Testing an Age-old Adage: Can Autopsy Findings be of Assistance in Differentiating Opioid Versus Cardiac Deaths?

Given the common occurrence of both opioid and cardiovascular deaths, and the concomitant use of opioids in those with cardiac disease, the present study was undertaken to see whether the old adage of using the triad of cerebral and pulmonary edema and bladder fullness to suggest an opioid death could be used to differentiate deaths due to opioid toxicity from deaths due to cardiac disease. Brain weight, lung weight, and bladder fullness were compared among opioid-related deaths, cardiac deaths, and a control population. It was found that opioid-related deaths were more likely to have heavy lungs, a heavy brain, and a full bladder, while cardiac-related deaths had smaller volumes of urine in the bladder and heavier hearts. In conjunction with a thorough investigation, these findings may be useful to forensic pathologists when determining whether a death is opioid-related, especially in the setting of concomitant cardiac disease.     

芒针深刺八髎穴治疗脊髓损伤后神经源性膀胱临床观察

目的 观察芒针深刺八髎穴治疗脊髓损伤后神经源性膀胱的临床疗效。方法 选取54例脊髓损伤后神经源性膀胱患者,先进行残损分级评级,再采用随机数字表法将其分为对照组和观察组,每组27例。对照组行常规针刺联合膀胱功能训练,观察组行芒针深刺八髎穴联合膀胱功能训练。比较两组患者治疗前后排尿日记指标、最大尿流率、膀胱残余尿量、生活质量指数评分以及临床疗效。结果 两组患者治疗后排尿日记各指标均较治疗前显著改善(P<0.05),且观察组各项指标改善情况显著优于对照组(P<0.05)。与治疗前比较,治疗后两组患者最大尿流率显著增加,膀胱残余尿量显著减少(P<0.05),且观察组最大尿流率增加程度及膀胱残余尿量减少程度均大于对照组(P<0.05)。与治疗前比较,治疗后两组患者生活质量指数评分均显著减少(P<0.05),且观察组患者生活质量指数评分减少程度显著大于对照组(P<0.05)。观察组疗效优于对照组(P<0.05)。结论 芒针深刺八髎穴能有效改善脊髓损伤后神经源性膀胱患者排尿情况及生活质量,恢复患者膀胱功能,减少膀胱残余尿量。     

Chinese Shichen for a Healthy Body and Mind

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防己黄芪汤对大鼠膀胱过度活动症的防治作用

目的 观察防己黄芪汤对大鼠膀胱过度活动症的防治作用。方法 ①选取雌性SD大鼠90只,随机取15只为假手术组,其余75只随机均分为模型组（复制逼尿肌不稳定（detrusor instability, DI）模型）,托特罗定组（0.5 mg/kg),防己黄芪汤高、中、低剂量组（分别为10、5、2.5 g/kg）,缩窄近端尿道出口,模型复制第3周开始给药,连续4周。末次给药后测定尿动力学参数,计算膀胱指数,并观察膀胱组织形态学变化。②复制体外膀胱逼尿肌过度活动模型,观察防己黄芪汤对其收缩活动的影响。结果 DI模型大鼠的排尿间隔时间显著缩短（P<0.01）,排尿点压、排尿压峰值、膀胱指数显著升高（P<0.01）,残余尿量明显增多（P<0.01）;膀胱发生明显的病理性改变。防己黄芪汤高、中剂量组和托特罗定组大鼠排尿间隔时间显著延长（P<0.05,或P<0.01）,排尿点压和排尿压峰值降低（P<0.01）,膀胱的残余尿量显著减少（P<0.01）;防己黄芪汤高剂量组和托特罗定组膀胱指数显著降低（P<0.05）,膀胱病变程度减轻。0.2 mol/L KCl溶液能显著增加正常大鼠逼尿肌的收缩频率和张力（P<0.01）,托特罗定(10-8 mmol/L)、防己黄芪汤（10、20、40 g/L）对KCl引起的逼尿肌收缩频率和张力的增加均有明显抑制作用。结论 防己黄芪汤可以改善DI大鼠的下尿路症状,可能是通过调节膀胱逼尿肌和尿道平滑肌的舒缩而发挥作用。