/blood* ; Time Factors

OBJECTIVE: To increase the death rate of fatal anaphylaxis in guinea pigs and the detectahie level of the tryptase of mast cell in hlood serum. METHODS: Seventy-four guinea pigs were randomly divided into five groups: original model group, original model control group, improved model group, improved model control group, improved model with non-anaphylaxis group. Using mixed human serum as the allergen, the way of injection, sensitization and induction were improved. ELISA was used to detect the serum mast cell tryptase and total IgE in guinea pigs of each group. RESULTS: The death rate of fatal anaphylaxis in original model group was 54.2% with the different degree of hemopericardium. The severe pericardial tamponade appeared in 9 guinea pigs in original model group and original model control group. The death rate of fatal anaphylaxis in improved model group was 75% without pericardial tamponade. The concentration of the serum total IgE showed no statistically difference hetween original model group and original model control group (P > 0.05), hut the serum mast cell tryptase level was higher in the original model group than that in the original model control group (P > 0.05). The concentration of the serum total IgE and the serum mast cell tryptase level were significantly higher in improved model group than that in the improved model control group (P < 0.05). CONCLUSION The death rate of the improved model significantly increases, which can provide effective animal model for the study of serum total IgE and mast cell tryptase.
Allergens/immunology* ; Anaphylaxis/pathology* ; Animals ; Cause of Death ; Disease Models, Animal ; Enzyme-Linked Immunosorbent Assay ; Forensic Pathology ; Guinea Pigs ; Humans ; Immunoglobulin E/blood* ; Larynx/pathology* ; Lung/pathology* ; Male ; Mast Cells/immunology* ; Serum/immunology* ; Tryptases/blood*

OBJECTIVETo investigate the substance basis and the mechanism of pseudoanaphylactoid reactions (PR) induced by Shuanghuanglian injection (SHLI).

METHOD(1)The study of PR and the substance basis of PR of SHLI: ICR mice were divided into different test groups, the mice were intravenously injected with solutions of different concentration of SHLI, baicalin, forsythin, caffeotannic acid, positive control Compound 48/80 and normal sodium. All test substances were mixed with 0.4% Evans blue. The reaction and vascular permeability of the ears were observed and measured 30 min after SHLI injection. (2) The study of mechanisms: Mice were pretreated with an oral administration of Astemizol, intraperitoneal injection of cyclophosphamide 75 mg x kg(-1) or Compound 48/80 4 mg x kg(-1), then mice were intravenously injected with SHLI. At last, vascular permeability of the ears in pretreated groups was compared with SHLI treatment alone group.

RESULTSHLI of 300 mg x kg(-1) and 600 mg x kg(-1) caused obvious vascular hyperpermeability, but baicalin, forsythin and caffeotannic didn't cause vascular hyperpermeability in the ears. The Astemizol can decrease the degree of SHLI-induced vascular hyperpermeability of the ears in the mice. After intraperitoneal injected with cyclophosphamide, there was a slight decrease in the degree of SHLI-induced vascular hyperpermeability, but there was no marked changes in the degree of the SHLI-induced vascular hyperpermeability after the mice were pretreated with Compound 48/80.

CONCLUSIONSHLI in clinic equivalent dose can cause vascular hyperpermeability. Baicalin, forsythin and caffeotannic may not result in the PR of SHLI. The mechanism of the PR maybe relate to that SHLI stimulates histamine release, the activation of leucocyte maybe take part in the SHLI-induced PR, too. Antihistamine drug can prevent the genesis of PR which induced by SHLI.

Anaphylaxis ; chemically induced ; pathology ; physiopathology ; Animals ; Chemistry, Pharmaceutical ; Drugs, Chinese Herbal ; administration & dosage ; adverse effects ; chemistry ; Injections ; Mice

OBJECTIVE: To investigate the effect and expression of the vascular cell adhesion molecule-1 (VCAM-1) in organs of rats died of anaphylactic shock. METHODS: The models of anaphylactic shock in rats were made and the immunohistochemistry of SABC was used to detect as follows: (1) The expression of VCAM-1 in rat lung, heart, brain, kidney, liver, spleen, stomach and intestine. (2) VCAM-1 levels in lungs at 10 min, 30 min after the allergic shock, and the time of death. (3) VCAM-1 levels in lungs of rats after the intervention of anti-VCAM-1. RESULTS: After the death, the expression VCAM-1 in lungs increased significantly relative to the control group and followed the extension of shock. In the rats which were injected with the anti-VCAM-1, the expression of VCAM-1 in lungs reduced. CONCLUSION (1) The expression of VCAM-1 shows difference in the various organs of rats after anaphylactic shock. The change of VCAM-1 is the most obvious in lungs and would increase followed the extension of anaphylactic shock. (2) After the anaphylactic shock, anti-VCAM-1 can inhibit the expression of VCAM-1 in rat lung.
Anaphylaxis/pathology* ; Animals ; Antibodies, Monoclonal/therapeutic use* ; Brain/metabolism* ; Disease Models, Animal ; Female ; Immunohistochemistry ; Kidney/metabolism* ; Lung/metabolism* ; Male ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Time Factors ; Vascular Cell Adhesion Molecule-1/metabolism*