损伤伴心血管系统疾病死亡42例法医病理学研究

目的探讨心血管系统疾病伴外伤死亡案例法医病理学特点,并从伤病的角度揭示两者之间的联系。方法42例心血管系统疾病伴损伤死亡案例均接受系统病理学解剖和组织学观察,且死因明确。结果42例中40岁以上者占到64.28%,男性较女性死者多。擦伤和挫伤在损伤中比例最大共占到80.95%,冠心病和高血压病死亡者各占45.24%、16.67%。损伤和疾病共存死亡案例共20例。结论在死因分析中年龄、性别、损伤类型、疾病分布有其规律性,死者中年龄偏老年化,损伤多为钝器、摔跌所致擦伤、挫伤。疾病中冠心病、高血压为最多。损伤和疾病对死因共同起作用的案例主。     

Pulmonary Cement Embolism After Kyphoplasty

Pulmonary polymethylmethacrylate (PMMA) cement embolism after kyphoplasty (KP) surgery is a quite frequent event as well as the pulmonary embolization of central venous catheter fragment. This report shows the case of a subject who, after KP, developed pulmonary embolism and who underwent thoracic surgery. After hospital discharge, the subject advanced a claim for damages toward the hospital where he was operated, complaining sensation of tenderness at the chest surgical scar and esthetic damage. To understand the nature of the embolism (either central venous catheter fragment or cement), chemical investigations were then ordered. Spectrometry identified the PMMA cement used for KP. When doubts rise about the origin of the embolized material, chemical investigations may reveal important data not only for clinical but also for forensic purposes.     

A Case of Sudden Infant Death Due to Incomplete Kawasaki Disease

Although Kawasaki disease (KD) is a self‐limiting disease, it may cause sudden cardiac death. Diagnosis of KD is principally based on clinical signs; however, some infant cases do not meet the criteria. Such cases are identified as incomplete KD. The sudden death risk in incomplete KD cases is similar to conventional KD. In our 5‐month‐old case, he had been admitted to a hospital for a fever and suppuration at the site of Bacille de Calmette et Guerin (BCG) vaccination. However, after discharge from the hospital, his C‐reactive protein (CRP) levels declined, he got indisposed and died suddenly. A medico‐legal autopsy revealed myocarditis, coronaritis, platelet‐aggregated emboli in coronary arteries, and myocardial degeneration, suggesting that the fatal myocardial infarction was due to thrombus emboli in the coronary arteries. Forensic pathologists therefore should pay attention to the cardiac pathology originated from incomplete KD as a potential cause in cases of sudden infant death.     

Commode Cardia—Death by Valsalva Maneuver: A Case Series

The Valsalva maneuver is used in clinical medicine for the diagnosis and/or treatment of various cardiovascular conditions. It can also be used in activities of daily living, such as defecation. Due to the cardiovascular effects produced during the Valsalva maneuver, it may be contraindicated in certain medical conditions and could be a trigger of sudden cardiac death. The incidence and prevalence of death following Valsalva maneuver in the presence of underlying cardiovascular disease, or “commode cardia,” has not been examined. In 2012, the Wayne County Medical Examiner's Office (Detroit, MI) investigated 21 deaths that occurred on the toilet, fourteen of which were due to cardiovascular disease. In another 31 deaths in the bathroom due to cardiovascular disease, the possibility that the decedent defecated immediately prior to death could not be excluded. Hence, the incidence of commode cardia in this population ranges from 2.3 to 7.4% of all cardiovascular‐related deaths.     

Molecular Pathology of Pulmonary Edema in Forensic Autopsy Cases with Special Regard to Fatal Methamphetamine Intoxication

Pulmonary edema is a common finding in fatal methamphetamine intoxication. However, the underlying mechanism remains poorly understood. This study investigated the molecular pathology of alveolar damage involving pulmonary edema in forensic autopsy cases. Seven candidate reference genes (RPL13A, YWHAZ, GUSB, SDHA, GAPDH, B2M, and ACTB) were evaluated in the lung by the geNorm module in qBase^plus software. RPL13A, YWHAZ, and GUSB were identified as the most stable reference genes. Using these validated reference genes, intrapulmonary mRNA expressions of matrix metalloproteinases (MMPs), intercellular adhesion molecule‐1 (ICAM‐1), claudin‐5 (CLDN‐5), and aquaporins (AQPs) were examined. Relative mRNA quantification using TaqMan real‐time PCR assay demonstrated higher expressions of all markers except for AQP‐5 in fatal METH intoxication cases. These findings suggested alveolar damage and compensatory response in fatal METH intoxication cases. Systematic analysis of gene expressions using real‐time qPCR is a useful tool in forensic death investigation.     

慢性乙醇中毒小鼠脑神经细胞IP3R1表达的变化

目的研究慢性乙醇中毒引起小鼠脑神经细胞Ⅰ型1,4,5-三磷酸肌醇受体（IP3R1）表达的变化。方法 40只小鼠随机分为90d、180d组,各组再分为正常对照组、10%、20%、30%乙醇组,每组5只,乙醇组给予相应浓度乙醇饮用至相应时间;取各组小鼠脑组织,分别采用免疫组化和Western blot方法检测脑皮质神经细胞IP3R1表达的变化;SPSS 13.0软件对实验数据进行单因素方差分析。结果正常IP3R1免疫组化染色物分布于神经细胞胞浆内。90d组随乙醇浓度的增加,IP3R1免疫组化阳性细胞数和阳性细胞率逐步增加,组间比较,差异显著（P〈0.05）;180d组中10%、20%乙醇组阳性细胞数和阳性细胞率逐步增加,组间比较,差异显著（P〈0.05）,而30%乙醇组阳性细胞数和阳性细胞率反而减少,且低于90d组的相同浓度组（P〈0.05）。Western blot与免疫组化检测结果基本一致。结论慢性乙醇中毒可引起小鼠大脑皮质神经细胞IP3R1表达增加,而高浓度（30%）、长时间（180d）乙醇使IP3R1表达降低,可能与神经细胞变性、坏死、数目减少有关。     

When benefitting a patient increases the risk for harm for third persons — The case of treating pedophilic Parkinsonian patients with deep brain stimulation

This paper investigates the question whether it is ethically justified to treat Parkinsonian patients with known or suspected pedophilia with deep brain stimulation — given increasing evidence that this treatment might cause impulse control disorders, disinhibition, and hypersexuality. This specific question is not as exotic as it looks at a first glance. First, the same issue is raised for all other types of sexual orientation or behavior which imply a high risk for harming other persons, e.g. sexual sadism. Second, there are also several (psychotropic) drugs as well as legal and illegal leisure drugs which bear severe risks for other persons. We show that Beauchamp and Childress' biomedical ethics fails to derive a veto against medical interventions which produce risks for third persons by making the patients dangerous to others. Therefore, our case discussion reveals a blind spot of the ethics of principles. Although the first intuition might be to forbid the application of deep brain stimulation to pedophilic patients, we argue against such a simple way out, since in some patients the reduction of dopaminergic drugs allowed by deep brain stimulation of the nucleus subthalamicus improves impulsive control disorders, including hypersexuality. Therefore, we propose a strategy consisting of three steps: (1) risk assessment, (2) shared decision-making, and (3) risk management and safeguards.     

Glamorizing sick bodies: how commercial advertising has changed the representation of HIV/AIDS

As a consequence of pharmaceutical advancements, HIV is no longer described in terms of the absence of health or presence of illness, and advertisements promoting anti-AIDS medications commercialize idealized and desirable bodies. The present study discusses representations of HIV/AIDS in commercial advertising and their change over time. The article traces the shift in AIDS/HIV representations in commercial advertising from the early 1990s, when images of decay and disease represented AIDS, to nowadays, when the wider availability of antiretroviral medications and their ability to prolong life produced new representations of HIV-afflicted bodies. Claiming that HIV individuals can lead a normal life where everything is possible, advertising has re-established the definition of a sick body. On the other hand, this marketing approach has important social implications because such representations minimize the seriousness of HIV infection and fail to take into account the real dangers of contracting HIV and to accurately represent the life with HIV and AIDS.     

Sudden Unexpected Death Due to Graves' Disease During Physical Altercation

We report a case of a 30‐year‐old woman who suddenly collapsed after having a physical altercation with her husband. Despite immediate resuscitation, she died on arrival at the hospital. The victim's parents requested an autopsy because they believed that their daughter was killed by her husband. Postmortem examination revealed that the victim had a diffusely enlarged thyroid gland and cardiomegaly with left ventricular hypertrophy. There was no evidence of significant trauma on the body. Further postmortem thyroid function tests and review of her medical history indicated that her death was due to Graves' disease. To the best of our knowledge, this is the first case reported of sudden death due to cardiac arrhythmia from Graves' disease induced by physical and emotional stress associated with the criminal activity of another person. The autopsy findings are described. In addition, the literature is reviewed and the significance of postmortem evaluation of thyroid hormones in the cases of sudden death is discussed.     

Carbon Monoxide Poisoning and Death in a Large Enclosed Ventilated Area

A 55‐year‐old man with a medical history of tobacco use suddenly collapsed while power washing an empty indoor pool in a hotel. The decedent was transported to the local hospital where he was pronounced. A postmortem examination revealed atherosclerotic heart disease and bilateral pulmonary edema and congestion. A postmortem blood carbon monoxide (CO) level was 27% saturation, and a CO performed on hospital admission blood was 49% saturation. CO poisoning is a common cause of toxicological morbidity and mortality in the United States. The circumstances most often occur in an enclosed environment and may be intentional or unintentional. CO poisoning has been reported in open, well‐ventilated spaces, but rarely results in death. A warning label was present on the engine clearly stating the dangers of CO emission. However, there was a false sense of security due to the large size of the pool room and the presence of industrial blowers that were being used for ventilation.