脂肪栓塞中苏丹Ⅲ染色的定量分析

目的探讨苏丹Ⅲ染色如何定量应用于脂肪栓塞的法医学鉴定。方法应用苏丹Ⅲ对11例肺脂肪栓塞猝死的案例和11例其他原因致死的案例进行染色,并结合统计学方法对脂肪栓塞的阳性面积百分率及脂肪栓子数进行定量分析。结果脂肪栓塞致死者肺内苏丹Ⅲ染色阳性面积百分率为（5±1．7）％、脂肪栓子数为（9±2．4）％,均远大于其他原因致死的案例（P〈0．01）。结论苏丹Ⅲ染色法定量分析在脂肪栓塞中的法医学鉴定上结果可靠。     

Occult Adrenocortical Carcinoma and Unexpected Early Childhood Death

A four‐year‐old previously well boy collapsed unexpectedly and was taken immediately to hospital, where he developed seizures and cardiogenic shock with lethal, rapidly progressing multi‐organ failure. At autopsy, the height was >90th percentile and there were indications of early virilization. Internally, a friable tumor of the left adrenal gland was identified that had invaded the left renal vein and inferior vena cava. Histology revealed typical features of an adrenocortical carcinoma with aggregated trabeculae of cells containing abundant eosinophilic cytoplasm and large pleomorphic nuclei. There was strong positive cytoplasmic staining for inhibin; mitochondria were shown on electron microscopy to contain prominent electron‐dense granules. Death was due to massive pulmonary tumor embolism. Although adrenocortical carcinomas are very rare and are more commonly found in adults, the current case demonstrates that they may also occur in childhood and be responsible for unexpected death by the very unusual mechanism of tumor embolism.     

静脉气体栓塞的研究进展

气体栓塞是一种较多见而又威胁生命的医疗操作并发症,在法医学实践中也时有所遇,但易被检验者所忽略;也常因尸体放置较久而给法医学检验和鉴定带来困难。在此综述了静脉气体栓塞的病因、病理生理变化、临床表现及诊断和法医学鉴定的意义及注意事项,认为超声心动图、CT和MRI等现代成像技术在气体栓塞的临床诊断和法医学鉴定中有积极的辅助作用。     

Suture Embolism of the Left Superior Lobar Pulmonary Artery

Endogenous pulmonary thromboemboli are a common cause of noncardiac sudden natural death. Embolism of exogenous material is a rare but potential finding in autopsies following surgeries, medical procedures, penetrating trauma, and nonparenteral drug abuse. This report describes the first case of a suture embolism of the left superior lobar pulmonary artery following complicated abdominal surgery.     

基质金属蛋白酶2在冠心病猝死心肌中的表达

目的探讨基质金属蛋白酶2（mmp2）在冠心病猝死（SCD）心肌细胞和间质中的表达与SCD的关系。方法选取本教研室2003年51例死亡鉴定病例,分为SCD组,患有冠心病但非SCD组（对照组1）,无严重冠脉粥样硬化（As）病变和其它心血管疾病组（对照组2）,无严重As病变但有其它心脏病组（对照组3）。采用免疫组化SABC法染色及图像分析技术,检测mmp2在各组心肌细胞和间质内表达的阳性率（R值）和平均灰度值（H值）,并比较各组间的差异。结果SCD组与3个对照组之间心肌细胞内romp2H值的差异均有显著性意义;SCD组与对照组2和3之间心肌间质内mmp2H值的差异有显著性意义;镜下各组心肌间质及心肌细胞内表达的阳性率差别明显。结论心肌间质及心肌细胞内mmp2同相表达增高与SCD的发生有密切关系,联合检测心肌和间质mmp2的表达对诊断SCD有重要意义。     

2型糖尿病脂代谢紊乱患者中医证型与血清同型半胱氨酸和胱抑素C关系

目的 探究2型糖尿病脂代谢紊乱的中医证型特点及其与冠心病预测因子血清同型半胱氨酸（homocysteine,Hcy）、胱抑素C（cystatinC,CysC）的关系。方法 共纳入300例2型糖尿病脂代谢紊乱患者,调查其中医证型,检测并比较各证型患者血清Hcy、CysC、空腹胰岛素（fastinginsulin,FINS）、空腹血糖（fastingplasmaglucose,FPG）和糖化血红蛋白A1c（glycosylatedhemoglobinA1c,HbA1c）及胰岛素抵抗指数（homeostasismodelassessmentofinsulinresistance,HOMA-IR）水平。结果 300例患者中,痰湿阻遏型、气阴两虚型、肝肾阴虚型、血瘀脉络型和脾肾阳虚型和其他证型的病例数分别105、84、34、39、12、16。各证型患者HbA1c和FPG比较,差异无统计学意义（P>0.05）;以血瘀脉络型患者Hcy、CysC和HOMA-IR水平为最高（P＜0.05,或P＜0.01）。结论 2型糖尿病脂代谢紊乱患者以痰湿阻遏型和气阴两虚证型最为常见,血瘀脉络型患者冠心病预测因子异常与胰岛素抵抗有关。     

通督调神针灸法对局灶性脑缺血再灌注模型大鼠皮质区CD34、CD133及血清VEGFR-2表达的影响

目的 探究通督调神针灸法对局灶性脑缺血再灌注模型（middle cerebral artery occlusion model/reperfusion model,MCAO/R）大鼠脑保护及血管新生的作用。方法 将150只SD大鼠随机分为假手术组、通督调神针灸组、常规针刺组、通心络药物组和模型对照组,每组30只。通督调神针灸组取百会穴艾灸,大椎穴刺络放血;常规针刺组选取风池、曲池、合谷、足三里、三阴交针刺治疗;通心络药物组予以通心络胶囊,每日每次1.0 g/kg灌胃。假手术组、模型对照组不予治疗;其余各组每日治疗1次,共28 d。治疗第7、14、21、28天处死大鼠立即取脑,脑组织石蜡包埋后切片,免疫组织化学法检测缺血皮质区CD34、CD133阳性表达,采用ELISA法检测VEGFR-2的表达。结果 MCAO/R大鼠缺血皮质区CD34、CD133及血清VEGFR-2表达量在第7天较高,随后逐渐降低;通督调神针灸法、常规针刺及通心络药物均可不同程度促进MCAO/R模型大鼠缺血皮质区CD34、CD133及血清VEGFR-2表达（P<0.05）,且通督调神针灸法促进MCAO/R模型大鼠缺血皮质区CD34、CD133及血清VEGFR-2表达水平高于常规针刺及通心络药物（P<0.05）。结论 通督调神针灸法能有效促进MCAO/R大鼠缺血皮质区CD34、CD133及血清VEGFR-2表达。     

心可舒片对非ST段抬高型急性冠状动脉综合征PCI患者非靶病变粥样硬化斑块的影响

目的 观察心可舒片联合西药对非ST段抬高型急性冠状动脉综合征经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）患者非靶病变粥样硬化斑块的影响。方法 将60例非ST段抬高型急性冠脉综合征PCI患者,采用随机数字表法随机分为对照组和治疗组,每组30例;对照组予以常规西药,治疗组在此基础上联合心可舒片;观察两组患者治疗前后血脂水平、炎症因子水平以及非靶病变血管粥样硬化斑块的血管内超声（intravascular ultrasound,IVUS）影像学指标。结果 治疗后两组患者总胆固醇、三酰甘油、低密度脂蛋白胆固醇、超敏C反应蛋白、白细胞介素-6水平、斑块负荷均显著降低（P＜0.05）,高密度脂蛋白胆固醇水平、最小管腔面积均显著上升（P＜0.05）,且治疗组上述指标改善程度较对照组更优（P＜0.05）。结论 心可舒片能显著改善患者血脂、炎症因子水平以及非靶病变血管粥样硬化斑块IVUS影像学指标。     

参元益气活血汤治疗冠心病心力衰竭患者临床疗效及对凝血酶、TGF-β1、Col-Ⅰ、Col-Ⅲ水平的影响

目的观察参元益气活血汤治疗冠心病心力衰竭的临床疗效及对凝血酶、血浆转化生子因子β1(transforming growth factor-β1,TGF-β1)、N末端脑钠肽前体(N-terminal brain natriuretic propeptide,NTproBNP)和血清Ⅰ型胶原(collagenⅠ,Col-Ⅰ)、Ⅲ型胶原(collagenⅢ,Col-Ⅲ)水平的影响。方法将84例冠心病心力衰竭患者随机分为治疗组和对照组,每组42例。对照组给予常规西药治疗,治疗组在常规西药治疗基础上予参元益气活血汤煎剂,两组疗程均为4周。观察两组治疗前后中医症状及证候积分变化,评价临床疗效,测定血浆凝血酶、TGF-β1、NT-proBNP,血清Col-Ⅰ、Col-Ⅲ水平,采用超声心动图检测左心室舒张末内径(left ventricular end-diastolic diameter,LVEDD)、左心室收缩末内径(left ventricular end-systolic diameter,LVESD)和左心室射血分数(left ventricular ejection fraction,LVEF)。结果与对照组比较,治疗组治疗后中医症状及证候积分均明显改善(P<0.05),治疗组临床疗效优于对照组(P<0.05);治疗组治疗后血浆凝血酶、TGF-β1,血清Col-Ⅰ和Col-Ⅲ水平均较对照组明显降低(P<0.05),LVEDD、LVESD、NT-proBNP均明显降低(P<0.05),LVEF明显升高(P<0.05)。结论参元益气活血方能够改善冠心病心力衰竭患者中医症状及证候,提高心功能,降低凝血酶及心肌纤维化水平。     

Fatal pulmonary embolism:: A comparative study of autopsy incidence in Hong Kong and Cardiff, Wales

All autopsy reports from 1990–1994 inclusive of the Department of Pathology, University of Hong Kong and the Wales Institute of Forensic Medicine were examined and cases of death due to massive pulmonary embolism were noted. The incidence of this condition was calculated and found to be insignificantly lower in the Hong Kong series than the Welsh series by statistical analysis, both in the crude incidence in all autopsies and when correcting for different case mixes in the two locations. The majority of cases in both locations were in the over-60 age group. The study helps refute the longstanding belief among Hong Kong physicians that fatal massive pulmonary embolism is rare in Hong Kong (with approximately 98% Chinese population) in comparison with a predominantly Caucasian population.