心肌及传导组织内3种蛋白的变化与SMDS的相关性

目的 观察心肌及传导组织内肌动蛋白、血浆白蛋白及纤维连接蛋白的染色变化，探讨青壮年猝死综合征(SMDS)死后诊断的新方法。方法 应用免疫组化S-P法，对SMDS及冠心病猝死者心肌及传导系统内肌动蛋白、血浆白蛋白和纤维连接蛋白的进行染色观察。结果 22例SMDS例猝死者心肌及传导系统内的肌动蛋白缺染17例；血浆白蛋白染色阳性18例；纤维连接蛋白染色阳性15例。并发现在SMDS中，8例有CCS严重病变。结论 心肌及传导系统内血浆蛋白、肌动蛋白改变与SMDS密切相关，部分SMDS病例死前存在早期心肌缺血或梗死的改变。     

基于眼组织结构的死亡时间推断研究进展

死亡时间(postmortem interval,PMI)推断是法医病理学研究的重点与热点问题。近年来,国内外学者利用眼组织推断PMI取得了一定进展,机体死后眼角膜、房水、虹膜、晶状体、玻璃体液、视网膜等改变均呈现与PMI高度相关的时序性变化规律。本文基于眼组织不同结构死后形态学、生物化学、分子学、遗传物质改变等方面,对PMI推断研究进展进行了综述,对存在的问题及发展趋势进行探讨。     

马凡综合征继发主动脉夹层误诊致死亡一例分析

主动脉夹层(Aortic Dissection,AD)为心血管系统灾难性急危重症.该病起病隐匿、进展迅速,患者死亡率居高不下,实践中也常因医方未能及时明确诊断、正确治疗,使患者错失早期救治的机会,业已成为医疗纠纷发生的重灾区.马凡综合征是一种先天性、遗传性结缔组织疾病,常累及患者心血管系统、眼和骨骼,四肢细长形似蜘蛛样...     

血浆蛋白的LSAB检测在青壮年猝死综合征的应用

用免疫组织化学LSAB法观察9例青壮年摔死综合征（SMDS）心传导系统组织及心肌细胞内血浆蛋白Al、Fn的改变，并以冠心病和非心脏病死亡者之心脏标本作对照。结果：SMDS组，8例Al阳性染色，7例Fn阳性染色；冠心病组，7例Al、Fn均呈阳性染色；非心脏病组心肌细胞内Al、Fn均呈阴性，而部分血管壁、结缔组织则呈阳性。提示部分SMDS病例有早期心肌缺血、心肌梗死的病理改变，其死亡原因应属心性猝死范畴。     

常见抗精神病药物心血管毒性的研究进展

心源性猝死居猝死发生率之首,除了心血管疾病等因素之外,抗精神病药物引起心血管损伤致心源性猝死也时常发生。在法医学司法鉴定案例中,因部分猝死案例有抗精神病药物服药史,案情调查可以发现心电图呈现缺血或者心律失常改变,但尸检后组织病理学检查无明显病理改变,故法医病理诊断该类型猝死存在一定困难。因此,研究抗精神病药物引起心源性死亡的原因和机制,寻找抗精神病药物引起心源性死亡的特异性指标尤为重要,本文通过对常见抗精神病药物药理作用及心血管毒性进行总结分析,为下一步开展抗精神病药物致心源性猝死的法医学研究及病理生理机制提供参考。     

眼损伤的法医学鉴定

眼是人体最重要的暴露感觉器官,也是人体组织最精密、最脆弱的器官,易遭受直接或间接暴力,导致视功能障碍。本文作者就眼损伤的特点及法医学鉴定进行总结和分析。眼损伤分为机械性损伤(擦伤、挫伤、穿孔、异物等)、非机械性损伤(烧伤、化学、辐射等)。外伤后导致眼球解剖学结构被破坏,失去正常视觉功能的案     

共有基因座数和等位基因数用于结直肠癌组织的身源认定

目的 探讨结直肠癌组织中STR基因座变异情况及其身源认定方法. 方法 用Identifiler系统对50对新鲜结直肠癌组织及其身源正常组织(CR-N)组进行STR分型,计算CR-N组中变异STR基因座及全不同基因座数(A0)、半相同基因座数(A1)、全相同基因座数(A2)和共有等位基因数(IAn),比较CR-N组、无关个体对(UI)组和全同胞对(FS)组中上述参数的分布差异,通过判别分析建立判别函数.结果 结直肠癌组织中STR基因座基因型改变发生率为3.33%.CR-N组中A1、A2和IAn呈显著偏态分布并与其在UI或FS组中分布差异显著.依据IAn、A1/A2分别建立了CR-N与UI、CR-N与FS的判别函数,其对结直肠癌组织身源认定错判率均为0.00%. 结论 结直肠癌组织中STR基因座基因型改变发生率较高;本研究所建立的判别函数是进行结直肠癌组织身源认定的一种可行方法.     

171例脑干颅神经损伤

目的　观察头部受力致脑干颅神经损伤的形态学改变 ,探讨脑干颅神经损伤形成机制及其与头受力部位和方式的关系。方法　 171例脑干标本 ,于双侧第 3～ 12对颅神经的根部水平横切取组织块 ,常规固定、脱水、包埋、切片、HE染色 ,光镜检查。结果　所有标本均见颅神经损伤。有动眼神经损伤 ( 12 0例 ,70 2 % ) ,面听神经损伤( 92例 ,5 3 8% ) ,三叉神经损伤 ( 85例 ,49 7% ) ,外展神经损伤 ( 4 5例 ,2 6 3 % ) ,舌下神经损伤 ( 3 1例 ,18 1% ) ,迷走神经损伤 ( 2 7例 15 8% ) ,舌咽神经损伤 ( 2 4例 ,14 0 % )及滑车神经和副神经损伤 (各 10例 ,5 8% )。损伤可为单侧或双侧 ,累及单条或多条。病理形态学改变有出血 ( 4 2例 ,2 4 6% ) ,水肿 ( 2 6例 ,15 2 % ) ,神经根部组织结构变形 ( 71例 ,41 5 % ) ,根部撕裂 ( 3 2例 ,18 7% )等。结论　脑干颅神经损伤是脑干损伤的并存病变 ;位脑干高位的颅神经损伤比位低位的多 ,粗的神经损伤比细的多而严重 ;动眼、面、听神经损伤的发生率较高。     

SPVER-A在客观评估视敏度中的法医学价值

目的探讨空间频率扫描翻转图像视觉诱发电位视力(SPVER-A)检查在法医学客观评定视敏度中的价值。方法选取正常眼共40只眼(矫正视力均≥4.9),分别测试行为视力(主观视力)及SPVER-A(客观视力),将客观视力、主观视力的数值进行对比及统计学分析。结果 (1)40只眼SPVER-A得出的客观视力的均值(x—)4.96,标准差(s)0.08,变异系数(CV)0.02;(2)40只眼的SPVER-A的客观视力(Visus值)与主观视力值的相关性(r=0.7097);(3)40只眼的客观视力数值均等于或低于主观视力数值。其中差值≤0.1者为39只眼,达到了97.5%,只有一只眼的客观视力数值与主观视力数值差值大于0.1。结论在正常眼人群中,SPVER-A所得客观视力与主观视力值有良好的相关性,是法医学客观评定视敏度极具潜力的新方法之一。     

HMGB1在创伤引起大鼠肺组织内质网应激中的作用

目的探讨高迁移率族B1(high mobility group B1,HMGB1)蛋白在创伤引起大鼠肺组织内质网应激(endoplasmic reticulum stress,ERS)变化中的作用。方法用标准重物挤压大鼠双后肢建立创伤应激致大鼠急性肺损伤模型。第一部分实验将大鼠随机分为体位对照组和挤压后6 h、18 h和30 h组,第二部分实验分为体位对照组、挤压后18 h组、HMGB1抑制剂正丁酸钠组和挤压后18 h+抑制剂组。用蛋白质印迹法检测肺组织HMGB1以及ERS相关蛋白(GRP78、caspase-12、CHOP和IRE1α)的表达变化。同时,常规HE染色观察肺组织病理学改变。结果与体位对照组比较,挤压大鼠后肢可引起肺组织中ERS相关蛋白(GRP78、caspase-12、CHOP和IRE1α)以及HMGB1蛋白表达明显增高,挤压后30 h时上述蛋白表达降低但仍高于体位对照组,同时大鼠出现明显肺损伤病理变化。与挤压后18 h组比较,挤压后18 h+抑制剂组大鼠肺组织中上述ERS相关蛋白及HMGB1蛋白表达降低,大鼠肺损伤病理变化减轻。结论创伤应激能启动HMGB1-ERS通路导致大鼠急性肺损伤。     

Marfan syndrome. A contribution to forensic medicine cases

A 19-year-old school boy suffered from fluctuating uncharacteristic chest pain in the last 20 h before his death. He died unexpectedly within a few minutes of a hemopericardium, which resulted from an aneurysmal rupture of the ascending aorta. The patient's past history as well as the autopsy and ultrastructural findings led to the diagnosis of Marfan's syndrome with alterations of the cardiovascular skeletal system but no ophthalmological involvement ("oligosymptomatic" form of Marfan's syndrome). Appraisal of the cause of death is made more difficult by the fact that medical treatment was undertaken on the same day, whereby subtotal liver crushing was established that had resulted from attempts at resuscitation.     

眼外伤后眼压增高法医学鉴定32例分析

目的分析眼部钝性外伤后眼压增高的原因及其特点,探讨法医学鉴定要点。方法选取资料完整的眼部钝性外伤后眼压增高鉴定案例32例,总结其眼压增高出现及持续时间、眼压增高的程度、主要临床表现、临床治疗方法及愈后视力、视野检查结果,分析其中的相关性。结果本组眼外伤后眼压增高者的临床表现包括外伤性虹膜睫状体炎、前房积血、晶体脱位与玻璃体积血等。虹膜睫状体炎导致的外伤后眼压增高持续时间短、程度轻,多不遗留严重后遗症;前房积血、玻璃体积血及晶体脱位等引发的眼压增高,则与其本身伤情的严重和广泛程度密切相关。结论对于眼外伤后眼压增高的鉴定,应重视：（1）眼压增高出现和持续的时间、增高的程度;（2）相关的临床治疗经过;（3）愈后的视觉功能状况,包括视力和视野检查结果;（4）分析导致眼压增高的原因及其与外伤的关系。     

大鼠骨骼肌挫伤愈合过程中caspase-3的表达及时间规律

目的观察大鼠骨骼肌挫伤愈合过程中,caspase-3的表达及其变化规律。方法制作大鼠右小腿骨骼肌挫伤模型,应用免疫组织化学法、Western blot法及caspase-3活性测定法对不同时间段大鼠骨骼肌挫伤后caspase-3表达进行检测。结果免疫组织化学及Western blot均显示,挫伤周边区caspase-3的活性随时间延长逐渐升高,5d时达最高峰,随后活性逐渐下降。免疫组织化学染色结果显示,伤后3～5d挫伤处坏死的骨骼肌细胞被清除干净,新形成的肌细胞大量增生,且新形成的肌细胞胞浆内有caspase-3表达;损伤后7～14d,新形成的肌细胞内仍然有caspase-3的阳性表达。结论大鼠骨骼肌挫伤后,挫伤周边骨骼肌表达caspase-3有一定的时间规律性,可望作为推断骨骼肌挫伤时间的指标之一;大鼠骨骼肌挫伤后,新形成的肌细胞表达caspase-3,提示caspase-3可能在骨骼肌分化过程中起重要作用。     

大鼠骨骼肌挫伤后p-CB1R的表达及与损伤时间的相关性

目的观察探讨大鼠骨骼肌挫伤愈合过程中p-CB1R的表达规律与损伤时间的相关性。方法健康成年雄性SD大鼠50只,体重220～250g,随机分为10组,每组5只,其中9组为实验组,1组为正常对照组。应用免疫组织化学染色和Western blot技术,检测50例大鼠骨骼肌挫伤后各时间段p-CB1R的表达情况。结果正常对照组大鼠骨骼肌未见p-CB1R表达;挫伤后p-CB1R阳性表达主要在单核细胞和成纤维细胞中,各时间段大鼠骨骼肌均未见阳性反应。伤后3～24h,阳性细胞以单核细胞为主;3～5d,阳性细胞以单核细胞和成纤维细胞为主;7～10d,阳性反应主要见于成纤维细胞,并于7d达到高峰;14d,p-CB1R阳性表达量有所下降。结论骨骼肌挫伤愈合过程中p-CB1R在单核细胞和成纤维细胞中的变化具有时序性,可望作为法医学推断骨骼肌挫伤时间的参考指标之一。     

Bilateral asymmetry of long arm bones and jugular foramen: implications for handedness

The analysis of asymmetry of the arm long bones and of the cranial jugular foramen has been used to suggest handedness in humans. However, because of the unavailability of documented skeletal material, neither criterion has been systematically tested. If both criteria are associated with handedness, they should also be intercorrelated within individuals. Data were collected from skeletal material of 125 males and 57 females to test whether this intercorrelation exists. According to Chi-square analysis, no statistically significant association was identified. After examining several hypotheses, it was concluded that until further substantiation, neither criterion is related to handedness to a degree appropriate for forensic science identification from skeletal remains.     

眼球钝挫伤后视网膜脱离的司法鉴定

目的分析眼球钝挫伤后视网膜脱离在法医临床学眼损伤及伤残鉴定中的致伤原因及因果关系。方法研究112例眼球钝挫伤后视网膜脱离案例,对其中视网膜裂孔类型、外伤至视网膜脱离时间、合并其他损伤或疾病进行分析。结果本组案例锯齿缘离断4.28%,黄斑裂孔12.50%,其他部位的裂孔(<90°)56.25%,巨大裂孔(>90°)5.00%,未发现裂孔的增殖性玻璃体视网膜病变(PVR)性视网膜脱离11.6%,其中45眼有不同程度的PVR。外伤至视网膜脱离的时间以1周～2个月为常见(61.60%)。合并中高度近视者83.93%,合并玻璃体混浊者52.68%。外伤与视网膜脱离存在直接因果关系者41.07%,存在间接因果关系者52.68%,外伤与视网膜脱离难以联系者6.25%。结论视网膜脱离与多种危险因素有关,外伤与视网膜脱离之间因果关系的分析是法医学眼损伤及伤残鉴定的重要内容。     

A sandwich enzyme immunoassay for human muscle-specific beta-enolase and its application for the determination of skeletal muscle injury

A sensitive sandwich enzyme immunoassay for human beta-enolase was developed and used to examine beta-enolase in blood or bloodstains as a marker for the determination of skeletal muscle injury. Human beta-enolase was purified from human skeletal muscle, and then an antibody against it was prepared. Polystyrene balls coated with rabbit anti-human beta-enolase IgG were incubated with human beta-enolase and then with anti-human beta-enolase Fab'-peroxidase conjugate. Peroxidase activity bound to the polystyrene balls was assayed by fluorometry using 3-(4-hydroxyphenyl)propionic acid as a hydrogen donor. The detection limit for human beta-enolase was 2.6 pg (30 amol) per assay. The degree of cross-reaction of the sandwich enzyme immunoassay for other organs except for heart (1/10) was about 1/150 or less. Moreover, the localization of beta-enolase in various human tissues was examined by Northern blot analysis, and this confirmed that beta-enolase was expressed only in skeletal and cardiac muscle. Antigenic activity in bloodstains containing beta-enolase was recovered well after storage for 60 days at room temperature. The ratio of beta-enolase to total protein in bloodstains made from non-traumatic blood, nasal hemorrhage and menstrual blood, was within the normal range. In contrast, the ratio of beta-enolase in bloodstains from traumatic blood was obviously elevated (10-30 fold) in comparison with non-traumatic blood. Furthermore, the ratio of beta-enolase was proved to be higher in stains adhering to weapons that had passed through skeletal muscle, indicating that detection of beta-enolase in bloodstains could be used to distinguish crime weapons. These results suggest that beta-enolase is a useful marker for identification of skeletal muscle injury as well as for detecting the origin of bleeding.     

从眼外伤损伤程度条款设计看新标准修订思路

损伤程度鉴定是法医临床学司法鉴定的主要内容。近年来,法医学司法鉴定工作人员不断呼吁对1990年与1996年发布实施的人体损伤程度鉴定相关标准进行修订。将于2014年1月1日施行的《人体损伤程度鉴定标准》,在条款内容和结构设计上发生了很大的变化,备受司法鉴定工作人员的广泛关注。眼外伤是比较常见的损伤类型,（《人体损伤程度鉴定标准》对眼外伤的条款规定较以往变化明显。本文从眼外伤的条款设计出发,通过横向和纵向比较,探讨和总结新标准的修订思路。     

Cardiovascular malformations and sudden death in infancy

BACKGROUND: We survey the postmortem findings of cardiovascular malformations in infants under the age of 1 year who died suddenly and unexpectedly, in a way that mimicked sudden infant death syndrome (SIDS), and evaluate the importance of the malformation for the fatal outcome. METHODS: Four hundred fifty-seven infants under the age of 1 year, who died between 1982 and 2001, were investigated at the Department of Forensic Medicine in Stockholm, Sweden. RESULTS: Cardiovascular malformations were found in 18 infants (3.9%). Only 6 of 18 malformations, mostly severe, were clinically diagnosed before death. In the other 12 infants, cardiovascular malformations were found, such as atrial or ventricular septal defects, coarctation of aorta, stenosis of the aortic or pulmonary artery orifice, and aneurysm of the membranous portion of the interventricular septum. In all instances, the heart weight was increased. CONCLUSIONS: The observation of undiagnosed cardiovascular malformations as the only explanation for the cause of sudden and unexpected death in apparently healthy infants may advocate more examinations of the infant during early life. It is also important to enlarge the debate of the cause of death in infants with cardiovascular malformations. Should they be included in borderline SIDS?