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.     

The Role of Postmortem Computed Tomography in the Evaluation of Strangulation Deaths

We explored the value of postmortem computed tomography (PMCT) to augment autopsy in evaluating strangulation fatalities. A literature search identified 16 studies describing autopsy findings in 576 deaths and two studies describing autopsy and PMCT findings in six deaths. Similar cases were identified from our institution, yielding 130 deaths with autopsy findings and 14 deaths with both autopsy and PMCT findings. The presence of laryngohyoid fracture and soft tissue hemorrhage was compared from autopsy and autopsy+PMCT cases. The detection rates of fractures in autopsy and autopsy+PMCT cases were not significantly different. PMCT identified all fractures observed at autopsy and five fractures not identified. While PMCT may not detect soft tissue injuries in decomposed remains or subtle internal hemorrhages in neck injury, it is equally able to detect bony injuries as autopsy and might surpass autopsy in detecting subtle fractures. We conclude PMCT is useful to supplement autopsy in strangulation cases.     

牦牛舌抗菌肽基因cDNA的克隆及其在生殖系统中的表达

为了解牦牛舌抗菌肽(LAP)基因序列的特征及其在生殖系统中的表达情况,采用RT-PCR法从牦牛睾丸、附睾组织中扩增LAP基因,重组到pMD19-TSimple载体中,进行了测序和序列分析,并应用RT-PCR检测了雌性牦牛生殖系统(卵巢、输卵管、子宫、阴道等组织)中LAPmRNA的表达。结果显示,克隆的LAP基因包含一195bp的完整开放阅读框(ORF),与牛LAP基因相似性达97.9%,该ORF编码的64个氨基酸含有β-防御素特征性结构,即6个在特定位置上的保守半胱氨酸残基;LAP在牦牛生殖系统上皮组织中均有表达。推测LAP在牦牛生殖系统的先天免疫中具有重要作用。     

山羊组织中硝唑尼特代谢产物的液相色谱-串联质谱检测

以替唑尼特为检测对象,建立了一种检测山羊组织中替唑尼特残留的液相色谱-串联质谱分析方法。样品经正己烷脱脂、乙腈提取,收集提取液于60℃水浴氮气吹干,乙腈溶解,经0.22μm微孔滤膜过滤后,采用多反应监测模式进行分析。结果显示,对于肝样品,替唑尼特在0.25～25μg/kg范围内线性关系良好(r20.99),检测限和定量限分别为0.1μg/kg和0.25μg/kg;对于肾、肌肉、脂肪样品,替唑尼特在0.1～25μg/kg范围内线性关系良好(r20.99),检测限和定量限依次为0.05μg/kg,0.1μg/kg;0.025μg/kg,0.05μg/kg;0.025μg/kg,0.05μg/kg。结果表明,该方法操作简单,灵敏度高,适用于山羊组织中替唑尼特残留量的检测。     

基于PTEN研究桃红四物汤治疗产后血瘀证的机制

目的 观察桃红四物汤对产后血瘀证大鼠子宫第10染色体缺失的碱性磷酸和张力蛋白同源物（phosphatase and tensin homolog deleted in chromosome 10,PTEN）mRNA及其蛋白表达的影响,探讨其祛瘀生新的作用机制。方法 采用米非司酮和米索前列醇灌胃法复制产后血瘀证大鼠模型,将模型大鼠分为模型组,阳性对照组（益母草颗粒4.3 g/kg）,桃红四物汤高剂量（18.0 g/kg）、中剂量（9.0 g/kg）、低剂量（4.5 g/kg）组,另设正常对照组。连续灌胃给药7 d后,麻醉大鼠并分离子宫,光镜下观察子宫血瘀状态,分别采用实时PCR和Western blot法检测子宫组织PTEN mRNA及其蛋白表达水平。结果 桃红四物汤能改善产后血瘀证大鼠子宫间质的充血、水肿。与正常对照组比较,模型组PTEN mRNA及其蛋白表达水平显著升高（P<0.05）;与模型组比较,桃红四物汤高剂量组PTEN mRNA及其蛋白表达水平均显著降低（P<0.05）,桃红四物汤中剂量组仅PTEN蛋白表达水平显著降低（P<0.05）。结论 桃红四物汤的祛瘀生新作用可能与其下调PTEN的表达有关。     

滋阴潜阳方对自发性高血压大鼠心肌纤维化相关蛋白表达的影响

目的 观察滋阴潜阳方对自发性高血压大鼠心肌纤维化的作用及其机制。方法 将40只雄性自发性高血压大鼠随机分为模型组,依那普利组,滋阴潜阳方高、低剂量组,每组10只,另取10只Wistar雄性大鼠作为正常组。各给药组分别每日2次、连续灌胃6周给予相应药物;记录各组大鼠血压值,Masson染色观察大鼠心肌组织病理变化,Western blot法检测大鼠心肌组织结缔组织生长因子（connective tissue growth factor,CTGF）、Ⅰ型胶原蛋白（collagenⅠ,Col-Ⅰ）、α-平滑肌肌动蛋白（α-smooth muscle actin,α-SMA）表达水平,RT-PCR法检测大鼠心肌组织CTGF、Col-Ⅰ、α-SMA mRNA表达水平。结果 与模型组比较,滋阴潜阳方高、低剂量组及依那普利组大鼠收缩压均显著降低（P＜0.05）;滋阴潜阳方高剂量组与依那普利组大鼠心肌组织蓝色心肌胶原纤维明显减少;滋阴潜阳方高剂量组和依那普利组大鼠心肌组织Col-Ⅰ、CTGF、α-SMA蛋白及mRNA表达水平均明显降低（P＜0.05）。结论 滋阴潜阳方能够降低自发性高血压大鼠的血压并抑制其心肌纤维化,其作用机制可能与其抑制心肌成纤维细胞的增殖、转分化有关。     

GC/MS研究海洛因代谢物在吸毒者体内的分布

应用GC／MS－SIM测定了海洛因代谢物吗啡在两例海洛因延缓死亡者的体内分布,并分析了收集到的7例案子的毛发（头发、腋毛和阴毛）中6-单乙酰吗啡和吗啡含量。生物检材和毛发经酸水解、提取、醋酸酐或双（三甲基硅基）三氟乙酰胺（BSTFA）衍生化,然后进行GC／MS-SIM分析。结果表明尿、胆汁和肝脏是判定死者是否曾使用海洛因的最佳检材;毛发分析与生物检材相比有其独特的优点,可提供数月甚至数年的用药情况。为公安司法机关打击吸毒、惩治犯罪提供更可靠、有效的证据。     

Concentration of carbon monoxide (CO) in postmortem human tissues: effect of environmental CO exposure

We studied how carbon monoxide (CO) is distributed within the human body through quantitation of CO concentrations in postmortem tissue samples from fatalities including possible CO exposure. Stored, frozen tissues were diced, sonicated in water, and 0.01-8.0 mg wet weight (ww) tissues were incubated with sulfosalicylic acid in CO-purged, septum-sealed vials. CO released into the headspace was quantitated by reduction gas chromatography. Mean tissue CO concentrations (pmol/mg ww) from subjects diagnosed to have no known CO exposure (control, N=14), died from fire (N=13), and CO asphyxiation (N=7), respectively, were: adipose (2;13;9), brain (3;13;65), muscle (15;97;297), heart (30;99;371), kidney (22;432;709, lung (54;690;2638), spleen (73;1366;3548), and blood (162;2238;5070). Carboxyhemoglobin concentrations were 1.4%, 25.2%, and 69.1% of total hemoglobin, respectively. We conclude that measurements of CO concentration in a variety of tissues can be used as markers for the degree of exogenous CO exposure and the identification of possible causes of death.     

死后离体人肝组织的激光共聚焦显微拉曼光谱分析

目的观察和探讨人死后肝组织细胞激光共聚焦显微拉曼光谱的变化规律及其与死亡时间的关系。方法离体肝组织于死后48～72h内每隔4h提取样品,采用激光共聚焦显微拉曼光谱技术进行检测。观察800cm-1～3 200cm-1范围内检测样本特征峰的变化,指认其对应的化学基团,选择强度比值I1094/I2923作为响应值,并进行统计学计算。结果在48～72h内,随时间的延长,肝组织细胞主要散射峰峰位无明显变化,而其峰强度有明显差异;与核酸有关的峰（1 094cm-1）强度随时间推移有明显下降;与脂类有关的峰（1 454cm-1、2 923cm-1）强度变化不明显;各相对峰强（I1094/I2923）随死亡时间的推移而减小,并得到回归方程（r=0.914）。结论人死后肝组织细胞DNA降解随死亡时间延长呈下降趋势,I1094/I2923值与PMI呈负线性关系。激光共聚焦显微拉曼光谱技术有望成为推断死亡时间的检测方法。     

医疗物品致人损害责任的举证制度研究

医疗物品致人损害责任是医疗损害责任的一种特殊形式,同时又具有产品责任的某些特点。对外,药品、消毒药剂和医疗器械致损的归责原则是无过错原则;而血液致损的归责原则是过错原则。对内,医疗机构承担的是无过错责任,因此在无过错时有权向最终的责任主体追偿。医疗物品责任实行的是谁主张,谁举证的归责原则,因此受损害方承担了证明医疗损害责任三个构成要件的证明责任;而医疗产品生产商和医疗机构都可以通过举证《产品质量法》规定的法定情况的存在而免责,但医疗机构不得对未投入流通这一情况而免责,血液提供机构承担了证明自己不存在过错的举证责任。为了更好的平衡举证责任和举证能力,我国应该对与证据价值密切相关的两个制度证据保全和医疗鉴定予以完善。