中国东北地区成年人尸体解剖冠状动脉外径的观察

目的法医病理学实践中缺乏可供参考的冠状动脉直径的参考值,本文目的为建立中国东北地区成年人尸体解剖案例中固定后心脏标本的各冠状动脉外径的参考值,并分析其与性别、年龄、身高、心脏重量的关系。方法收集中国医科大学法医司法鉴定中心于2010年～2016年受理的852例案件,依次测量左冠状动脉前降支、左冠状动脉回旋支与右冠状动脉主干管腔的外径。结果成年人各冠状动脉的外径与年龄、心脏重量均呈正相关关系,不同性别间冠状动脉主干的外径存在显著性差异,女性的各冠状动脉外径均小于男性。结论法医病理学实践中需要根据不同性别、年龄、心脏重量来判断各冠脉外径的大小。     

基于MRI的中国汉族成人颅面径线测量与分析

目的通过MRI和VGStudio MAX 2.2软件对中国汉族成人颅面相关径线进行测量,并分析其与性别、年龄、身高以及体重的关系。方法按颅面标志点设定4条径线。A径线：在正中矢状面上颏下点至头顶点的最大直线距离;B径线：在正中矢状面上发际点至后头点的最大直线距离;C径线：在水平面上左、右外眼点间的最大直线距离;D径线：在冠状面上左、右侧颧点间的最大直线距离;用VGStudio MAX 2.2软件对MRI图像数据进行三维重建,直接用软件的测量工具对颅面的相关径线进行测量,并用SPSS 16.0进行分析。结果 A、B、C、D径线的均值分别为（237.54±8.63）mm、（173.07±8.28）mm、（89.58±4.46）mm、（127.34±8.16）mm,与性别有着显著性差异（P〈0.01）;其中A、C、D径线与身高,A、D径线与体重,C径线与年龄,均存在明显的直线相关关系。结论中国汉族成人颅面径线A、B、C、D均存在明显的性别差异;且A、C、D径线与身高,A、D径线与体重,C径线与年龄,均存在明显的直线相关关系。     

尸检中心瓣膜的测量能区别是否心脏死

在397例法医尸检中,用填塞的锥体测量4个完整的心瓣膜周长,评定死后心脏疾病的诊断是否心脏死亡,瓣膜的大小用统计回归比较,评价可变因素的结果,其可变因素包括:性别、年龄、体重、体格     

汉族人肩、髋关节活动范围及与年龄、性别间的关系

目的探讨汉族人肩、髋两大关节的活动范围(range of motion,ROM)与现行《法医临床检验规范SF/ZJD0103003-2011》的差异性,并初步阐明性别、年龄因素对其ROM产生的影响。方法法医临床案件中选取仅单侧肩或髋关节受伤的汉族样本案例,将其健侧关节的ROM与现行标准《法医临床检验规范SF/ZJD0103003-2011》中的参考值的平均值进行比较分析,并对比该侧的不同年龄段(0~25岁、26~40岁、41~50岁、51~60岁及60岁以上)及性别间的差异。结果正常人体肩、髋关节的ROM的实际值与标准中参考值的平均值有较大的差异;5个不同年龄段肩、髋关节的部分方向ROM正常值存在差异且均随年龄的增长呈进行性下降的趋势。50岁以上人群在肩关节外展上举和髋关节内收、外旋等部分方向ROM正常值存在性别差异。结论正常汉族人肩、髋关节ROM存在年龄差异性,性别差异在50岁以上人群中较为明显。《法医临床检验规范SF/Z JD0103003-2011》标准所提供的参考值范围与实测值存在一定的差异。     

法医骨学推断计算机专家系统的开发研究

目的构建计算机法医骨学推断专家系统。方法利用面向对象的方法,综合现有法医人类学统计资料,系统结合了模糊匹配和DS证据理论两种推理手段,使用融合了框架和产生式的知识表示方法进行专家系统构建。结果开发出具有开放知识库、可操作性强的法医骨学性别、年龄、身高推断软件。结论本系统具有较大的可信度和有效性,能够很好的辅助法医技术人员开展工作。     

窦房结间质增生与年龄及右冠状动脉病变程度的关系

目的研究年龄及右冠状动脉粥样硬化病变程度对窦房结间质增生的影响。方法选择右冠状动脉有粥样硬化病变的心脏标本,登记年龄,复查并登记右冠状动脉病变,窦房结取材,常规制片,HE染色及Massom三色染色,用图像分析系统分析窦房结间质增生程度及右冠状动脉粥样硬化斑块病变的阻塞程度。结果右冠状动脉粥样硬化病变程度及年龄对窦房结间质增生的影响都有统计学意义(P0.001);右冠状动脉粥样硬化病变程度对窦房结间质增生的影响强度约为年龄的2.16倍。结论年龄及右冠状动脉粥样硬化病变程度均与窦房结间质增生有线性关系,右冠状动脉粥样硬化病变程度导致窦房结间质增生较年龄因素更为明显。     

肋骨的个体识别

根据骨骼进行身高推断、性别判定、年龄判定以及同一认定等是法医人类学个体识别的重要内容。肋骨是骨骼系统的重要组成部分，在性别和年龄的判定中具有重要的应用价值。本文主要就肋骨在性别和年龄判定两个方面的国内外研究做一概要回顾，为肋骨的进一步研究提供参考。     

冠状动脉开口畸形猝死2例

1案例简介案例1毛某,男,9.5岁,学生。某日下午5时因故被3位高年级女生追赶并殴打胸腹及小腿等处。挣脱后跑开在一石凳上坐了几分钟,在场同学见其突然倒地,扶不起来。呼叫120急救车来检查时发现已经死亡。死后20小时尸检:右面部、右额部发际上见大小6.5cm×2.9cm和2.5cm×2.0cm皮肤擦伤,右腰部有大小1.5cm×0.4cm及0.4cm×0.2cm二处皮肤擦伤,颈部右侧见一长3.5cm皮肤划痕,心脏重110g,左右心室分别厚1.1cm和0.3cm,左右冠状动脉共同开口于右主动脉窦内,开口直径分别为0.2cm和0.3cm,两者相距0.3cm,探查见左冠状动脉起始部走行于升主动脉和肺动脉…     

冠状动脉发育异常猝死1例

1　案　例贾某 ,男 ,17岁 ,学生 ,某日 11时许 ,在上体育课长跑后突然倒地 ,口吐白沫死亡。死后 5ｈ尸检。尸长 171ｃｍ ,发育正常 ,营养一般 ,尸斑呈暗紫红色 ,分布于背侧未受压部位 ,指压褪色 ;尸僵存在于四肢。双瞳孔等大 ,各 0 6ｃｍ ,双眼球睑结膜充血 ,口唇及四肢末端紫绀。右侧前额、眉弓、眼角外侧、口角外上见点片状皮肤擦伤。心脏重 2 75 ｇ,右房室壁厚 0 3ｃｍ、 0 4ｃｍ ,左房室壁厚 0 3ｃｍ、 1 5ｃｍ ,心肌细胞核肥大 ,心内膜下心肌空泡变性。各瓣膜正常 ,左冠状动脉前降支开口处直径0 15ｃｍ ,距左冠状动脉开口 1 3ｃｍ…     

依据手足印推算身高体重的可行性研究

目的探讨身高、体重与足迹、手印长宽的关系,有助于利用犯罪现场的手印、足迹推断遗留人的身高与体重。方法通过足迹、手印的捺印和测量,大量地收集样本足迹、手印与身高、体重等数据,借助SPSS数理统计软件,进行一元线性回归分析。结果分别建立了由左右足迹、手印全长、掌宽推算身高与体重的十个一元线性回归方程,并对依据左、右侧指标分别推算结果的可靠性进行比较研究。结论可利用回归法由足迹、手印来推算身高、体重。在左右两侧足迹、手印都可利用的情况下,推断身高时应优先选用右侧;推断体重时应优先选用左侧。     

A study of various morphologic variables and troponin I in pericardial fluid as possible discriminators of sudden cardiac death

Pathologists frequently examine victims of sudden cardiac death. In some cases, a firm diagnosis of cardiac-related death can be made based on conclusive gross and histologic findings. In many other cases, we find evidence supportive of, but not diagnostic of, cardiac death (e.g., atherosclerotic coronary artery disease, cardiomegaly, myocardial scarring). A final cohort consists of cases of sudden death with minimal to mild cardiac disease, no other significant pathology, and negative toxicologic studies. This prospective study compared 38 cardiac-related deaths with 52 control cases with respect to concentrations of pericardial cardiac troponin I (cTnI), heart weight, evidence of old and/or recent myocardial injury, and presence of significant coronary artery disease. The influence of documented chest trauma and/or perimortem cardiopulmonary resuscitation (CPR) on levels of cTnI was also analyzed. Even though median cTnI levels were significantly higher in cardiac deaths than in controls (p = .003), cTnI was not found to be a significant predictor of cardiac deaths, as determined by discriminant analysis (p = .52). Heart weight >500 g, evidence of old and recent myocardial injury, and significant coronary artery disease were seen statistically more often in cardiac deaths than in controls (p < or = .005 in each case), and median age was significantly higher in cardiac deaths than in controls (p = .001). Based on a stepwise logistic regression model, significant coronary artery disease, old and recent myocardial injury, and heart weight >500 g were found to contribute significantly to the prediction of cardiac death. Finally, neither chest injury nor CPR significantly affected concentrations of cTnI in pericardial fluid. These data confirm that the presence of acute and remote myocardial injury, significant coronary artery disease, and cardiomegaly (heart weight >500 g) strongly supports the diagnosis of a cardiac-related death. In contrast to a recently published report, we do not find that elevated concentrations of cTnI in pericardial fluid are strong indicators of cardiac-related deaths using our methodology.     

冠心病合并冠状动脉血栓猝死的法医病理学特征

目的探讨冠心病合并冠状动脉血栓形成导致猝死的法医学特征。方法收集96例因冠心病而猝死的案例,并将其分为血栓形成组与无血栓形成组,对发病时间、诱因、病理特征等方面进行分析。结果两组都以男性为主,在季节和时间节律分布、诱因构成上差异无统计学意义,但血栓形成组中年龄〈40岁发病率更高;血栓形成组的心脏质量和冠脉狭窄程度低于无血栓形成组,而两组冠脉粥样硬化累及的支数（≥2）、累及长度及合并心梗等指标差异均无统计学意义,但血栓形成组有低于无血栓形成组的趋势。结论两组人群都以男性为主且发病诱因、冠脉病变部位及致死机制相似,但血栓形成组的发病年龄较轻,心脏的病变程度较低,法医学解剖中当认真鉴别。     

Variation in Methods of Cardiac Dissection—A Potential Confounder in Measuring Cardiac Weight at Autopsy

To evaluate whether the weight of the heart measured at autopsy may be affected by the type of dissection, a prospective study was undertaken of the weights of sequential cases of nonpediatric hearts. Four hundred fifty‐eight hearts were examined (age range 17–96 years; mean 55.9 years; M:F = 3:1). The hearts were each weighed fresh, once the apex had been sliced, the auricles of the atria opened and blood drained, and again once the cardiac chambers had been opened completely. The difference in the partially and fully opened heart weights (range 146–1028 g; mean 434.8 g; range 134–1011 g; mean 420.8 g, respectively) (p < 0.05) ranged from 0 to 100 g (mean 14 g). In the most extreme example, the weight of the partially opened heart was 30.3% higher than that of the fully opened specimen. Failure to fully open the heart prior to weighing may result in significant error.     

Stressful events as a trigger of sudden death: a study of 43 medico-legal autopsy cases

The reports relating emotional stress to sudden death are largely anecdotal. In addition to experimental and electrophysiological studies, an opportunity for a better understanding of possible stress-related sudden death (SSD) may be provided by medico-legal autopsies. The goal of our autopsy study was to analyze cardiovascular pathologic findings in cases of SSD and if possible identify mechanisms by which the stressful event (SE) could be the cause. Forty three cases were studied (29 males and 14 females). In all cases, the SE and the death were witnessed. The age range was 22 to 90 years in males (mean, 52) and 30 to 92 years in females (mean, 64). Death occurred in all cases without premonitory symptoms. In 20 cases, death occurred during the SE and in the other 23 cases occurred within 2 h of the event. SE included fear, 15 cases; altercation, 21 cases; sexual activity, 3 cases; police questioning or arrest, 4 cases. According to police reports, in 40 cases (90%), the victims had no previous clinical history of cardiovascular disease. At autopsy, the heart weight in males ranged from 255 to 1000 g with a mean of 517 g and in females the range was 250–700 g with a mean of 417 g. In only 3 cases, gross and microscopic examination of the heart was normal. In 2 of the remaining 40 cases the subjects died of subarachnoid hemorrhage. In 38 cases, a cardiac cause of death was found as follows: coronary heart disease, 27 cases; cardiomyopathy, 6 cases; aortic valvular stenosis, 2 cases and right ventricular dysplasia, 3 cases. A coronary artery thrombosis was found in 8 cases of sudden coronary death. Post myocardial infarction fibrosis was present in 25 cases (92%) of sudden coronary death. In conclusion, it appears from our autopsy study that SSD occurs primarily in those individuals with severe heart disease, especially coronary heart disease.     

Cardiac rupture in acute myocardial infarction: a reassessment

Cardiac rupture as a complication of acute myocardial infarction (AMI) has been described as occurring infrequently. Because of the recent dramatic decrease in autopsy rates, the authors believe that current studies do not accurately represent the frequency of this catastrophic complication. Autopsy protocols and archived histologic slides of patients with AMI were retrospectively reviewed to determine whether the frequency of cardiac rupture, as a complication of AMI, is altered when a non-hospital-based patient cohort after autopsy is evaluated. This review yielded 153 cases of 41 women and 112 men, whose postmortem examinations revealed gross and histologic evidence of AMI. Cardiac rupture was present in 30.7% of these cases. Of the 47 patients with rupture, 35 had no relevant medical history. The remaining 12 patients had various medical conditions. None of the patients in the rupture group had previously treated symptoms related to coronary artery conditions. Whereas women constituted 26.8% of the total AMI group, they had a cardiac rupture rate of 61%. By contrast, men with AMI had a cardiac rupture rate of 19.6%. All patients in the cardiac rupture group had heart weights over the predicted expected weight as a function of body weight. Age, gender, and heart weight were significant factors associated with cardiac rupture, whereas body mass index was not significantly related. When these factors were evaluated jointly, age was a significant explanatory factor for rupture among both men and women, whereas body mass index and heart weight were significant for men but not for women. When the rupture sites occurred on the left ventricular myocardium, the anterior wall was affected in 21 cases (45%), the posterior wall in 18 (38%), the lateral wall in 4 (9%), and the apex in 3 (6%). The right ventricular myocardium ruptured in 1 case (2%). Most of the patients had severe multivessel coronary artery disease. Histologic study of the specimens showed that the majority of ruptures occurred between 24 and 72 hours after myocardial infarction. This study showed a frequency of cardiac rupture of 30.7% in patients with AMI and sudden death according to medical examiner's records. These findings confirm and reinforce the importance of postmortem examination and autopsy as an adjunct to clinical medical practice.     

中国人离体子宫测量与形态观察

对80例已知身源的离体子宫作10个项目的测量及大体形态观察,根据不同生理发育阶段(14～18岁为青春期,19～45岁为育龄期)和不同孕育情况分成5个组(Ⅰ组为青春期组,均无孕育史,Ⅱ组为育龄期无孕育史组;Ⅲ组为育龄期有正常生育史组;Ⅳ组为育龄期仅有人工流产史组;Ⅴ组为育龄期仅有剖腹产史组)进行比较分析,探讨不同生理发育阶段和不同孕育史的子宫形态差异。分析结果表明,Ⅰ组的重量、全长和体腔长度3项均数显著低于Ⅱ组;Ⅲ组的重量、体宽和宫口大小3项均数显著大于Ⅱ、Ⅳ两组;Ⅱ、Ⅳ两组各项均数差异不显著;Ⅴ组宫口大小的平均值与Ⅱ、Ⅳ组差异不显著,显著小于Ⅲ组。子宫大体形态观察的结果发现,子宫外口呈圆形的占2.5％,呈椭圆形的占13.75％,呈横形的占83.75％;子宫体有疤痕的仅见于Ⅴ组,而子宫颈有疤痕的在Ⅲ,Ⅳ、Ⅴ组中均见到;子宫颈糜烂现象在5个组中均有发现;Ⅲ、Ⅳ两组的部分标本子宫棕榈襞有损伤,其他3组未见损伤。     

猪离体心脏冠状动脉的MSCT造影

目的 通过对猪离体心脏冠状动脉进行多层螺旋CT（MSCT）造影成像,探索离体心脏血管造影技术的具体操作方法及参数.方法 应用自主改装的血管造影装置,分别将脂溶性和水溶性对比剂以不同灌注量（50、60、70 mL）和不同灌注-成像时间间隔（5、10、20 min）灌注猪离体心脏冠状动脉,进行MSCT扫描和三维图像效果比较,由2名放射科医生对各组的造影成像效果进行评估和记录,并对结果进行统计学分析. 结果 脂溶性对比剂对冠状动脉周围脂肪造成浸润和破坏而影响造影成像效果,而水溶性对比剂未出现类似结果.灌注-成像时间间隔为5 min,且灌注量为60 mL和70 mL时造影成像质量最佳. 结论 本研究的血管造影参数为后期开展尸体在体心脏冠脉造影奠定基础.     

Sudden unexpected death following exercise and congenital anomalies of coronary arteries. A report of two cases

Two cases of anomalous origin of the left coronary artery from the pulmonary trunk with unusually prolonged post-childhood survival are presented. In both cases, death was associated with physical exertion. The pathological findings included enlarged right coronary ostium, myocardial hypertrophy, endocardial fibrosis, and focal myocardial scarring.     

Sudden natural death at the wheel--a particular problem of the elderly?

Thirty-nine autopsy cases of sudden natural death at the wheel were analysed with special respect to the questions if this is a peculiar problem of the elderly and if there are particular pathological features in the elderly. The ages ranged from 33 through 83 years and the median age was 56.4 years. 97% of the deaths were attributable to cardiovascular diseases, about 90% to coronary heart disease. People older than 60 years of age tended to exhibit severe chronical arterio-sclerotic changes of the coronary arteries, especially multiple calcified stenoses and myocardial scars, but there was a low percentage of recent thrombotic occlusion of a coronary artery.     

Polysarcia adiposa: morbid obesity

From October 1988 to March 2005, there were at least 92 autopsy cases where morbid obesity was present and/or where it was attributed to the cause of death in the coronial district of Auckland, New Zealand, a city with a population of over 1 million people. Obesity has been researched internationally, and much is known about associated comorbidities such as atherosclerotic disease, hypertension, and diabetes, to name a few. However, in the morbidly obese (body mass index>or=40 kg/m2), only 14 of 92 cases were found to have ischemic heart disease due to coronary atherosclerosis as the principal cause of death, and slightly over half (48/92) have some degree (mild, moderate, severe) of coronary atheroma. There is a strong positive correlation between heart weight and body weight. Only 8 livers were normal, all others showing some form of steatosis, venous congestion, and fibrosis/cirrhosis. The mean weights of the heart, lungs, and liver were above the normal reference range in almost all cases. In conclusion, the study did not follow the widely published finding of the positive correlation between morbid obesity and ischemic heart disease in terms of mortality, but the study was consistent with other studies on the organ manifestations of morbid obesity, particularly for the heart, lungs, and liver.