法医尸检资料120例的回顾性分析

目的:分析120例猝死及非正常死亡案件尸体的一般情况、死因、动机等特点。方法:对120例猝死及非正常死亡事件的法医尸检资料给予回顾性分析。结果:(1)120例尸检资料中男72例(60.00%),女48例(40.00%)。年龄5~82岁,其中高峰年龄段为16~45岁,占53.33%(64/120);(2)交通事故(意外事件)发生率最高为29.17%;(3)猝死及非正常死亡发生的时间以10~13时最多,占42.50%(51/120);(4)中枢神经系统疾病是老年致死的主要疾病,而心血管系统疾病是中青年致死的主要疾病;单刃锐器为他杀案例的最常用作案工具,杀人动机为谋财;自杀案件死因为农药中毒、高坠及溺死。结论:正确树立中青年的价值观、社会观、人生观,关注此类群体的身心健康是全社会应该重视的焦点问题。同时,相关部门应加大管制刀具的监管力度,增强人们的法律观念,以此遏制不良案件的发生率。     

院前死亡219例流行病学分析

目的:分析我院院前死亡患者的流行病学特征,提高院前急救水平,最大限度降低院前死亡率.方法:采用回顾性资料收集的方法,对该院2012-2014年度所有院前死亡患者的年龄、性别、呼救时间、死因等要素进行调查统计分析.结果:本组院前死亡病例219例,男女比为1.67:1,平均年龄(69.71±17.28)岁,院前死亡11月、2月较高,4、7、8、9月较低;日时间段高峰为8:00~10:00;死因前3位依次为猝死(32.4%),神经系统疾病(20.55%)恶性肿瘤(20.09%).结论:①15~79岁,随年龄增长院前死亡逐渐增加,应改变亚健康状态,积极正确治疗基础疾病,.②猝死是首要死因,心脑血管疾病年轻化,把宣传常见心脑血管疾病急症表现的科普知识常规化,对提高院前急救成功率有重要意义.     

猝死致医疗纠纷42例尸检病例临床病理分析

目的：分析猝死致医疗纠纷病例的死因,评价临床与病理诊断符合率.方法：42例猝死致医疗纠纷病例,于死亡48 h内尸检并行病理组织学检查,分析死亡原因、病理检查及临床诊断符合率、猝死病例年龄及发生猝死的医院级别.结果：17例猝死原因为心血管系统疾病,其中16例误诊,临床诊断符合率仅为5.58％;11例为呼吸系统疾病,9例误诊,临床诊断符合率仅为18.1％;42例猝死病例年龄10 d～65岁,35岁以上者20例,占47.6％,≤10岁年龄组占30.9％;猝死病例多发生在1、2级医院,分别占52.3％和33.3％.结论：临床误诊是发生猝死的主要原因,提高1、2级医院的诊疗水平是降低临床猝死发生率的重要手段.     

急诊死亡病人247例死因调查分析

目的了解急诊病人死因及威胁人类生命的主要原因,提高急救水平.方法对我院1998年247例急诊死亡病例进行汇总分类.结果 247例急诊死亡病人中,死因依次为循环系统疾病、损伤和中毒、猝死、体征症状不明情况和恶性肿瘤,死亡高峰年龄在60～80岁,季节集中在夏季7～8月份.结论普及院前急救知识,提高危重病、多发伤的诊治水平.     

轻微外伤后死亡24例法医学分析

目的探讨轻微损伤为诱因导致死亡的案件法医学检验鉴定要点。方法通过对24例轻微损伤后死亡案例的一般材料、致伤后经过时间、致伤因素、疾病诊断和死因等进行回顾性分析。结果此类案件死亡原因以心血管系统心肌疾病引起猝死最常见,其次为中枢神经系统。结论正确的评价损伤、疾病和死因的关系,对于划分刑事责任、处理民事纠纷具有十分重要的意义。     

15例猝死的临床及尸检分析

猝死是中、老年人常遇到的出乎意料的突然死亡.即在予料不到的情况下6小时内死亡者,均列为猝死.现将15例结合尸检病理诊断分析其发病机制及死因,并对猝死综合征的诊断进行探讨.本文15例尸检病例,年龄30～39岁6     

猝死尸检79例统计分析

本文分析了猝死尸检79例,男女之比为2:1,朝鲜族和汉族之间猝死发病率无差异.猝死的两个高峰年龄是21～40岁及10岁以下;12月和1月寒冷季节猝死者22例(28.1％),在22:00～6:00时间内发病者28例(35.4％).致猝死的疾病以心血管系统疾病最多,为34例(43.3％);其中在1965年以前以克山病猝死者为多,而在1966年以后以冠心病猝死者为多.尸检中不能确定死因者13例(16.5％).     

脑肿瘤猝死4例的法医病理学分析

非正常死亡案例的死因确定是法医检案工作的重要内容之一,由于受传统观念的影响,我国尸体解剖仍有一定的阻力,因而对死因确定造成困难,笔者在实际工作中遇到4例脑肿瘤导致猝死的涉及法医案例,报告如下。     

甲状腺疾病猝死10例分析

目的分析甲状腺疾病导致猝死法医病理学尸体解剖案例的特点及规律,探讨此类案例的案件特点,为法医学检案提供指导.方法收集昆明医学院司法鉴定中心2003年1月至2009年10月涉及甲状腺疾病猝死案例10例,按照性别、年龄、有无病史、病理类型、肉眼观病理形态学改变、案情调查、医院内还是医院外死亡、镜下病理改变等指标进行分类整理和分析.结果甲状腺炎占4例,弥漫性毒性甲状腺肿2例,甲状腺肿瘤2例,机体急性缺血致甲状腺出血2例,甲状腺疾病构成根本死因的占5例,均为医疗纠纷案件.结论法医病理组织学检验是正确识别和鉴定甲状腺疾病猝死的关键.     

院前死亡219例流行病学分析

目的:分析我院院前死亡患者的流行病学特征,提高院前急救水平,最大限度降低院前死亡率。方法:采用回顾性资料收集的方法,对该院2012-2014年度所有院前死亡患者的年龄、性别、呼救时间、死因等要素进行调查统计分析。结果:本组院前死亡病例219例,男女比为1.67:1,平均年龄(69.71±17.28)岁,院前死亡11月、2月较高,4、7、8、9月较低;日时间段高峰为8:00~10:00;死因前3位依次为猝死(32.4%),神经系统疾病(20.55%)恶性肿瘤(20.09%)。结论:115~79岁,随年龄增长院前死亡逐渐增加,应改变亚健康状态,积极正确治疗基础疾病,。2猝死是首要死因,心脑血管疾病年轻化,把宣传常见心脑血管疾病急症表现的科普知识常规化,对提高院前急救成功率有重要意义。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.