Death Due to an Unusual Angio‐Seal‐Related Complication: Case Report and Literature Review

Angio‐SealTM is a vascular closure device (VCD) that can be applied to the femoral artery following cardiac catheterization to achieve hemostasis. Although it has been demonstrated to be superior to conventional manual pressure and to reduce time to hemostasis and patient ambulation, the use of this VCD is not without its complications. In this report, we describe the case of a 55‐year‐old man who died due to an extremely rare event that occurred several hours after the deployment of an Angio‐SealTM VCD: acute complete transverse laceration of the femoral artery that occurred because of the particular fragility of the vessel due to an unrecognized and asymptomatic arteriosclerotic disease. Few data are available in the literature about the incidence of such events, and much more remains to be done to determine how to prevent and manage its occurrence.     

Severe Retinal Hemorrhages with Retinoschisis in Infants are Not Pathognomonic for Abusive Head Trauma

The combination of subdural hemorrhage (SDH), retinal hemorrhage (RH), and encephalopathy, or the presence of severe retinal hemorrhages alone in infants, is often attributed to and has been stated to be pathognomonic for abusive head trauma (AHT) or shaken baby syndrome. These beliefs have been challenged, because the same constellation of findings has been identified in accidental head injuries and natural diseases, and most if not all of the studies that support the concept of diagnostic specificity have serious flaws in their methodology. Presented here are two cases of severe retinal hemorrhages with retinoschisis associated with subdural hemorrhage in a natural disease and with severe cerebral edema in an accidental head injury. These cases challenge the dogma that severe retinal hemorrhages with retinoschisis are pathognomonic for AHT.     

表没食子儿茶素没食子酸酯诱导人肝癌细胞HCCLM6凋亡的研究

目的 观察表没食子儿茶素没食子酸酯(epigallocatechin gallate, EGCG)对人高转移肝癌细胞HCCLM6凋亡的作用及探讨其作用机制。方法 甲基噻唑基四唑染色法检测EGCG对人肝癌细胞HCCLM6细胞增殖的抑制作用,流式细胞术检测细胞凋亡率和EGCG对HCCLM6细胞周期的影响,免疫荧光技术检测EGCG处理的HCCLM6细胞中血管内皮生长因子(vascular endothelial growth factor, VEGF)和骨桥蛋白(osteopontin, OPN)表达的变化。结果 EGCG可显著抑制肝癌细胞HCCLM6的增殖,且呈浓度依赖性;EGCG使细胞周期明显阻滞于G0/G1期;EGCG可明显导致HCCLM6细胞凋亡,使VEGF、OPN表达水平显著下降。结论 EGCG可以诱导肝癌HCCLM6细胞凋亡,其作用机制可能与阻滞细胞周期和调控VEGF、OPN表达有关。     

补肾安胎冲剂对复发性流产患者血清血管内皮生长因子及其可溶性受体-1的影响

目的 探讨补肾安胎冲剂治疗复发性流产（recurrent spontaneous abortion,RSA）的机制。方法 采用酶联免疫吸附法检测30例RSA患者治疗前后及30例正常早孕妇女血清血管内皮生长因子(vascular endothelial growth factor,VEGF)及其受体——可溶性fms样酪氨酸激酶-1(soluble fms like tyrosine kinase 1,sFlt-1)的水平。结果 治疗组妊娠成功率为80.0％;与对照组比较,治疗组治疗前血清VEGF显著降低（P<0.01）,sFlt-1显著增高（P<0.01）;治疗组治疗后与治疗前比较,VEGF显著升高(P<0.01),sFlt-1显著降低(P<0.01);保胎治疗无效者与保胎治疗成功者比较,血清VEGF水平显著降低（P<0.01）,血清sFlt-1水平显著增高（P<0.05）。结论 补肾安胎冲剂治疗RSA的机制可能与提高血清VEGF水平,降低血清sFlt-1水平,从而促进胎盘绒毛血管的形成有关。     

Distinguishing Atherosclerotic Calcifications in Dry Bone: Implications for Forensic Identification

Atherosclerotic calcifications, as calcified atheromatous elements, are markers of cardiovascular disease. However, the literature gives little information regarding their morphological aspect, making their identification very rare in skeletonized cases. In this paper, we document the morphological, histological, and SEM aspects of atherosclerotic plaques collected from unclaimed cemeterial skeletal remains from an identified osteological collection and extracted from well‐preserved cadavers autopsied at the medico‐legal institute of Milan. Each of the three analyses provided similar results: atherosclerotic calcifications are convex‐concave plaques with a stratified structure, a pale‐yellow coloration in autopsy cases and yellow to brown when recovered in dry bone. Histologically, undecalcified and decalcified sections showed a stratified aspect formed by superimposed layers. Lastly, the SEM analysis showed a precise view of the stratified structure of the plaques in transverse section. As markers of disease, atherosclerotic calcifications can provide important antemortem information on the deceased that may be compared to antemortem data.     

挤压伤大鼠血清对血管内皮细胞凋亡的作用及机制探讨

目的观察挤压伤大鼠血清对血管内皮细胞凋亡的影响及可能机制。方法培养小牛主动脉内皮细胞,观察挤压伤大鼠血清对培养的血管内皮细胞凋亡及胞内钙浓度的影响,并检测血浆内皮素-1(endothelin-1,ET-1)及心钠素(atrial natriuretic peptide,ANP)的含量。结果与正常大鼠血清相比,挤压伤大鼠血清致细胞的凋亡百分数由(8.26±1.75)%降为(2.75±0.90)%,胞内钙浓度由(96.98±3.95)nmol/L增加到(118.79±3.22)nmol/L,挤压伤大鼠血浆内皮素-1和心钠素含量显著增高。结论肢体挤压伤大鼠血清可抑制血管内皮细胞的凋亡,此效应可能与内皮素-1和心钠素诱发胞内钙浓度增加有关。     

Lethal Epistaxis

Epistaxis or nosebleed refers to bleeding from the nostrils, nasal cavity, or nasopharynx. Occasional cases may present with torrential lethal hemorrhage. Three cases are reported to demonstrate particular features: Case 1: A 51‐year‐old woman with lethal epistaxis with no obvious bleeding source; Case 2: A 77‐year‐old man with treated nasopharyngeal carcinoma who died from epistaxis arising from a markedly neovascularized tumor bed; Case 3: A 2‐year‐old boy with hemophilia B who died from epistaxis with airway obstruction in addition to gastrointestinal bleeding. Epistaxis may be associated with trauma, tumors, vascular malformations, bleeding diatheses, infections, pregnancy, endometriosis, and a variety of different drugs. Careful dissection of the nasal cavity is required to locate the site of hemorrhage and to identify any predisposing conditions. This may be guided by postmortem computerized tomographic angiography (PCTA). Despite careful dissection, however, a source of bleeding may never be identified.     

头部外伤后伴发病理性蛛网膜下腔出血致猝死11例鉴定分析

头部外伤后伴发病理性蛛网膜下腔出血致猝死１１例鉴定分析肖柏坤，曾建华，孙跃刚（ｌ．江西医学院法医教研室；江西３３０００６２．江西医学院第一附属医院脑外科；江西３３０００６３．南昌市公安局刑事科学技术研究所；江西３３０００６）Ａｎａｌｙｓｉｓｏｆ１１Ｃ...     

HIF-1α、VEGF-A在心律失常大鼠心肌组织中的变化

目的观察大鼠心律失常后缺氧诱导因子-1α(hypoxia inducible factor-1α,HIF-1α)和心肌血管内皮生长因子-A(vascular endothelial growth factor-A,VEGF-A)的表达变化,探讨心律失常与冠状动脉供血不足引起的急性心肌缺血中两指标表达规律的不同。方法利用CaCl_2诱导大鼠心律失常,应用免疫组织化学染色、Western印迹法和实时荧光定量PCR检测大鼠心律失常后6 h内HIF-1α和VEGF-A的表达及变化情况。结果心律失常致死的大鼠心肌组织中HIF-1α及VEGF-A呈弥漫性表达,在心律失常发生的早期两者表达均呈增加随后下降;心律失常发生时即产生广泛的心肌缺血且范围不随时间增大。结论HIF-1α和VEGF-A在心律失常大鼠心肌组织中均有表达,可为致死性心律失常和冠状动脉供血不足引起的急性心肌缺血的鉴别诊断提供依据。     

Mechanism of Death in Hanging: A Historical Review of the Evolution of Pathophysiological Hypotheses

Abstract: In cases of hanging, the exact mechanism leading to death has yet to be elucidated. Most of our contemporary knowledge is still based on writings from the end of the 19th and the beginning of the 20th century. This article reviews the historic experiments that shaped our current theories. Medico‐legal textbooks written in English and French from 1870 to 1930 were reviewed. Various animals, such as rabbits, mice, and dogs, have been used to develop animal models of hanging. Limited human studies on cadavers and judicial hangings have provided some additional insight into the pathophysiology of death by hanging. The main pathophysiological theories described were respiratory asphyxia, interruption to cerebral blood flow because of occlusion of vessels in the neck, and cardiac inhibition secondary to nerve stimulation. The relative contributions of each of these theories to death in cases of hanging is still debated today.