广泛软组织挫伤后器官形态学的研究

目的探索法医病理学诊断广泛软组织挫伤、挤压综合征致死案例的形态学改变。方法采用大鼠广泛软组织挫伤模型和人体挤压综合征致死标本,对器官进行HE染色、肾肌红蛋白HSP免疫组化染色及电镜观察。 结果肾肌红蛋白的阳性率分别为60％、75％、95％;心肌、脑组织阳性染色率为90％;广泛软组织挫伤短期内死亡的大鼠肾电镜观察,可见多种组织细胞病理改变致使毛细血管腔狭窄、闭塞等。结论建立了较理想的大鼠广泛软组织挫伤形成的挤压综合征动物模型;为此类研究积累了具有一定实用价值的病理形态学资料。     

大鼠脊髓挫伤后BDNF表达的实验性研究

目的探讨大鼠脊髓挫伤后脑源性神经营养因子(BDNF)在脊髓内的表达变化规律。方法建立大鼠脊髓挫伤模型,以正常脊髓组织为对照,采用RT-PCR和免疫组化SABC法对伤后即刻、1h、3h、6h、12h、1d、3d、5d、7d大鼠脊髓组织中的BDNF和BDNF mRNA进行检测,并对所得数据进行统计学分析。结果正常大鼠脊髓组织细胞内有低水平的BDNF mRNA表达和少量BDNF阳性染色细胞,BDNF mRNA和BDNF的积分光密度(IOD)值分别为45.83±3.545、20286.225±2094.955,BDNF阳性细胞数为16.50±3.391;伤后6~12h,BDNF mRNA和BDNF呈升高趋势,5d达高峰,二者的IOD值及阳性细胞数分别为795.83±112.55、54272.143±2704.239和158.17±12.287。伤后7d,BDNF mRNA和BDNF的IOD值及阳性细胞数分别为655.17±80.871、42249.928±809.391和100.17±5.529。各组之间比较,其差异具有统计学意义(P<0.05)。BDNF免疫阳性细胞在损伤早期主要是脊髓神经元和少量星形胶质细胞,后期则以小胶质细胞为主。结论大鼠脊髓挫伤后,脊髓组织细胞中的BDNF及其mRNA增多,并随伤后时间呈现一定规律性变化。     

盐酸曲马多在大鼠体内的分布特点

目的观察盐酸曲马多在大鼠体内的分布及其特点。方法大鼠以3倍和6倍LD50228mg/kg剂量盐酸曲马多灌胃染毒致死,取材,薄层色谱法检测其心、肺、肝、脾、肾、大脑和血内盐酸曲马多的浓度。结果3倍LD50剂量组大鼠肾、肺、血、肝、大脑、脾和心组织盐酸曲马多的浓度分别为112±15、59±17、53±31、32±19.7、22±11.5、20±20、16.7±8.3μg/g或μg/ml;6倍LD50剂量组大鼠血、肺、肝、心、肾、大脑和脾中盐酸曲马多的浓度分别为107.6±7.2、26.3±20、11.7±6.6、11.2±7.2、10.3±3.6、6.38±0.2、6.1±0.3μg/g或μg/ml。结论3倍LD50剂量组大鼠,肾、肺、血内盐酸曲马多浓度最高;6倍LD50剂量组大鼠血、肺、肝中盐酸曲马多的浓度最高。盐酸曲马多中毒时,血、肝、肺和肾可以作为法医毒物分析的检材。     

SPE-LC-MS/MS法测定尿液与血液中海洛因3种代谢物

目的采用SPE-LC-MS/MS方法,同时检测尿液与血液中海洛因主要代谢物3-β-D-葡萄糖醛酸吗啡(M3G)、吗啡和O6-单乙酰吗啡(O6)。方法采用BAKERBONDTMspe Octadecyl(C18)进行提取,应用LC-MS/MS方法检测并通过MRM及内标法进行量化。结果尿液中M3G、吗啡、O6-单乙酰吗啡的最低检测限(LOD)分别为1.24pg、6.71pg、0.47pg;回收率依次为82.25±12.25%、93.75±13.25%、88.70±11.90%。血液中M3G、吗啡、O6-单乙酰吗啡的最低检测限分别为1.50pg、8.21pg、0.52pg。回收率依次为89.85±21.15%、73.70±17.90%、90.10±3.90%。结论本文所建方法同时适用于尿液与血液中海洛因主要代谢物M3G、吗啡、O6-单乙酰吗啡的提取、净化、分析。     

大鼠皮肤挫伤修复过程中NF_κB P65表达的研究

目的探讨皮肤挫伤修复过程中,核转录因子(NFkB)P65在挫伤区不同时间表达的变化规律。方法 应用免疫组化技术对挫伤后0h、3h、6h、9h、12h、1d、3d、5d、7d、10d的大鼠皮肤挫伤组织中NFkB P65的表达进行研究。结果伤后3h,挫伤区内浸润的少量多核粒细胞的胞质中NFkB P65呈弱阳性表达,阳性率为(3.20％±0.15％);伤后6h,阳性表达增强,阳性率为(11.33％±0.88％);伤后12h,表达继续增强,阳性率(75.67％±0.82％);伤后1d,在浸润的几乎所有单核细胞和多核粒细胞的胞质和胞核中均可见NFkB P65呈强阳性表达,阳性率为(97.33％±0.88％),表达达高峰,以后逐渐下降。结论 大鼠皮肤挫伤修复过程中,NFkB P65在挫伤后的炎症反应中发挥重要作用;同时,NFkB P65在挫伤区内多核粒细胞,单核细胞及成纤维细胞中的表达呈规律性变化,可对挫伤时间的推断提供参考。     

过敏性休克豚鼠血浆咽喉肺组织中P物质的观测

目的探讨过敏性休克法医学鉴定的诊断指标。方法制备豚鼠过敏性休克的动物模型,应用放射免疫法测定其血浆中P物质浓度;免疫组化SABC法和BI-2000图像分析系统对咽喉和肺组织的P物质免疫反应进行染色观测,计算阳性指数(PI)。结果与对照组含量(87．70pg±7．60pg／μl)相比,过敏性休克豚鼠血浆中P物质含量 (131．01pg±18．93pg／μl)增加,其差异具有极显著意义(P<0．01);呼吸道内P物质免疫阳性反应增强,实验组咽喉和肺组织PI值分别为63．59±14．51和55．98±14．8,对照组咽喉和肺组织PI值分别为33．32±8．04和20．51±6．76, 两组差异具有极显著意义(P<0．01)。结论 P物质在过敏性休克豚鼠血浆浓度增加和呼吸系统组织中免疫阳性反应增强,可能有助于过敏性休克的法医病理学诊断。     

利多卡因在蛛网膜下腔麻醉致死犬体内的分布

目的 观察利多卡因蛛网膜下腔致死犬体内的分布及脊髓液、脊髓与血液中利多卡因含量的比值。方法薄层扫描法检测血、脊髓液、侧脑室液、各节段脊髓和各脏器组织中利多卡因含量。结果 蛛网膜下腔麻醉致死犬脊髓液、各节段脊髓、脑、血液和其它各脏器中利多卡因含量分别为485.6±51.5μg/ml、226.8±35.2-353.8±44.0μg/g、44.9±11.51μg/g、40.3±6.5μg/ml和13.5±13.7-38.0±9.8μg/g。脊髓液与血液中利多卡因含量之比为12.4±2.7,各节段脊髓与血液之比为5.7±0.9-9.0±2.6。结论 蛛网膜下腔麻醉致死犬脊髓液中利多卡因含量最高,脊髓中次之,血液和其它组织中含量较低。脊髓液/血液、脊髓/血液比值平均可达12.4和5.7-9.0。     

刑事部分中止审理,附带民事部分可先行判决

案　情　　杨某之妻与余某因邻里纠纷产生口角，1996年7月3日下午4时许，杨某至余某住处，与余某发生吵打。当日下午余某去医院验伤，检验结论为：1．头部外伤，脑震荡？2．头部、面部软组织挫伤。事后，派出所民警要求验伤医生指明软组织挫伤占体表面积的百分比。验伤医生根据当天的实际伤情，在验伤报告单上补写了皮下斑占体表7％左右。受当地公安局委托，司法部司法鉴定科学技术研究所于1996年9月23日作出法医临床学鉴定书，结论为：余某全身多处软组织挫伤，尿中红血球异常增多，精神分裂症复发，此伤情已构成轻伤。余某遂诉至法院，要…     

新书介绍

由司法部司法鉴定科学技术研究所吴军副主任法医师编著、上海医科大学陈康颐教授审阅的《应用法医临床学》一书即将由中国医药科技出版社(北京西城区北礼土路甲38号,邮政编码100810)出版,(预计在1990年底出版)该书系统介绍了法医临床学的范畴、检验方法、诊断、损伤程度评定、鉴定和大量的实践资料以及这一学科的最新进展.全书共分十七章.详细介     

法医学领域的SCI收录期刊与国内期刊比较

<正>法医学是医学和法学相交叉的边缘学科,是应用医学、生物学及其他自然科学的理论与技术,研究并解决司法实践中有关医学问题的一门医学科学~[1]。广义的法医学涉及多种学科,涵盖面极其广泛,主要包括法医病理学(forensic pathology)、法医临床学(forensic clinical medicine)、法医人类学(forensic anthropology)、法医牙科学(forensic dentistry)、法医弹     

创伤的AIS评分与损伤程度评定对比分析的研究

ＡＩＳ评分法是国际医学临床上公认的创伤严重度评价方法之一。作者收集了本室５４６例伤害案件，分别给予损伤程度评定及ＡＩＳ评分，设为损伤程度组和ＡＩＳ组。两组比较，经Ｘ２检验，Ｐ＜０．００１；经Ｓｐｅａｒｍａｎ等级相关检验ｒｓ＝０，９４０，Ｐ＜０．００１，均有高度显著性，反映两组之间有密切关系而且损伤程度组的程度变化与ＡＩＳ组分级变化有关系。提示：轻伤、重伤可以参照ＡＩＳ严重度分级、编码，由此为轻、重伤分级、标准的计算机化及国际间的交流提供新方法。     

SPE/UPLC法检测血中吗啡、苯丙胺类及氯胺酮

目的建立SPE/UPLC方法在同一条件下同时检测血中吗啡、苯丙胺类及氯胺酮。方法采用SCX 3cc（60mg）固相萃取柱萃取血中吗啡、MA、MDMA、MDA及氯胺酮,用超高效液相色谱（UPLC）-二极管阵列检测器（PDA）检测,结合保留时间和紫外光谱进行定性、定量分析,对实验各环节进行优化,并进行实际案例检测。结果吗啡、MA、MDMA、MDA、氯胺酮的固相萃取提取回收率分别为81.4%±2.51%、88.2%±2.48%、91.8%±2.03%、93.8%±1.46%、74.8%±2.27%,峰面积和质量浓度的线性关系良好（r〉0.999）,线性范围分别为0.08～100μg/mL、0.4～100μg/mL、0.2～75μg/mL、0.3～75μg/mL、0.4～100μg/mL,检出限分别为30pg、200pg、80pg、100pg、200pg。结论本文所建方法适用于血中吗啡、苯丙胺类、氯胺酮常见毒品的筛选及定量分析。     

高血压大鼠挤压伤后心功能指标与伤病关系分析

目的观察高血压病大鼠肢体挤压后的早期心肌损伤情况,并分析其在伤病关系分析中的意义。方法原发性高血压大鼠按打击程度随机分为4组,用自由落体装置打击大鼠右侧大腿,然后观察血压、心率变化,测量血清生化指标(肌酸激酶、肌酸激酶同功酶、乳酸脱氢酶、肌酐、尿素氮、α-羟丁酸脱氢酶、天门冬氨酸转移酶),并观察大鼠心、脑、肾的形态学改变。结果打击后大鼠血压、心率均有不同程度的上升,并且随着打击力度的增加而增加,但打击组间没有显著性差异。各组血清生化物表现为随打击力度的增加而上升,轻中重打击作为整体损伤组与对照组比较有显著性差异,天门冬氨酸转移酶、肌酸激酶、肌酸激酶同功酶在打击组间比较具有显著性差异。结论挤压性打击损伤造成了SHR早期心肌损伤,并且此指标可以运用于高血压病与损伤共存下的伤病关系分析。     

Pathologic features of fatal shark attacks

To examine the pattern of injuries in cases of fatal shark attack in South Australian waters, the authors examined the files of their institution for all cases of shark attack in which full autopsies had been performed over the past 25 years, from 1974 to 1998. Of the seven deaths attributed to shark attack during this period, full autopsies were performed in only two cases. In the remaining five cases, bodies either had not been found or were incomplete. Case 1 was a 27-year-old male surfer who had been attacked by a shark. At autopsy, the main areas of injury involved the right thigh, which displayed characteristic teeth marks, extensive soft tissue damage, and incision of the femoral artery. There were also incised wounds of the right wrist. Bony injury was minimal, and no shark teeth were recovered. Case 2 was a 26-year-old male diver who had been attacked by a shark. At autopsy, the main areas of injury involved the left thigh and lower leg, which displayed characteristic teeth marks, extensive soft tissue damage, and incised wounds of the femoral artery and vein. There was also soft tissue trauma to the left wrist, with transection of the radial artery and vein. Bony injury was minimal, and no shark teeth were recovered. In both cases, death resulted from exsanguination following a similar pattern of soft tissue and vascular damage to a leg and arm. This type of injury is in keeping with predator attack from underneath or behind, with the most severe injuries involving one leg. Less severe injuries to the arms may have occurred during the ensuing struggle. Reconstruction of the damaged limb in case 2 by sewing together skin, soft tissue, and muscle bundles not only revealed that no soft tissue was missing but also gave a clearer picture of the pattern of teeth marks, direction of the attack, and species of predator.     

Forensic Epidemiologic and Biomechanical Analysis of a Pelvic Cavity Blowout Injury Associated with Ejection from a Personal Watercraft (Jet‐Ski)

Jet‐propelled personal watercraft (PWC) or jet‐skis have become increasingly popular. The means of propulsion of PWC, which is a jet of water forced out of small nozzle at the rear of the craft, combined with a high risk of falling off of the seat and into close proximity with the water jet stream, raise the potential for a unique type of injury mechanism. The most serious injuries associated with PWC falls are those that occur when the perineum passes in close proximity to the jet nozzle and the high‐pressure water stream enters the vaginal or rectal orifice. We describe the forensic investigation into a case of an anovaginal “blowout” injury in a passenger who was ejected from the rear seat position of a PWC and subsequently suffered life‐threatening injuries to the pelvic organs. The investigation included a biomechanical analysis of the injury mechanism, a summary of prior published reports of internal pelvic injuries resulting from PWC falls as well as other water sports and activities, and a comparison of the severity of the injuries resulting from differing mechanisms using the New Injury Severity Score (NISS). The mean (±standard deviation [SD]) NISS values for reported PWC injuries [not including the NISS of 38 in this case study] were 11.2 (±9.5), while the mean value for reported water‐skiing falls was half that of the PWC group at 5.6 (±5.2). It was concluded that the analyzed injuries were unique to a PWC ejection versus other previously described non‐PWC‐associated water sport injuries. It is recommended that PWC manufacturers help consumers understand the potential risks to passengers with highly visible warnings and reduce injury risk with revised seat design, and/or passenger seat “deadman” switches.     

Mandibular fracture following stab injury with a knife

Stab injuries of the face accompanied by fractures of the jaws are rare. The report deals with the case of a young man, who suffered a penetrating stab injury to the cheek and fracture of the mandible in an assault. The forensic questions to be answered were if the findings were compatible with a stab and subsequent fracture, if one of the confiscated instruments could have been the causative weapon and if the injury had to be assessed as life-threatening. Both the soft and the hard tissue injury confirmed the assumption that they were caused by a stab. It was not possible, however, to assign the injury to a specific knife from the submitted exhibits on the basis of the clinical findings. In the discussion the serious nature of stab injuries in the facial region is emphasized.     

原发性脑干损伤组织学诊断要点

目的 探讨人头面部受击致原发性脑干损伤的组织病理学诊断标准。方法 用171例脑干损伤者的脑干颅神经根部作水平切块,HE染色光镜下观察;另取50例非脑干损伤死亡者作对照。并用统计学方法分析两组所见病变。结果 损伤组见脑干浅表部(32.7％-55.6％)或脑干内部挫伤(57.9％-85.9％)、颅神经根部损伤(动眼神经70.2％,面及位听神经53.8％,三叉神经49.7％等)、星形胶质细胞反应性增生、肥大(34.5％-57.3％)及水肿(19.3％-57.3％)改变,与对照组相比,脑干的挫伤、颅神经根部损伤和星形胶质细胞反应性增生、肥大有显著差异(P<0.001),水肿无明显差异(P>0.05)。结论脑干浅表部和/或脑干内部挫伤、颅神经根部损伤及星形胶质细胞反应性增生肥大可作为原发性脑干损伤的诊断依据。     

Hepatic glycogen staining. Applications in injury survival time and child abuse

Hepatic glycogen stores have long been known to decrease with starvation, trauma, acute stress, and shock. In this study, hepatic tissue was examined in 122 decedents ranging in age from 1 to 88 years who died of a variety of causes. Hepatic tissue was stained for glycogen/carbohydrates using the Best's carmine and/or period acid-Schiff (PAS)-alcian blue methods in 121 cases. The liver samples were evaluated for amount of staining, staining around hepatic injuries (if present), and presence of histologic abnormalities. Prominence of staining was decreased with increasing survival times after injury (P=.0001) and increasing postmortem interval. Staining along the edges of hepatic injuries was decreased in antemortem injuries but not in postmortem-induced injuries (P<.0001). If used in conjunction with circumstantial and autopsy information, hepatic glycogen/carbohydrate staining using the Best's carmine and PAS-alcian blue methods could greatly aid in the determination of injury survival times and the vital nature of questionable injuries in child deaths and other cases.