Sudden unexpected death due to a previously undiagnosed plasma cell dyscrasia

The plasma cell dyscrasias are a diverse group of disorders characterized by the production of a clonal paraprotein. Sudden death is a recognized complication of the plasma cell dyscrasias, most commonly in individuals with cardiac involvement by amyloidosis. However, the current forensic literature has no reported cases in which sudden death resulted from complications of a plasma cell dyscrasia that was first diagnosed by postmortem histologic examination. We present the case of a woman whose sudden and unexpected death resulted from a seizure. Postmortem examination revealed no evidence of trauma or a grossly identifiable natural disease process that would have accounted for her death. However, microscopic and immunohistologic studies revealed a previously undiagnosed plasma cell dyscrasia, the clonality of which was determined by immunohistochemical studies for immunoglobulin light chains, that was not associated with amyloid deposition. This case elucidates a previously unrecognized cause of sudden unexpected death and illustrates the importance of microscopic studies in selected cases examined in medical examiner/coroner offices.     

Subsumtionsautomat oder Ersatzgesetzgeber?

Der Beitrag besch?ftigt sich mit jener Rolle, die der Rechtsprechung bezüglich der Weiterentwicklung des ?sterreichischen Wohnrechts zukommt. Er zeigt ua die praktische Bedeutung auf, die der richterlichen Rechtsanwendung und Rechtsfortbildung in diesem Bereich zukommt, thematisiert die Frage, ob es in der wohnrechtlichen Rechtsprechung zu "Grenzverwischungen" zwischen Rechtsanwendung und Rechtspolitik kommt und analysiert charakteristische St?rken und Schw?chen von richterlicher Rechtsfortbildung im Wohnrecht.     

Institutional Collective Action on Drugs: Functional and Vertical Dilemmas of Unused Pharmaceuticals

The authors use the Institutional Collective Action Framework to analyze the barriers, opposition, and opportunities for residential pharmaceutical disposal programs in the United States via a case study on a series of take‐back programs pioneered in the state of Washington by local and state governments, as well as the corresponding backlash from federal agencies. While successful in some ways, these innovative solutions directly challenged the competing federal policy regimes controlled by the Drug Enforcement Agency (DEA), and, to a lesser extent, the Environmental Protection Agency (EPA). Findings from case studies suggest that functional dilemmas created by existing institutions with entrenched regulatory regimes are a key challenge to finding efficient solutions to vertical ICA dilemmas. Conclusions, then, connect to the broader ICA research agenda, and implications for multi‐level governance issues.     

Analyzing Territorial and Sectorial Dimensions of Public–Private Partnerships in Science,Technology, and Innovation policies

The performance of innovation systems depends, to a great extent, on the degree of public–private collaboration they involve. Thus, innovation policies often aim to enhance this collaboration through public–private partnerships. These partnerships are a multidimensional phenomenon whose success depends on factors related to each of their dimensions. This paper proposes the use of an analytical model that reflects the multidimensional nature of public–private partnerships and analyses to what extent they are applied in a specific innovation system in order to identify the territorial and sectorial factors that act as barriers or drivers to use them. This model aims to help policy makers design appropriate public–private partnerships in each context. The case under review is the Spanish innovation system, given that this system has been suffering from a structural lack of collaboration for several decades, despite the implementation of policies aimed to foster this. Thus, if the model works, it should be able to identify key factors that influence greater or more restricted use of the different PPP formulas.     

糖肾宝冲剂对糖尿病肾病患者外周血内皮祖细胞及相关炎性因子的影响

目的 观察糖肾宝冲剂对糖尿病肾病（diabetic nephropathy,DN）患者外周血内皮祖细胞（endothelial progenitor cells,EPCs）数量及其增殖能力的影响,探讨其可能的作用机制。方法 将92例DN患者,按随机数字表法分为治疗组和对照组,每组46例。对照组采用降血糖、降血压、降血脂等常规治疗,治疗组在对照组疗法基础上加服糖肾宝冲剂,疗程16周。观察两组治疗前后空腹血糖（fasting plasma glucose,FPG）、血清肌酐（serum creatinine,SCr）、尿白蛋白排泄率（urinary albumin excretion rate,UAER）、尿N-乙酰β-D氨基葡萄糖苷酶（N-acetyl β-D-glucosaminidase,NAG）,血清超敏C-反应蛋白（high-sensitivity C-reactive protein,hs-CRP）、肿瘤坏死因子-α（tumor necrosis factor,TNF-α）、白细胞介素-6（interleukin,IL-6）水平,以及血清EPCs数量及其增殖能力。结果 与治疗前比较,治疗后两组UAER、NAG、hs-CRP、TNF-α及IL-6均显著下降（P<0.01）,外周血EPCs数量及其增殖能力均显著升高 （P<0.01）, 但治疗组在改善上述指标方面均显著优于对照组（P<0.01）。结论 糖肾宝冲剂能显著提高DN患者外周血EPCs数量及其增殖能力,减轻肾损害,其作用机制可能与抑制DN的炎性反应有关。     

白坚木碱类二聚体在Caco- 2细胞模型中的吸收机制研究

目的 考察白坚木碱二聚体(10-dehydroxyl-12-demethoxy-conophylline,wtdr-11)在人类结肠癌细胞系Caco-2细胞模型中吸收和转运机制.方法 建立Caco-2单层细胞完整模型,采用超高效液相色谱-荧光法(ultra-high performance liquid chromat...     

新藤黄酸诱导卵巢癌A2780细胞凋亡的作用研究

目的 研究新藤黄酸对卵巢癌细胞增殖的抑制作用及其可能的机制。方法 采用MTT检测新藤黄酸对卵巢癌A2780细胞存活率的影响,采用fluo-3AM染色荧光显微镜观察新藤黄酸对A2780细胞钙离子水平的影响,采用Hoechst 33342染色荧光显微镜观察细胞的凋亡率,采用PI染色流式细胞仪检测新藤黄酸对细胞周期的影响,采用Annexin Ⅴ-FITC/PI染色流式细胞仪检测新藤黄酸对细胞凋亡率的影响,采用Western blot检测凋亡相关蛋白表达的影响。结果 MTT检测结果表明,新藤黄酸对卵巢癌细胞A2780的增殖具有抑制作用,且抑制作用具有明显的剂量依赖性;fluo-3AM染色荧光显微镜下观察,可见各浓度新藤黄酸均能升高A2780细胞内钙离子水平,且呈现浓度依赖关系;PI染色流式细胞仪检测结果表明,新藤黄酸能阻滞A2780细胞于G0/G1期;Hoechst 33342染色和Annexin Ⅴ-FITC/PI染色流式细胞仪检测结果表明,随着新藤黄酸浓度的增加,A2780细胞凋亡率呈现增高的趋势;Western blot检测结果表明,新藤黄酸可以促进凋亡相关蛋白p53、细胞色素C以及Caspase-9表达水平升高。结论 新藤黄酸具有抑制卵巢癌A2780细胞增殖和诱导肿瘤细胞发生线粒体凋亡的作用。     

细胞凋亡参与脑心综合征心肌损伤及针刺干预作用

目的 观察心肌细胞凋亡在脑心综合征(cerebral-cardiac syndrome,CCS)发病中的作用机制及针刺的干预作用。方法 从60只健康SD大鼠中随机选择10只作为伪手术组,其余50只用于CCS模型复制,从模型复制成功的大鼠中随机选取30只,分成模型组、针刺组和非经非穴组,每组10只。采用胶原酶加肝素联合注射大鼠尾状核方法复制CCS模型,伪手术组向大鼠尾状核注入等量生理盐水。模型复制后72 h处死动物,分别采用苏木精-伊红（hematoxylin-eosin,HE）染色、脱氧核糖核苷酸末端转移酶介导的缺口末端标记法(terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling,TUNEL)和免疫组织化学法检测心肌组织病理变化、细胞凋亡及半胱氨酸天冬氨酸蛋白酶3(Caspase 3)的表达。结果 HE染色示伪手术组心肌结构正常,模型组心肌细胞变性、坏死,大量平滑肌断裂;TUNEL及免疫组织化学染色提示模型组出现较多凋亡细胞,Caspase 3大量表达,针刺组TUNEL染色阳性细胞和Caspase 3阳性细胞均较模型组和非经非穴组显著减少(P<0.01)。结论 心肌细胞凋亡参与了CCS大鼠心肌损伤,其机制可能与上调凋亡蛋白酶Caspase 3表达有关,而针刺可拮抗CCS大鼠心肌组织细胞凋亡。     

化学治疗合臭氧穴位注射对中晚期非小细胞肺癌患者生命质量的影响

目的 观察臭氧穴位注射合化学治疗对中晚期非小细胞肺癌患者生存质量的改善作用。方法 将65例原发性非小细胞肺癌患者分为对照组（32例）和观察组（33例）,分别采用常规化学治疗和常规化学治疗联合臭氧穴位注射治疗,以Karnofsky评分变化评估两组患者的生命质量。 结果 观察组Karnofsky评分升高率显著高于对照组（P<0.05）;观察组白细胞分级显著优于对照组（P<0.05）,其白细胞分级显著偏于0级和Ⅰ级。结论 臭氧穴位注射联合常规化学治疗方案可显著改善中晚期非小细胞肺癌患者的生存质量,降低化学治疗药物的不良反应。     

芪黄煎剂对胃切除大鼠肠淋巴细胞MAdCAM-1、ICAM-1及其mRNA表达的影响

目的 观察大鼠胃切除术后小肠内滴注芪黄煎剂对黏膜地址素细胞黏附分子-1（mucosal addressin cell adhension molecule-1,MAdCAM-1）与细胞间黏附分子-1（intercellular adhesion molecule-1,ICAM-1）及其mRNA表达的影响。方法 将60只SD大鼠分为3组,每组20只。假手术组大鼠仅行腹部皮肤切开后缝合手术,模型组大鼠胃切除后给予肠内营养液能全素,芪黄煎剂组大鼠胃切除后先给予芪黄煎剂再滴注营养液能全素。连续给药7 d后,采用免疫组织化学法检测MAdCAM-1、ICAM-1蛋白表达水平,采用RT-PCR荧光定量法检测MAdCAM-1、ICAM-1mRNA相对表达水平。结果 与假手术组比较,模型组大鼠PP结中MAdCAM-1、ICAM-1及其mRNA表达水平均明显下降（P<0.05）;与假手术组比较,芪黄煎剂组大鼠PP结中MAdCAM-1、ICAM-1及其mRNA表达水平明显升高（P<0.05）。结论 芪黄煎剂能增加肠黏膜效应部位MAdCAM-1、ICAM-1及其mRNA表达水平,改善胃切除术后肠黏膜免疫屏障功能。