微波消解-扫描电镜联用法在溺死诊断中的应用

目的探讨微波消解-扫描电镜联用法在溺死诊断中的应用价值。方法收集已知死因的尸体标本105例,其中水中尸体85例(生前溺死70例,死后抛尸入水15例),陆地自然死亡尸体20例。水中死亡案例同时收集落水处水样。分别用微波消解-扫描电镜联用法(方法 A)和硝酸破机-光镜联用法(方法 B)对上述尸体的离体肺、肝、肾、骨髓组织及水样进行硅藻定性、定量检测。结果①溺死尸体的肺、肝、肾、骨髓中及落水处水样硅藻检出率:A法分别为100%、94.3%、92.9%、82.9%、100%,硅藻检验阳性率为100%;B法分别为90%、62.9%、51.4%、28.6%、92.9%,硅藻检验阳性率为65.7%。②两种方法检出的硅藻种类与落水处水样中硅藻的种类均一致。③两种方法在死后入水尸体离体的肺中也检出少量硅藻(<3个/2g肺组织),但在死后入水尸体的其它脏器及陆地自然死亡尸体脏器中均未检出硅藻。结论微波消解-扫描电镜联用法较硝酸破机-光镜联用法对尸体离体组织脏器中的硅藻检出率高,方法灵敏,定性准确。     

Undiagnosed, untreated acute promyelocytic leukemia presenting as a suspicious sudden death

Acute promyelocytic leukemia (APL) is a subtype of acute myelogenous leukemia frequently associated with clotting abnormalities and severe hemorrhagic diathesis. The disease is associated with a high incidence of early fatal hemorrhage. We report the sudden death of a 40-year-old male without significant medical history in which foul play had been initially suspected. A thorough postmortem investigation performed on the decedent lead to the diagnosis of APL. Cause of death was a cerebellar hematoma. Underlying APL should be considered in the differential diagnosis when unexplained bleeding is encountered in a decedent. This case emphasizes the value of routinely collecting bone marrow during an autopsy to enable accurate testing and diagnosis.     

Complex Congenital Heart Malformation Including Transposition of the Great Vessels,Presenting as Sudden Unexplained Infant Death

Transposition of the great vessels (TGV) is a common congenital heart defect that is difficult to diagnose before birth. Antenatal diagnosis is associated with increased survival. Unusual features such as anomalous pulmonary artery origin may delay cyanosis, decreasing clinical suspicion. A three‐week old female infant who had never been cyanotic presented for forensic autopsy due to onset of unresponsiveness at home. History included risk factors for TGV and signs of heart enlargement that were not recognized during life. Cardiac pathology consultation identified D‐type TGV with additional rare anomalies. TGV may present as sudden unexplained infant death (SUID) for forensic autopsy if variant features prevent development of cyanosis. Cardiac pathology consultation is helpful in clarifying these features.     

Stability of life-time psychiatric diagnoses among offenders in community and prison settings

The dearth of studies investigating diagnostic stability among offenders, and diagnostic stability being important from the patient’s mental health perspective, as well as from a public health, training and research standpoint, highlights the need to evaluate lifetime stability of ICD-10 psychiatric diagnoses for offenders in community and prison settings. A case-linkage design linked a two-year population-based cohort of male-sentenced prisoners with a state-wide psychiatric register (23,742 psychiatric consultations). Four measures of diagnostic stability were calculated for each setting as well as across settings, for all offenders who received at least two psychiatric diagnoses. Temporal consistency was moderate for schizophrenia spectrum disorders and low for affective, anxiety and personality disorders, and was higher in prison setting than community settings. Diagnostic instability highlights that the course of mental illness and clinical features among offenders may genuinely vary over time, across community and prison settings and may lead to complexities regarding psychiatric care for this population     

The factors associated with criminal recidivism in Finnish male offenders: importance of neurocognitive deficits and substance dependence

Neurocognitive deficits and psychiatric disorders are often brought up as risk factors of recidivism. In this study, we investigated how neurocognitive and academic deficits and psychiatric disorders (including substance dependence) are associated with criminal recidivism and prison career among male offenders. In a health survey of Finnish prisoners, 72 sentenced male prisoners were examined in Turku prison using a neurocognitive test battery and psychiatric assessment including a standardized psychiatric interview (SCID-I, II). The neurocognitive and academic tests were chosen to assess domains of cognitive functioning and reading, spelling and mathematical skills. Our results showed that the combination of neurocognitive deficits and substance dependence was connected to recidivism. Axis I diagnosis (major mental disorders) and substance dependence were connected with neurocognitive and academic deficits. Moreover, first-time offenders had fewer neurocognitive deficits and Axis I disorders, less substance dependence and fewer personality disorders than those with several convictions. Rehabilitation of cognitive functions and academic skills, along with intervention for mental health problems and substance dependence could help to prevent the unfavourable circle of criminal career.     

Postmortem Measurement of Human Chorionic Gonadotropin in Vitreous Humor and Bile

Abstract: Postmortem human chorionic gonadotrophin (HCG) blood assay can confirm postmortem diagnosis of pregnancy or document situations in which HCG levels are elevated. In some cases, however, blood sampling is not possible at autopsy. In this study, HCG was quantified by enzyme‐linked fluorescent assay (ELFA) in the bile (n = 5), vitreous humor (n = 4), and postmortem blood (n = 4) of five pregnant women. There were no false negatives in the pregnant subjects (n = 5) or false positives in controls (n = 34), enabling this test to be recommended for routine use in forensic contexts in which the detection of elevated HCG levels could be of interest.     

RyR2相关心脏性猝死的研究进展

雷诺定受体2(ryanodine receptor 2,RyR2)是心肌细胞肌浆网上主要的钙释放通道,主要参与心肌的兴奋收缩耦联过程,其基因突变及调控异常可导致心肌舒张期钙漏引起心律失常,甚至猝死。本文重点综述RyR2基因突变及调控异常引起心脏性猝死的机制,并对以后的研究提出建议,旨在为心脏性猝死的法医学诊断提供一种新的思路。     

我国工伤保险程序存在的问题及完善

工伤保险自诞生以来就具有强大的影响力,原因之一在于其程序简便易行。然而在我国,劳动者申请工伤保险待遇却要历经多重程序,耗时之长、过程之艰难已经成为工伤保险制度优越性发挥的障碍,为此,应以法律人本主义理念改革我国的工伤保险程序。     

105例儿童抽动障碍临床资料分析及中药疗效观察

目的 了解儿童抽动障碍的临床特点及中医证型分布,观察中药治疗儿童抽动障碍的临床疗效。方法 以确诊为抽动障碍的105例儿童作为研究对象,进行临床分析。在停用所有西药2周后,予自拟抽动1号方加减治疗3个月,观察疾病疗效和中医证候疗效。结果 105例儿童抽动障碍的临床表现多样化,误诊率高达57.1%,中医证型分布以肝亢风动型最多,自拟抽动1号方治疗儿童抽动障碍的总有效率达93.3%,随访1年后复发率为21.9%。结论 具有平肝熄风、镇静止痉功效的自拟抽动1号方对儿童抽动障碍有较好疗效,且无明显不良反应。     

口蹄疫病毒非结构蛋白3ABC基因的原核表达及其产物的活性检测

利用分别带有BamHⅠ和HindⅢ酶切位点的引物扩增出FMDV 3ABC基因,将其克隆到pMD18-T载体。经BamHⅠ和SalⅠ酶消化后,克隆到表达载体pGEX-6p-1上,构建重组质粒pGEX-3ABC。将该重组质粒转化到大肠埃希氏菌BL21(DE3)pLysS,经终浓度1 mmol/L的IPTG诱导,获得约70 ku的融合蛋白GST-3ABC。Western-blotting结果显示,表达的融合蛋白GST-3ABC可以与感染FMDV的牛血清发生免疫反应。以纯化的GST-3ABC蛋白为抗原的间接ELISA检测结果与以VP2蛋白为抗原的间接ELISA检测结果相比较,表明,融合蛋白GST-3ABC可以用于鉴别感染FMDV和疫苗免疫的牛血清。