ApoE的研究进展及其在脑外伤发生中的意义

载脂蛋白E(ApoE)是血浆中主要的载脂蛋白之一,参与机体的脂质代谢及调节胆固醇平衡,其基因多态性与多种疾病相关,在神经系统的正常生长和损伤后的修复过程起重要作用。近来发现其免疫反应性与脑损伤时间有一定规律性,可望将其作为法医检案中判定脑损伤时间的客观指标。     

ApoE的研究进展及其在脑外伤发生中的意义

载脂蛋白E（ApoE）是血浆中主要的载脂蛋白之一,参与机体的脂质代谢及调节胆固醇平衡,其基因多态性与多种疾病相关,在神经系统的正常生长和损伤后的修复过程起重要作用.近来发现其免疫反应性与脑损伤时间有一定规律性,可望将其作为法医检案中判定脑损伤时间的客观指标.     

载脂蛋白E与脑损伤的研究进展

载脂蛋白E(apolipoprote in E,apo E)在脑损伤愈后过程中起着重要的作用,在损伤后不同时段,apo E含量及出现部位均呈现一定的波动性,而这些问题对探讨脑损伤的治疗及在法医学中推断脑损伤时间有十分重要的意义。本文现就这些问题的相关研究作一概述。     

载脂蛋白J与脑损伤的研究进展

载脂蛋白J在脑损伤中发挥重要的神经保护功能,参与脑损伤修复,在损伤后不同时段,Apo J含量及定位均呈现规律性的波动,即时空动态性,因此,对脑损伤的治疗及法医病理学脑损伤时间推断具有重要意义,本文综述了近期Apo J相关研究进展。     

突触体素在弥漫性脑损伤后的表达水平变化

目的根据突触体素在脑损伤后的变化规律,研究其与弥漫性脑损伤后损伤时间之间的关系。方法垂直撞击SD大鼠造成脑损伤模型,在不同时间点处死大鼠,取脑组织冠状断面进行突触体素染色,将染色结果进行灰度值测定,并用SPSS软件对灰度值进行分析,从而推断损伤后随时间变化的突触体素变化情况。结果突触体素在损伤后一段时间内,随时间的变化呈现双拐曲线,显示突触体素表达与脑损伤及其修复过程密切相关。结论根据脑组织内突触体素的含量变化在一定范围内可以用于推断脑损伤时间。     

大鼠脑损伤后EPO及其受体表达与损伤时间的关系

目的研究大鼠脑损伤后脑组织中促红细胞生成素(erythropoietin,EPO)及其受体(erythropoietin receptor,EPOR)的表达与损伤时间的关系。方法 72只SD大鼠随机分为对照组(36只)、脑损伤组(36只),在建模后1、2、4、8、12、24 h每组各取6只大鼠处死,取挫伤部位脑组织,应用实时荧光定量PCR和Western印迹法检测不同时间点EPO以及EPOR的mRNA表达和蛋白表达情况。结果伤后24h内,EPO及EPOR的表达随损伤时间的增加而呈上升趋势。EPO的mRNA及蛋白表达与损伤时间之间存在相关性,其相关系数分别为0.875、0.911(P0.05);EPOR的mRNA及蛋白表达与损伤时间之间存在相关性,其相关系数分别为0.936、0.905(P0.05)。结论大鼠颅脑损伤早期EPO及EPOR的表达呈逐步上升趋势,与损伤时间具有相关性,可以作为脑损伤时间推断的参考。     

神经生化标志物S100β蛋白研究进展

S100β是一类钙离子结合蛋白,是轴突的生长因子,由神经系统胶质细胞分泌,广泛分布于神经组织中,在正常情况下发挥重要的生理作用,但分泌过高具有神经毒性。脑损伤后血清中S100β水平有时间的规律性,并与脑损伤程度有密切关系,可以作为脑损伤后神经生化新标识物。本文综述了近年来的S100β蛋白的分子生物学基础、神经生理作用及其在神经组织损伤、疾病中的作用机制。     

78例交通事故致颅脑外伤后癫痫的法医学鉴定分析

外伤后癫痫是颅脑损伤,尤其是重型颅脑损伤后严重的并发症.外伤后癫痫可由颅内出血、凹陷性骨折刺激、脑损伤愈合和继发脑损伤等导致,在交通事故伤残等级鉴定中,是一个较复杂的问题.本文收集本鉴定所2009-2010年8150例交通事故中78例颅脑损伤后涉及癫痫的鉴定案例,并对颅脑损伤的严重程度、发生部位与癫痫的相关性及鉴定的注意要点进行初步分析.     

大鼠脑外伤后脑组织MMP-9的表达与损伤时间相关性

目的观察大鼠脑外伤后脑组织MMP-9的表达规律,探讨其在损伤时间推断中的应用价值。方法健康SD大鼠75只,随机分为损伤组、假损伤组和正常对照组。损伤组采用自由落体方法建立脑损伤模型;致脑损伤后分10个时间点,采用HE染色观察损伤区的变化,采用免疫组化方法检测各时间点阳性细胞的种类和比值,并与假损伤组和对照组进行统计分析比较。结果免疫组化染色显示损伤组伤后1h可见中性粒细胞阳性着色,6h后可见神经细胞阳性染色并逐渐增强,伤后5d阳性细胞数达到峰值,而后开始减弱,14d基本消失。假损伤组和正常对照组未见阳性表达。将实验组中2h～7d阳性细胞比值与其它各时间点相比,差异有统计学意义(P<0.05);实验组各时间点与假损伤组和对照组相比,差异均有统计学意义(P<0.05)。统计分析结果见表1。结论损伤后MMP-9阳性表达的规律性,有望成为脑损伤时间判定的参考指标。     

GFAP和VEGF在创伤性脑损伤中表达的研究进展

创伤性脑损伤是世界上导致死亡及残疾的主要原因之一。检测对中枢神经系统损伤有高度特异性和敏感性的生物标志物,可以在一定程度上反映损伤情况。胶质纤维酸性蛋白与血管内皮生长因子均可作为颅脑损伤的生物学标记物,其表达变化规律、峰值出现时间,与创伤性脑损伤的严重程度及损伤时间的推断密切相关,对于法医病理学具有重大意义。该文对胶质纤维酸性蛋白与血管内皮生长因子的分子生物学特性及其在创伤性脑损伤中的表达进行综述。     

颅脑损伤所致精神障碍的相关因素研究

目的探讨颅脑损伤所致精神障碍的相关因素。方法以成都市公安交通管理局事故处理大队提供的因道路交通事故造成颅脑损伤的255名存活者为研究对象,在颅脑损伤治疗终结后进行智商测验、记忆商测验、SCID -I评估、PDQC和SCICP评估、脑电地形图检查,并完成人口学资料的收集。依据CCMD-3诊断标准中有关器质性精神障碍的分类进行精神障碍的诊断。结果 255例颅脑损伤患者中,罹患各类精神障碍者共185例,发生率为 72．5％。与颅脑损伤所致精神障碍相关的因素有:患者的文化程度低、脑挫裂伤、脑损伤程度重、左额叶和左颞叶损伤、多脑叶联合损伤及BEAM异常程度重。结论颅脑损伤所致精神障碍的发生率较高;患者的文化程度、颅脑损伤的性质、程度、部位及多脑叶联合损伤等因素对精神障碍的发生具有一定影响。     

Position paper on fatal abusive head injuries in infants and young children

This article represents the work of the National Association of Medical Examiners Ad Hoc Committee on shaken baby syndrome. Abusive head injuries include injuries caused by shaking as well as impact to the head, either by directly striking the head or by causing the head to strike another object or surface. Because of anatomic and developmental differences in the brain and skull of the young child, the mechanisms and types of injuries that affect the head differ from those that affect the older child or adult. The mechanism of injury produced by inflicted head injuries in these children is most often rotational movement of the brain within the cranial cavity. Rotational movement of the brain damages the nervous system by creating shearing forces, which cause diffuse axonal injury with disruption of axons and tearing of bridging veins, which causes subdural and subarachnoid hemorrhages, and is very commonly associated with retinal schisis and hemorrhages. Recognition of this mechanism of injury may be helpful in severe acute rotational brain injuries because it facilitates understanding of such clinical features as the decrease in the level of consciousness and respiratory distress seen in these injured children. The pathologic findings of subdural hemorrhage, subarachnoid hemorrhage, and retinal hemorrhages are offered as "markers" to assist in the recognition of the presence of shearing brain injury in young children.     

轻型颅脑损伤ABR的纵向研究

目的　探索轻型颅脑损伤的电生理学指标 ,为早期临床诊断和预后判断以及法医学活体伤害鉴定提供依据。　方法　对相关病例进行脑干诱发电位 (ABR)的动态观察 ,并对结果进行统计学分析。　结果　6 0例轻型颅脑损伤患者伤后 48小时ABR的检测 ,显示主要异常表现为I-III峰间潜伏期的延长 ,说明此类损伤可造成脑干的功能紊乱。同时通过对其中 40例进行ABR追踪检测 ,结果显示大部分患者受伤三个月后脑功能状态恢复正常。　结论　轻型颅脑损伤ABR变化具有一定的特征 ,提示可作为早期临床诊断和预后判断以及法医学活体伤害鉴定的客观依据 ,应引起关注并展开进一步研究。     

The neuropsychology of offending

Abstract

Structural damage or abnormality of the brain may be related to offending. What is known about the consequences of lesions to the frontal and temporal lobes and of the results of head injury, suggests psychological changes that might well enhance the risk of offending, and in particular violent offending. Evidence from two sources is reviewed, that based on studies of offender groups and that based on those follow-up studies of clinically defined samples of head injury victims which have reported offence related outcomes. Despite some methodological limitations, the balance of evidence is that frontal damage and possibly temporal lobe damage is related to offending, particularly violent offending, and that head injury can act to precipitate offence related behaviour. It is suggested that future research needs to concentrate more on the factors that mediate the link between brain damage and offending behaviour.     

不同部位颅脑摔跌伤的特征分析68例

目的探讨不同受力部位颅脑摔跌伤后损伤程度和特征差异。方法收集摔跌所致颅脑损伤68例,根据案情、受伤过程、临床体征、CT影像资料将受伤部位分为颅前部、颅侧部、颅后部;损伤类型分为颅骨骨折、硬脑膜外血肿、硬脑膜下血肿和脑挫裂伤;损伤数量分为单一和多发伤;颅骨骨折分为受力点骨折和非受力点骨折;脑挫裂伤分为冲击伤、对冲伤等。运用非参数统计χ2检验比较其频数分布。结果不同摔跌部位颅骨骨折和颅脑损伤程度存在明显差异(P0.05),颅后部摔跌颅骨骨折远离受力点多见,多发伤为主,而颅前部、颅侧部受力点骨折多见,单处损伤多见;颅后部、颅侧部摔跌后脑挫裂伤发生率高,以对冲部位多见,颅前部摔跌后脑挫裂伤发生率低,冲击伤亦多见。结论摔跌部位不同颅脑损伤程度和特征存在差异,CT检查资料有助于损伤机制推断。     

Concentrations of toluene in the body killed by an injury to the head shortly after ingesting thinner

An autopsy was conducted on a male showing leather-like skin damage, revealing the cause of death to be an injury to the head. Thinner was found scattered around the scene of death, and stomach and intestine contents smelled strongly of solvent. Toxicological analysis was conducted to determine whether or not the solvent was of a lethal level. Using gas chromatography, peaks of toluene, xylene, and ethylbenzene were detected in the blood and gastric contents. No toluene was detected in the urine, and therefore it was concluded that the decedent died of a severe head injury shortly after solvent ingestion. In the literature, toluene concentrations in blood and lung samples were determined as both fatal and non-fatal but clear differences in the fatality of toluene in solid organ samples, namely, the brain, liver and kidneys were shown. The brain is especially useful in postmortem analysis. In this case, the concentration of toluene in the brain was 20.0 microl/g, which was considered as a non-lethal level.     

头部外伤后伴发病理性蛛网膜下腔出血致猝死11例鉴定分析

头部外伤后伴发病理性蛛网膜下腔出血致猝死１１例鉴定分析肖柏坤，曾建华，孙跃刚（ｌ．江西医学院法医教研室；江西３３０００６２．江西医学院第一附属医院脑外科；江西３３０００６３．南昌市公安局刑事科学技术研究所；江西３３０００６）Ａｎａｌｙｓｉｓｏｆ１１Ｃ...     

头外伤后基底节区血肿的伤与病鉴别2例

头外伤后基底节区血肿的伤与病鉴别２例王宁敏，常林（北京最高人民检察院技术局；北京１００７２６北京市高级人民法院；北京１０００３９）ＤＩＦＦＥＲＥＮＴＩＡＴＩＮＧＴＲＡＵＭＡＴＩＣＡＮＤＨＹＰＥＲＴＥＮＳＩＶＥＢＡＳＡＬＧＡＮＧＬＩＡＨＡＥＭＡＴＯＭＡ...     

Inflicted head injury in infants

There is scant neuropathological information in the child abuse literature; even the best reviews include assumptions based on the findings of a few inadequate early studies. Our recent series of 53 fatal cases (Brain 124 (2001) 1290, 1299 [1,2]) demonstrated age-related patterns of brain injury and showed the substrate of severe encephalopathy in the infants to be hypoxic brain damage, not diffuse traumatic axonal injury ('DAI'), as had previously been thought. About one-third had craniocervical injuries, particularly in the brain stem, suggestive of stretch injury to the neuraxis. Our interpretation was that this finding implied a mechanism of injury--brain stem damage from stretch injury to the neck with resultant apnoea--that could account for the clinical scenario in many cases, and for which violence would not necessarily be required. Since publishing this study we have turned our attention to the subgroup of infants who die without objective signs of injury, such as skull fracture or impact, whose carers are accused of abuse, usually, "violent shaking", on the pathologic findings alone. Given the striking discrepancy that there often is in such cases between the relatively trivial findings in the brain and the accusations of violence, we have been looking at the pathogenesis of the typical intracranial bleeding. A histologic study of dura from 50 paediatric autopsies, none of whom had suffered a head injury, has led us to propose that the subdural and retinal bleeding in such cases may well have a physiological aetiology, rather than being caused directly by trauma.