Sudden and Unexpected Death in Three Cases of Ehlers‐Danlos Syndrome Type IV*

Abstract: Ehlers–Danlos syndrome (EDS) type IV is a connective tissue disorder characterized by the inability to produce sufficient amounts of collagen or a defect in the structure of collagen. The most serious complications include a rupture of a viscus or vascular rupture with or without mural dissection. Death may result from internal hemorrhage. This report describes three cases of sudden and unexpected death caused by EDS type IV. Two cases involved hemothorax as a result of dissection of the subclavian artery and aorta, respectively. The third case represented spontaneous pulmonary rupture and hemorrhage. A detailed family history should be sought, and additional specimens collected to confirm the diagnosis, including skin fibroblasts for collagen testing and blood for DNA testing. The forensic pathologist should consider the possibility of EDS type IV upon discovery of spontaneous visceral or arterial rupture and should alert the family members of this hereditary and potentially fatal condition.     

Cardiovascular Conditions and the Evaluation of the Heart in Pregnancy‐Associated Autopsies

Abstract: Pregnancy‐associated death is defined as the death of a woman from any cause during pregnancy or in the year after delivery. This review concentrates on cardiac conditions that may result in pregnancy‐associated death including, but not limited to, acute myocardial infarction, endocarditis, peripartum cardiomyopathy, and prolonged QT syndrome. Lethal vascular conditions may also occur involving arterial dissection and thromboembolism, on occasion exacerbated by hypercoagulability, and altered hormonal and physiologic states. The autopsy evaluation of these patients includes a careful assessment of the medical history particularly for prior pregnancy‐related conditions, fetal loss, and episodes of unexplained collapse. A family history of sudden death at an early age may be significant. At autopsy, evaluation for underlying syndromes such as Marfan, or evidence of intravenous narcotism should be undertaken. Autopsy examination involves careful dissection of the heart and vessels with consideration of conduction tract studies and possible genetic evaluation for prolonged QT syndrome.     

Two Fatal Cases of Hidden Pneumonia in Young People*

Abstract: Acute respiratory distress syndrome (ARDS) is a severe lung disease characterized by inflammation of the lung parenchyma leading to impaired gas exchange. This condition is often lethal, usually requiring mechanical ventilation and admission to an intensive care unit. We present two fatal cases of hidden pneumonia in young people and discuss the pathophysiological mechanism of ARDS with reference to the histological pattern. A complete forensic approach by means of autopsy and histological, immunohistochemical, and microbiological, examination was carried out. In both cases the cause of death was cardio‐respiratory failure following an acute bilateral pneumonia with diffuse alveolar damage and ARDS associated with sepsis and disseminated intravascular coagulation. Our cases suggest on one side the importance of an early diagnosis to avoid unexpected death while on the other that the diagnosis of ARDS has to be confirmed on the basis of a careful postmortem examination and a complete microscopy and microbiological study.     

浅谈群体性突发事件的现场控制

群体性突发事件的现场控制．是指挥员及其指挥机关为控制群体性突发事件现场形势而进行的指挥活动。公安机关在群体性突发事件的现场处置中,首先要保持信息来源的稳定、畅通。其次要采取内外警戒、现场处置、法制宣传、现场取证的方式方法,进而恢复社会秩序,平息事态。第三要尽快了解两个“核心”。一是“事件核心”,即引发群体性突发事件的根源和导火线;二是“人物核心”．调查事件的发现者以及引发该群体性事件的目的,仔细查明发现事件的核心人物的背景和企图,重点施策．分化瓦解。     

依法应对处置突发群体性事件的思考

近年来,全国一些地方相继发生突发群体性事件,引起社会各界的广泛关注。在当前严峻复杂的社会稳定形势下,亟待抓紧研究建立应对处置突发群体性事件的应急管理机制。针对突发群体性事件的发展状况,指出当前国内突发群体性事件的一些主要特点。从政治学角度,深入探究突发群体性事件的肇因,为从根本上预防和减少群体性矛盾提供有益的启示。从预防与应急准备、实时监测与预警、应急处置与救援、事后恢复与重建等四个方面,提出应对处置突发群体性事件的工作制度,以规范处置行为,提高处置能力,维护社会稳定大局。     

生物化学指标检测在心源性猝死法医鉴定中的应用

早期缺血性心肌病变引起的心源性猝死（sudden cardiac death,SCD）由于发病突然,常缺乏典型的形态学改变和临床表现,易被怀疑为刑事案件,查明其死亡原因对法医学实践有指导作用。本文对国内外有关无机离子、肌酸激酶、肌钙蛋白、心房利钠尿肽、脑利钠尿肽等生物化学指标检测在诊断SCD方面的研究进展加以综述,以期为SCD的法医学诊断提供参考。     

Application of 3D Laser Scanner to Forensic Engineering

In the case of building collapses and overturned structures, a three‐dimensional (3D) collapse or overturn model is required to reconstruct the accident. As construction sites become increasingly complex and large, 3D laser scanning is sometimes the best tool to accurately document and store the site conditions. This case report presents one case of a structure collapse and one case of an overturned crane reconstructed by a 3D laser scanner. In the case of structural collapse of a prefabricated shoring system, a 3D model reconstructed all the members successfully, a task that is nearly impossible using a scale such as a tape measure. The reconstructed prefabricated shoring system was verified through a structural analysis through comparison with the construction drawings to investigate faults in construction. In the case of the overturned crane, the jib angle and other major dimensions were successfully acquired through 3D laser scanning and used to estimate the working radius. As a result, the propriety of the working radius with the given lifting load was successfully determined.     

Ebstein Anomaly and Sudden Childhood Death

A 13‐year‐old girl is reported who died suddenly and unexpectedly in her sleep from previously undiagnosed Ebstein anomaly. At autopsy, there was dilatation of the right atrium with marked dilatation of the right auricle and apical displacement of the tricuspid valve into the right ventricular cavity with atrialization of the upper portion of the right ventricle. There were also prominent dysplastic changes in both the septal and posterior leaflets of the tricuspid valve with thickening of the valve and fusion of leaflets to the wall of the ventricle. Histology of the myocardium showed focal, minor microscopic areas of interstitial fibrosis with marked fibrous dysplasia and thickening of the tricuspid valve. Lethal arrhythmias occur in this condition because of the geographical relationship of the conduction system to the abnormal anatomical structures. As adolescents who died suddenly are often minimally symptomatic, cases will rarely present de novo to forensic autopsy.     

非高血压主动脉夹层破裂猝死8例法医病理学分析

目的探讨非高血压主动脉夹层猝死的死因、临床症状及法医病理形态学特点,以期为非高血压主动脉夹层猝死的法医病理学诊断及规范尸体检验提供参考。方法对2007-2015年本司法鉴定中心受理鉴定的8例非高血压主动脉夹层猝死的案例进行统计、归纳和分析。结果非高血压主动脉夹层破裂多见于40岁以下男性,病理分型主要为De Bakey I型,临床表现多不典型,无1例临床确诊。经基因检测1例确诊为Marfan综合征,1例存在Smad3基因变异。非高血压主动脉夹层均无高血压病史,排除外伤,均未见高血压病相关病理学改变,镜下大动脉检见弹力纤维减少、平滑肌减少、囊性中膜变性、炎细胞浸润等改变,某些案例还见于中动脉。结论非高血压主动脉夹层发病机制复杂,与遗传学和炎症等多因素密切相关,常常波及全身多血管病变的特点。尸检时除了系统检验大血管的同时,还有必要对全身的中动脉进行检验,建议积极进行基因检测,探究发病机制。     

制约与解释--生活场景对法律生命的考量

人与社会存在的固有事实与本来逻辑显示,内含秩序与正义两大终极价值的法律与人的生活场景紧密结合在一起.法律的存在也是一个过程,具有断裂的可能性.人的生活场景是由自然性的物质世界、社会性的物质世界、文化世界、关系世界构成的统一体,决定着法律的生成、运作与进化;法律也不断地解释着人的生活场景,法律的生命在解释的过程中体现出来.在此过程中,法律必须具有深厚的亲和力.