Reforming the coroner and death certification service

The intention of the Home Office is to introduce a new system that combines an independent check on all deaths and a professional oversight of death patterns, with, for the majority of cases, the minimum of bureaucracy. No public consultation is intended, so that reforms are not delayed. However as the proposals are developed in the coming months, the details, practicalities and costs will be discussed “with relevant professionals (not defined) and those with experience of the existing arrangements”. The imperfections of the present system are outlined. It is hoped the medical profession will have an input, since statements such as “ ‘hospital post mortems’, which are for medical research and public health protection purposes” need amendment. There should be a change in perception of the audit value of this procedure to BOTH the family and the treating doctor. Unfortunately it is proposed the new system in total should cost no more than at present. “Professionals” (not defined) will be involved in the financial detail.All deaths, after verification and certification of the medical cause of death (if known) would then be referred to the ‘medical examiner’ based in the coroner's office. He/she would be a qualified doctor employed by the new coroner service and independent of the Health Service. The medical examiner could provide supplementary advice on medical matters required by the coroner. “Retention of tissue should only take place where absolutely necessary and the coroner and his or her other staff should take account of the needs of families and friends carefully throughout the process.” “Coroners could take advice from their medical examiner to ascertain and prescribe the minimum level of invasiveness to establish the cause of death.” This issue is far from resolved, as signified by a recent call from the DoH giving a grant to study the value of MRI versus a full post mortem. No thought is given to systemic diseases, which may present in one organ system or another disease process, other than that causing death. Medical examiners will have to keep abreast of current developments in medicine BUT will be outside the NHS, which could cause problems. Medical examiners will be appointed (with an input from Regional Directors of Public Health) and managed from within the coroner service. They would work closely with the registrar of births and deaths.Deaths from unnatural causes or when the medical cause of death is unknown will result in judicial inquests. The medical examiner will have an input into causes of death and relevant investigations.Details of the proposed structure of the system are given, as well as the investigative and other roles of Coroner's officers.The establishment of medico-legal centres, as “examples of good practice” is advocated. The drawbacks of this system are stressed in this paper. There is at present an on-going review of forensic pathology services and it is hoped thought will be given to the increasing trend for sub-specialisation in medicine.     

Follow-up study in a patient with Setleis syndrome

We report on an 8-year-old Japanese boy with Setleis syndrome. The patient had a very characteristic “coarse” facial appearance, bitemporal “forceps marks,” skin aplasia, sparse hair, and skin hypo- and hy-perpigmentation. He also had previously undescribed manifestations, including an aberrant hair pattern of the forehead, linear skin lesions on the forehead, short palpebral fissures, a small skin tag on the right cheek, cone-shaped teeth, and pectus carinatum. Dermatoglyphic studies documented aberrant distal palmar creases (simian crease variant), 8 arches, and reduced total finger ridge count. When serial photographs were reviewed, his facial characteristics became more obvious with increasing age. © 1995 Wiley-Liss, Inc.     

Medullary locomotor strip and column in the cat

Responses of lateral medullary neurons to microstimulation of two points in the locomotor strip—rostral and caudal to the obex—were recorded intracellularly in mesencephalic decerebellated uncurarized cats. Excitatory and inhibitory postsynaptic potentials and orthodromic action potentials occurred up to 20 ms after a single stimulus. A number of cells responded to stimulation of a locomotor point by a repetitive discharge, and in some cells synaptic responses were evoked by contralateral stimulation. The responsive neurons were scattered among other cells in the lateral medullary tegmentum. At least one-third of neurons with synaptic responses to stimulation of the rostral locomotor point were antidromically invaded from the caudal one. The characteristic length of these descending axons was between 4 and 9 mm, although there were longer axons too.The lateral medullary cells which give synaptic responses to stimulation of the locomotor strip form the locomotor column located medial to the strip, and a portion of these cells send their axons to the strip. It is suggested that the activity is propagated polysynaptically along the column through axonal collaterals of its neurons. One can assume that when repetitive stimulation achieves a threshold for locomotion such a propagation occurs without decrement. As a result, spinal stepping generators are activated.     

T suppressor lymphocytes reverse ongoing acute allograft rejection

(LEW X BN)F1 cardiac allografts are rejected within 8 days in untreated LEW recipients. At the critical time point of 5 days after transplantation, the obviously rejecting grafts are enlarged and maximally infiltrated by host cells as shown by 111In-labeled lymphocyte tracer studies. However, when such hearts were retransplanted back to naive (LEW X BN)F1 secondary hosts, they survive indefinitely, showing that even late rejection is reversible in the absence of sustained host immunological drive. Attempts were then made to abrogate this advanced immune responsiveness using Cyclosporine (CsA). CsA therapy (15 mg/kg/day for 7 days) starting from day 5 produced indefinite graft survival, similar as if initiated at the time of operation. Addition of exogenous IL-2, which drives the proliferation of Tc, could not reverse this effect. Serial changes in phenotype of lymphocyte subpopulations infiltrating both acutely rejecting and indefinitely functioning cardiac allografts in unmodified and CsA treated hosts, respectively, were then studied. Ratio of Th:Tc/s cells in acutely rejecting grafts was 1.6 by day 3; it inverted abruptly to 0.7 by day 5-6, suggesting predominance of Tc/s during the later stages of allograft rejection. Similarly, treatment with CsA produced a transient depression of Th, with recovery of original Th:Tc/s ratio during the next 2-3 weeks. Adoptive transfer experiments were then performed to investigate the functional significance of these findings.(ABSTRACT TRUNCATED AT 250 WORDS)     

IDENTIFICATION OF PFRIODIC COMPONENTS IN PHYSIOLOGICAL MEASUREMENTS

Baseline diastolic blood pressure measurements made on a single subject for 120 consecutive days were utilized to demonstrate the use of autocorrelation techniques for the identification of cycles of one or more periods present in the data. Provided only a single period is present, averaging techniques using this period as the base may be used to smooth the data. However, few physiological variables cycle so simply. Smoothing not only may introduce spurious cycles, but it also eliminates much non-random (and, therefore, meaningful) variance.     

c-erbB-2、VEGF和组织蛋白酶D在胃癌中的表达及其相关性

目的：探讨癌基因c-erbB-2、血管内皮生长因子（VEGF）和组织蛋白酶D（Cath-D)在胃癌中的表达及其与胃癌生物学行为的关系。方法：采用免疫组织化学（S－P）法，检测了102例胃癌手术标本中c-erbB-2、VEGF及Cath-D的表达，同时观察了网状纤维分布与c-erbB-2、Cath-D之间的关系，并将检测结果与跟踪随访资料进行了综合分析。结果：102例胃癌组织中c-erbB-2表达阳性率为38.24%（39／102），与胃癌浸润深度（P＜0.05）、淋巴结转移（P＜0.05）密切相关；VEGF表达阳性率为50％（51／102），与胃癌浸润深度（P＜0.01）、生长方式（P＜0.01）、淋巴结转移（P＜0.01）密切相关；Cath-D表达阳性率为81.37%(83/102)，与胃癌浸润深度（P＜0.05）、生长方式（P＜0.05）、淋巴结转移（P＜0.05）及脉管内有无癌栓（P＜0.05）有关。对生存期分析显示：Cath-D、VEGF、c-erbB-2阳性患者预后差，5年生存率低于阴性表达患者。结论：c-erbB-2、VEGF及Cath-D与胃癌的生长、浸润、转移、预后有密切关系，可作为判断胃癌生物学行为和预后的重要指标。     

Tissue cages for study of experimental streptococcal infection in rabbits. II. Humoral and cell-mediated immune response to erythrogenic toxins

Infection of rabbits with erythrogenic toxin producing streptococcal strains caused a marked increase of humoral antibodies, which was detected by immunoprecipitation and ELISA. An antibody response directed towards the erythrogenic toxin type A was demonstrated by fused rocket immunoelectrophoresis. All toxinogenic reference strains produced ET type A under in vivo conditions despite that this toxin was not always demonstrated under in vitro conditions. The infection resulted in an increase of mitogenic response of peripheral lymphocytes to the initial nonspecific mitogenic erythrogenic toxins, whereas the Con A stimulation was depressed starting 14 days after infection and lasting during a period of 90 days. Since a normal antibody response was evoked, it seems likely that the T helper cell function was not affected.     

Role of apoptosis controlled by cytochrome c released from mitochondria for luteal function in human granulosa cells

PROBLEM: The aim of this study was to investigate the relationship between apoptosis by the mitochondrial pathway and luteal function in human granulosa cells. METHOD OF STUDY: Granulosa cells were obtained by ultrasound-guided follicular aspiration from patients undergoing in vitro fertilization and embryo transfer. After the addition of RU486, cells were stained with a mitochondria-specific fluorescent dye, MitoTracker Red CM x Ros. Using flow cytometry and National Institute of Health image, the mitochondrial fluorescent area was measured. After staining with Hoechst 33258 dye, the number of apoptotic bodies per 1000 cells were counted at random on photomicrographs. Homogenates were used for sodium dodecyl sulphate-polyacrylamide gel electrophoresis and Western blot analysis using antibodies against cytochrome c or caspase-3. RESULTS: The incidence of apoptotic bodies increased and the mitochondrial membrane potential decreased time dependently. The opposite effect was observed dose dependently with RU486 treatment. Western blot analysis showed increased cytochrome c expression, after treatment with 1-2 microg/mL of RU486 which then decreased with 5-10 microg/mL of RU486. Caspase-3 expression increased dose dependently with RU486. CONCLUSIONS: These results suggest that the activation of caspase-3 caused by cytochrome c released from mitochondria plays an important role in apoptosis-related luteal function in human granulosa cells.     

Primary respiratory syncytial virus infection in mice

A mouse model of respiratory syncytial virus (RSV) infection is described. A high-titered, large-volume inoculum results in replication of RSV to a high titer in lungs of BALB/c mice. Mice older than 15 weeks of age are more susceptible to RSV infection. Titers up to 10(6.9) plaque-forming units (pfu)/gram lung can be attained in 32-week-old mice. Older mice experience a clinical illness manifested by ruffled fur, reduced activity, and weight loss. Lung histology of older mice infected with RSV shows bronchiolitis and increased number of lymphocytes and macrophages in alveolar spaces compared with that of mice less than 8 weeks old. This model will serve as the basis for investigating immunodeterminants of recovery and protection from RSV infection.     

应用免疫组化技术检测胃癌组织p53、c-erbB-2、p21、nm23基因表达产物及其临床意义

目的：为探讨胃癌组织p53、c-erbB-2、p21、nm23联合基因表达产物对胃癌诊断与治疗方面的价值。方法：应用免疫组化技术检测了手术切除胃癌组织p53、c-erbB-2、p21、nm23基因产物表达。结果：p53蛋白表达阳性率37．6％-46．2％，c-erbB-2为34．6％-56．8％，p21为37．8％。61．5％，nm23为30．8％-70．3％；非胃癌组织(胃、十二指肠溃疡、胃息肉、重度不典型增生)未见c-erbB-2、p21、nm23基因表达。c-erbB-2、p21的表达与胃癌的分化程度有关，p21、nm23基因表达与肿瘤浸润深度、肿瘤转移程度有关。p53、c-erbB-2、p21、nm23四种肿瘤蛋白在胃镜活检标本和手术切除标本中表达是一致的，无显著性差异。结论：对胃癌组织检测p53、c-erbB-2、p21、nm23基因表达产物在胃部的良恶性肿瘤鉴别、非手术临床分期的判断及指导胃癌的临床诊断与治疗等方面具有一定价值。