昆明市103例高坠死亡案件的坠落高度以及案件性质分析

目的对103例高坠死亡案例进行回顾性分析,研究尸体损伤与坠落高度、坠落高度与水平移行距离、水平移行距离与案件性质之间的关系。方法收集2001~2015年间昆明市公安局所受理的高坠案例共103例,所得数据均经spss17.0进行统计检验。结果颅骨骨折在坠落高度为11米以上时的概率较大,四肢骨折在各高度出现的概率均比较大,肋骨骨折在坠落高度为21米以上时的概率较大,尸体的坠落高度与水平移行距离存在正相关关系。坠落高度在11米以上时自杀多见,水平移行距离在1.1m以上时自杀多见。结论尸体损伤、水平移行距离可作为辅助手段估算坠落高度,水平移行距离可作为判断案件性质的参考数据。     

CBS在脑挫伤后损伤时间推断中的作用

目的观察胱硫醚β合成酶(cystathionineβ-synthase,CBS)在脑挫伤后皮质中不同时段的表达变化。方法利用改良的自由落体装置建立小鼠脑挫伤模型,通过Western印记法和免疫组织化学方法检测不同时间点(1 h、6 h、12 h、1 d、2 d、3 d、7 d)损伤区周围皮质CBS的表达变化。结果 Western印迹法显示,CBS在脑损伤后皮质中的表达下调,在损伤3 d时降到最低,于损伤7 d恢复到正常水平。免疫组织化学结果显示,CBS在正常皮质中有表达,损伤后表达逐渐减弱,损伤3 d后阳性表达明显减少,7 d恢复到正常水平。结论 CBS有望成为法医学推断脑挫伤后损伤经过时间的参考指标。     

窖蛋白与不明原因心源性猝死的相关性研究进展

不明原因心源性猝死(unexpected sudden cardiac death,USCD)因其不伴有心脏结构的异常,尸体解剖呈阴性改变,一直是法医病理学鉴定的热点难题。USCD可能与部分致死性心律失常有关,该类心律失常多由心脏离子通道蛋白或其相关蛋白发生异常所致。窖蛋白可以通过其脚手架区域与多种心肌离子通道蛋白结合,在维持心肌动作电位的去极化和复极化中起到关键作用。当窖蛋白由于基因突变或蛋白表达异常等因素导致其结构和功能受到影响时,受其调控的心肌离子通道的功能也受到损害,继而引起多种离子通道病的发生,出现心律失常甚至心源性猝死。研究窖蛋白对离子通道功能的影响对于探索恶性心律失常及心源性猝死的发生机制具有重要意义。     

IMA和H-FABP在心源性猝死法医学诊断中的应用

急性心肌缺血的发生是心源性猝死的最常见原因,而如何认定早期急性心肌缺血是法医学研究的热点,同时也是临床预防心肌梗死发生的重要环节。本文通过对缺血修饰白蛋白(ischemia modified albumin,IMA)和心型脂肪酸结合蛋白(heart-type fatty acid binding protein,H-FABP)的结构、功能、临床应用价值及法医学中的应用前景进行综述,旨在分析二者是否可作为早期心肌缺血的生化检测指标用于心源性猝死的诊断,并为今后选择心源性猝死的科研方向提供借鉴。     

全外显子组测序对肥厚型心肌病猝死者的基因分析

目的在全外显子组水平分析1例肥厚型心肌病(hypertrophic cardiomyopathy,HCM)猝死病例的相关致病性基因突变。方法对1例具有HCM病理学特征的猝死病例样本,利用Illumina~Hi Seq 2500平台进行全外显子组测序(whole exome sequencing,WES)。测序数据分析以hg19为参照序列,筛选可疑的单核苷酸变异位点,通过PhyloP、PolyPhen-2、SIFT等软件进行突变的保守性和功能分析。结果经过筛选,发现该病例的MYBPC3基因发生C719R杂合突变。结论利用二代测序技术进行全外显子组水平的分子解剖(基因突变检测和分析),有助于明确HCM的分子机制,并为死因分析提供新的方法和思路。     

胰岛素中毒法医学研究进展

胰岛素作为一种临床上常见的降血糖药物,可以有效控制糖尿病患者血糖,使之维持在正常范围。但过量胰岛素可导致死亡,其中以意外中毒最多见,其次为自杀,胰岛素他杀虽极为罕见,但值得高度重视。胰岛素中毒致死的法医学鉴定极为困难,虽然相关研究已取得一定的进展,但在法医学实践中,这类案件仍然是一大难题。本文从法医病理学的角度,对胰岛素中毒的死亡机制、病理学改变、检测手段、注意要点及诊断要点进行综述,为法医学实践提供帮助。     

Intravascular bullet embolism to the right atrium

Bullet embolism is a relatively unusual complication of gunshot wounds. Embolism to the right atrium comprises <5% of all reported intravascular bullet emboli. We report an additional case of bullet embolus to the right atrium of a 0.38-caliber bullet following a gunshot wound to the chest. The intracardiac bullet was recognized radiologically on presentation, but the patient was hemodynamically stable and managed conservatively, with the bullet left in place. The missile remained within the heart without clinical significance for several years and was recovered from the right atrium only at the time of autopsy. To the best of our knowledge, this is the first documented case of a 0.38-caliber bullet which embolized to the right atrium and remained inconsequential for an extended period of time.     

Forensic applications of sodium rhodizonate and hydrochloric acid: a new histological technique for detection of gunshot residues

Demonstration of the presence of lead residues deriving from gunshot in skin and underlying tissues is essential for the correct forensic analysis of numerous legal cases. Optical microscopy remains the fastest, cheapest diagnostic technique, even though its sensitivity and specificity are poor because of the scarce quantity of histological tissue that can be examined and possible environmental lead pollution. To confirm the presence of lead from gunshot residues, we applied to histological sections of human skin a technique proposed by Owens and George in 1991 for macroscopic detection of lead on the clothing of shooting victims, involving a reaction with sodium rhodizonate and subsequent confirmation by color change on application of HCl. Our results demonstrate the technical possibility of using this macroscopic technique even on histological samples and support the need for further studies on a larger series of cases correlated with the type of ammunition and firing distance.     

Case series of completed suicides by burning over a 13-year period

Suicide by burning is an extreme act that is uncommon in the United States and throughout the Western world. The characteristics of people who complete such acts are not well understood. To address this issue, we examined the death records of the King County Medical Examiner's Office in Washington State over the 13 years from 1996 to 2009. Twenty-five cases of suicide by burning were identified and used to characterize decedent demographics, circumstances of death, and motivating factors. Compared to other methods of suicide, burning demonstrated a significant overrepresentation of decedents who were women, 40-59 years of age, and Asian/Pacific Islander. They also tended to have previous psychiatric illness and/or substance abuse issues. Self-burning predominantly occurred at the decedent's residence with the intent of suicide given. There was no unifying theme in motivating factors. Together, these data represent the characteristics of people whose death is because of suicide by burning in King County, Washington.