电针督脉对缺血性脑损伤大鼠神经细胞凋亡的影响

目的：揭示电针治疗在缺血性脑血管疾病中的分子机制。方法：采用原位标记法，研究电针督脉的大椎、百会经穴对缺血性脑损伤的保护作用。凝闭大鼠大脑中动脉致局灶性脑缺血10h后，选择末端脱氧核苷酸转移酶介导dUTP缺口末端标记法（TUNEL）检测神经细胞的凋亡状况，并观察电针对其影响。结果：电针组大脑皮质梗死区内TUNEL染色阳性细胞显减少，与模型组比较，差异有显性意义（P＜0．01）。结论：电针可抑制脑缺血后脑内神经细胞凋亡。     

电针对血管性痴呆大鼠学习记忆能力及脑血流量的影响

目的：观察电针对血管性痴呆(vascular dementia，VD）模型大鼠学习记忆能力和局部服血流量（regional cerebral blood flow,rCBF )的影响。方法：用双侧颈总动脉反复缺血－再灌注结合腹腔注射硝普钠法，并配合行为学测试确定模型。术后7d电针百会、大椎、足三里（双）治疗。用跳台法评价各组大鼠不同时期的学习记忆能力，治疗后测定各组大鼠顶叶有海马rCBF。结果：VD大鼠在电针治疗后的行为学测试成绩明显提高（P＜0．01），其低下的大脑顶叶及海马rCBF水平明显改善（P＜0．01）。结论：电针对VD大鼠的学习记忆能力有显的改善作用；电针能促使机体低灌流的缺血服组织灌流水平恢复，可能有助于与学习记忆相关的传导环路的修复。     

补肾生髓方和益气活血方对局灶性脑缺血再灌注大鼠额顶叶皮质Notch信号通路Nurrl、SMO mRNA及其蛋白表达的影响

目的 探讨补肾生髓方和益气活血方对脑缺血再灌注大鼠额顶叶皮质Notch信号转导通路Nurr1、SMO mRNA及其蛋白表达的影响。方法 采用线栓法复制右侧大脑中动脉阻塞局灶性脑缺血再灌注大鼠模型,将大鼠随机分为假手术组、模型组、补肾生髓方组和益气活血方组。脑缺血2 h后,持续灌注7 d。采用PCR检测额顶叶皮质Nurr1、SMO mRNA表达水平,采用Western blot检测其蛋白表达水平。结果 与假手术组比较,模型组Nurr1、SMO mRNA及其蛋白表达水平均明显上调（P<0.05）;益气活血方组和补肾生髓方组Nurr1 mRNA及其蛋白、SMO蛋白相对表达水平均较模型组明显下调（P<0.05）;模型组、益气活血方组和补肾生髓方组SMO mRNA相对表达水平比较,差异无统计学意义（P>0.05）;益气活血方组与补肾生髓方组Nurr1、SMO蛋白表达水平有显著差异（P<0.05）。结论 补肾生髓方和益气活血方促进脑组织修复的作用与其下调Notch信号转导通路中Nurr1、SMO mRNA及其蛋白表达有关。     

不同时程吗啡依赖大鼠依赖相关脑区光镜和电镜观察

目的探讨吗啡依赖中枢神经系统毒理病理不同时程的变化。方法背部皮下递增注射吗啡建立吗啡依赖大鼠模型,光镜和透射电镜下观察不同时程大鼠吗啡依赖相关脑区,即蓝斑核、中脑导水管周围灰质、黑质、豆状核、杏仁核、海马的病理组织学变化,并对突触进行计数,比较与空白对照组的差异。结果吗啡依赖大鼠6个依赖相关脑区均出现神经细胞固缩或肿胀,神经纤维肿胀,线粒体肿胀、畸形,内质网扩张,多聚核糖体解聚,突触数量增多;胶质细胞、脑膜下淋巴细胞增多,随依赖时间的延长而更加显著,并可见胶质结节形成。吗啡依赖8周组、4周组, 大鼠突触数量较空白对照组增多,其差异具有非常显著性意义(P<0．01);吗啡依赖8周组大鼠突触数量的增多,与吗啡依赖1周组、2周组大鼠比较,其差异具有非常显著性意义(P<0．01)。结论吗啡依赖大鼠依赖相关脑区神经细胞呈缺血缺氧性及退行性改变,突触数量增多,并随吗啡依赖时限的延长而明显。     

大鼠实验性脑梗死早期CT值和GFAP表达变化的研究

目的探讨大鼠24h内实验性脑梗死CT值及脑内胶质纤维酸性蛋白(GFAP)的表达变化,以间接推测脑梗死的发生时间。方法参照Longa线栓法建立大鼠大脑中动脉栓塞脑梗死模型,在不同时相点进行头颅CT扫描,测量右侧脑梗死和左侧未梗死区脑组织的CT值并求出两侧的差值。同时用免疫组化检测脑内GFAP的表达变化。结果6h组大鼠CT平扫均有明确的脑梗死灶,梗死与非梗死两侧脑组织CT值的差值与梗死时间呈直线正相关,GFAP表达与梗死时间也有一定的相关性。结论血管栓塞引起的脑梗死最早于梗死发生后6h可以诊断,并可通过脑梗死与非梗死两侧CT值的差值计算及GFAP表达变化来推测脑梗死发生的时间。     

35例胰腺出血案例死亡原因分析

３５例胰腺出血案例死亡原因分析刘敏，吴家Ｃａｕｓｅｓｏｆｄｅａｔｈｏｆｐａｎｃｒｅａｓｈｅｍｏｒｒｈａｇｅ：３５ａｕｔｏｐｓｙｃａｓｅｓｒｅｐｏｒｔ￥ＬｉｕＭｉｎ；ＷｕＪｉａｗｅｎ（ＤｅｐａｒｍｅｎｔｏｆＦｏｒｅｎｓｉｃＰａｔｈｏｌｏｇｙ，ＷｅｓｔＣ...     

Undiagnosed, untreated acute promyelocytic leukemia presenting as a suspicious sudden death

Acute promyelocytic leukemia (APL) is a subtype of acute myelogenous leukemia frequently associated with clotting abnormalities and severe hemorrhagic diathesis. The disease is associated with a high incidence of early fatal hemorrhage. We report the sudden death of a 40-year-old male without significant medical history in which foul play had been initially suspected. A thorough postmortem investigation performed on the decedent lead to the diagnosis of APL. Cause of death was a cerebellar hematoma. Underlying APL should be considered in the differential diagnosis when unexplained bleeding is encountered in a decedent. This case emphasizes the value of routinely collecting bone marrow during an autopsy to enable accurate testing and diagnosis.     

Petechial Hemorrhages and Ethanol in Deaths from Intoxication

Petechiae in conjunctivae and in the palpebrae/skin of the eyelids are of particular interest for the forensic pathologist, because of their association with pressure on the neck. They have been described in the eyelids of intoxicated persons both in case reports and in text books of forensic pathology. We studied 590 deaths caused by intoxication, and 75 had petechiae either in the conjunctivae, the eyelids, or in both locations. We examined the influence of drugs and ethanol on the location of the petechial hemorrhages in these deaths. Deaths with ethanol in blood and in urine/vitreous humor more often had petechiae in both locations than those without. This association was statistically significant, independent of body position and livor mortis. No association between the location of petechiae, medicinal drugs, or narcotics was found. These results suggest that ethanol may contribute to the development of petechial hemorrhages in deaths from intoxication.     

颅内出血患者血清IL-6、TNF-α变化在法医临床鉴定中的意义

目的探讨颅内出血患者血清IL-6、TNF-α的水平变化及在法医学的临床意义。方法采用酶联免疫吸附法(ELISA)对颅内出血患者住院后不同时间段血清IL-6、TNF-α水平进行检测,并与正常对照组的健康受试者进行比较分析。结果研究组重型与轻型患者后第1、3、5、7天血清IL-6、TNF-α水平较正常对照组明显增加,重型患者入院第5、7天的血清IL-6、TNF-α较轻型患者明显增加,差异有统计学意义(P0.05);根据患者最后结果(死亡组和存活组),发现死亡组随着时间延长,在第5、7天时IL-6、TNF-α水平显著高于存活组(P0.05)。此外,血清IL-6和TNF-α水平呈正性显著相关(r=0.721,P0.05)。结论检测颅内出血患者血清IL-6、TNF-α水平对观察其病情变化有重要意义,可作为法医学鉴定的辅助手段。     

A death due to subinvolution of the uteroplacental arteries

A 19-year-old G1P0 Caucasian woman died 8 days postpartum because of the subinvolution of the uteroplacental arteries. Microscopic examination of the placental implantation site revealed large, dilated spiral arteries containing partially occluding thrombi in the superficial myometrium. The presence of cytotrophoblasts within and surrounding the spiral arteries was confirmed by low molecular weight cytokeratin immunohistochemistry. Infection of the Cesarean section incision site was demonstrated by the growth of Staphylococcus aureus and Streptococcus agalactiae Group B in the wound as well as the intrauterine blood clot. Although subinvolution of the placental site may be a cause of delayed postpartum hemorrhage and significant morbidity, the underlying pathophysiologic mechanism is unknown.