1 案例资料 1.1 简要案情 某年1月28日中午12时许,卢某在武汉市某钢管租赁站内,与死者周某因纠纷发生打斗后被他人劝开.劝开后双方仍进行争吵,争吵过程中周某突然瘫软在地.卢某见状赶紧上前查看并拨打120急救电话,卢某在120电话的指导下对周某进行了胸外按压,一直持续到120救护车赶到现场.周某被送至医院后,经胸外按压等抢救无效,约25min后宣布死亡.

混合痔在临床上广泛采用吻合器痔上粘膜环切钉合术(procedure for prolapse and hemorrhoids,PPH)治疗,PPH术后尿潴留是较常见的并发症之一,多数经过心理疏导、物理疗法等干预措施后缓解,少数经导尿处理后恢复,因术后尿潴留导致膀胱憩室者罕见.尿潴留行导尿操作是临床上非常普通且安全的诊疗措施,虽然导尿操作的刺激、牵拉或疼痛可诱发心脑血管不良反应,但也罕见报道;因PPH术后并发尿潴留并膀胱憩室,行导尿操作后发生猝死的案例更是未见报道.本文报道1例此类法医病理学检验案例,以期引起临床和法医鉴定中重视和警惕.

目的 探讨经皮椎体后凸成形术治疗骨质疏松性胸腰椎压缩骨折及塌陷伴发真空征的临床效果.方法 将68例OVCF伴发IVP患者按手术方式分为PKP和PVP组,术后随访6个月,观察患者术中骨水泥用量、 骨水泥渗漏情况、 栓塞、 椎体再骨折发生率及神经损伤等并发症发生情况.结果 PKP组骨水泥用量、 椎体再骨折发生率、 骨水泥渗漏率显著低于PVP组(P<0.05).结论 PKP能显著改善OVCF伴发IVP及塌陷患者腰椎功能.

Medical disputes in China are historically poorly documented. In particular, autopsy-based evaluation and its impact on medical malpractice claims remain largely unstudied. This study aims to document autopsy findings and medical malpractice in one of the largest cities of China, Wuhan, located in Hubei Province. A total of 519 autopsies were performed by the Department of Forensic Medicine, Wuhan University School of Medicine, Wuhan, China, over a 10-year period between 2004 and 2013. Of these cases, 190 (36.6%) were associated with medical malpractice claims. Joint evaluation by forensic pathologists and clinicians confirmed that 97 (51.1%) of the 190 claims were approved medical malpractice cases. The percentage of approved malpractice cases increased with patient age and varied according to medical setting, physician specialty, and organ system. The clinico-pathological diagnostic discrepancy was significantly different among various physician specialties (P = 0.031) and organ systems (P = 0.000). Of those cases involved in malpractice claims, aortic dissection, coronary heart disease, and acute respiratory infection were most common. Association between incorrect diagnosis and malpractice was significant (P = 0.001). This is the first report on China's medical malpractice and findings at autopsy which reflects the current state of health care services in one of the biggest cities in China.

•This manuscript aims to describe the effects of neuropeptide Y on primary rat cardiomyocytes.•The set of experiments includes analysis of cell viability, ATP content and mitochondrial membrane potential using commercially available analysis kits, mitochondrial structure by TEM and mRNA and protein levels of a potential mediator of the effects, PGC-1alpha.•The rationale for these experiments is that NPY has been linked to cardiomyopathies, which in turn are often characterized with mitochondrial dysfunction.•It is still unclear if increased NPY in cardiomyopathies is beneficial or harmful, and what are the direct effects of NPY on cardiomyocyte mitochondrial function.•Therefore, the data is potentially of interest.

Objective:To investigate cases of medical tangle in resent years in the Third grade A‐level hos‐pitals in some city and analyze the factors affacting the occurance of medical tangles .Methods:Analyze 211 re‐cords of medical tangle happened in three Third grade A‐level hospitals in some city during the period from January 2011 to December 2013 retrospectively ,take the cases which ,based on 1∶2 ,were involved the con‐current same kind of cases in charged by different doctors from the same section as the control group .Collect the basic data ,the data of patient party and the data of the medical party .Make single factor analysis and multiple factor analysis on the factors which may affect the occurance of medical tangle with χ2 test and logis‐tic regression model .Results:The single factor analysis revealed that medical costs ,education degree ,jobs , types of medical insurance of the patient partys ,medical service attitude and actions of the medical staff were the factors w hich resulted in the medical tangles ;multiple factor analysis of logistic regression hinted that medical service attitude and actions of the medical staff were the independent factors which resulted in the medical tangles .Conclusion:Medical service attitude and actions of the medical staff are the independent fac‐tors w hich result in the medical tangles and they are also the protective factors .

Medical disputes in China are historically poorly documented. In particular, autopsy-based evaluation and its impact on medical malpractice claims remain largely unstudied. This study aims to document autopsy findings and medical malpractice in one of the largest cities of China, Wuhan, located in Hubei Province. A total of 519 autopsies were performed by the Department of Forensic Medicine, Wuhan University School of Medicine, Wuhan, China, over a 10-year period between 2004 and 2013. Of these cases, 190 (36.6%) were associated with medical malpractice claims. Joint evaluation by forensic pathologists and clinicians confirmed that 97 (51.1%) of the 190 claims were approved medical malpractice cases. The percentage of approved malpractice cases increased with patient age and varied according to medical setting, physician specialty, and organ system. The clinico-pathological diagnostic discrepancy was significantly different among various physician specialties (P=0.031) and organ systems (P=0.000). Of those cases involved in malpractice claims, aortic dissection, coronary heart disease, and acute respiratory infection were most common. Association between incorrect diagnosis and malpractice was significant (P=0.001). This is the first report on China's medical malpractice and findings at autopsy which reflects the current state of health care services in one of the biggest cities in China.

In forensic identification,the blood alcohol concentration detection has to be conducted to get the evidence for drunk driving.Based on the fact that alcohol can be decomposed in human body and there are lots of factors that may affect the physicochemical properties of alcohol, this paper aims to review those factors that may influence the blood alcohol concentration detection, including blood specimen collection and preservation,detection methods, body corruption,diffusion of alcohol in the stomach and disease of the Decedent.It is suggested that all these factors should be considered in future forensic cases to detect accurately blood concentration of drivers.

肋骨骨折法医学的诊断主要依靠医学影像学检查结果,影像学的误诊或漏诊将直接影响鉴定意见的准确性,从而可能导致刑事或民事案件的审判错误.本文详尽地总结和分析了肋骨骨折各种影像学检查技术的优缺点、漏误诊原因、法医学鉴定现状及法医鉴定时需考虑的因素,以提高法医学鉴定的准确性.

The compound crossbow can be used to eject syringe-like dart loaded with poisonous solution. Succinylcholine (Sch) is a short-acting neuromuscular blocker medically used to achieve complete relaxation of muscle for a good intubation condition. Without the help of an artificial respirator, intramuscular injection of a large dose of Sch can paralyze the respiratory muscle and result in the receiver's death. In this paper, we present the homicide case of a young male killed by Sch from a syringe-like dart ejected by a compound crossbow. The subcutaneous and muscular hemorrhages observed around the entry were more severe than that caused by a medical injection. Additionally, other autopsy results showed the external appearance of a pinhole, general asphyxia signs and pathological findings which were not characteristic. The discovery of a syringe-like dart at the scene is the critical clue and reason for analyzing for Sch, which is commonly used to load syringe-like dart to paralyze and steal dog in the countryside of China.

目的:观察电除颤后纤维连接蛋白在窦房结中的表达规律.方法:选取尸体解剖标本中接受过电除颤者设为电除颤组；仅施行人工心肺复苏术而未接受电除颤者设为复苏组；未实施人工心肺复苏术或电除颤者设为对照组.窦房结取材,分别行H-E及纤维连接蛋白(Fn)免疫组织化学显色,光镜观察并用图像分析系统检测窦房结中纤维连接蛋白平均光密度值.结果:电除颤组窦房结中纤维连接蛋白表达明显增加,与复苏组、对照组比较,差异有统计学意义；复苏组与对照组比较,差异无统计学意义.结论:电除颤后窦房结形态改变,纤维连接蛋白表达增加,电除颤对窦房结的形态和纤维连接蛋白表达均有影响,死因分析时应予以考虑.

Objective: To investigate the relationship between the expression of connexin 43(Cx43) in myocardial cell of the left ventricle for patient with hypertensive heart disease(HHD) who died suddenly. Methods: Twenty autopsy cases were selected from the Department of Forensic Medicine of Wuhan University during 2009-2011.The cases were divided into two groups(HHD group and control group) with 10 cases in each group.After conventional pathological examination,Cx43 in the left ventricular myocardium of each case was detected with immunohistochemical staining.Results: In HHD group,the Cx43 positive staining were found in the cytoplasm or side-side connection of ventricular myocardial cell,and the positive area and average optical density of Cx43 positive particles were significantly decreased as compared with that respectively of the control group(both P 0.01).Conclusion: The expression of myocardial Cx43 is significantly decreased in sudden-death cases with hypertensive heart disease,which suggests the decreased expression of Cx43 may have relation with sudden death of hypertensive heart disease.

Objective:To investigate the diagnostic value of multi-slice spiral CT(MSCT) for rib fracture with digital radiography(DR) in comparison,and further to assess its potential application value in forensic identification.Methods:For 80 patients with rib fructures,th frontal and oblique DR film and MSCT with varied 3D-reconstruction techniques such as volume rendering(VR),maximum intensity projection(MIP),multi-planar reformation(MPR) and thin axial images were analyzed retrospectively.The rates of indenified,suspected and missed diagnosis in rib fracture were compared between MSCT and DR.Results:65 cases with 188 fractures were correctly diagnosed by DR,with the indenified diagnosis rate 73.44%(188/256),the suspect diagnosis rate 7.44%(19/256) and the missed diagnosis rate 19.14%(49/256).79 cases with 253 fractures were correctly diagnosed by MSCT,with the indenified diagnosis rate 98.05%(251/256),the suspect diagnosis rate 1.17%(3/256) and the missed diagnosis rate 0.78%(2/256).There is significant statistic difference between DR and MSCT(P 0.01) for diagnosis of rib fracture.Conclusion:The display rate of rib fracture with MSCT 3D-reconstruction was much higher than that of DR.DR can be used as a routine screening examination,and MSCT can provide further definite diagnosis and reliable evidence for clinical forensic identification.

1案例资料 1.1简要案情 某男,1岁6个月.2010年11月3日出现低热、恶心和呕吐,在当地卫生院按胃肠炎治疗2天,效果不佳.继而双腕、臀部和口腔出现疱疹,咳嗽并易惊,低热不退,仍在当地卫生院按普通感冒治疗.11月8日,出现高热和四肢瘫而转入某市医院.入院检查:神志清楚,精神差;舌、腕部皮疹;四肢肌张力高、肌力差;呼吸急促,双肺可闻及湿性啰音.白细胞数18.2×109/L,淋巴细胞比率61.3％.入院后给予抗病毒、脱水和抗生素治疗并心电监护.18h后,患儿出现烦躁不安、全身抽搐、口吐白沫,继而心跳、呼吸停止,经抢救无效死亡.

目的:通过对37例老年人尸检案例的性别、年龄、死因、诱因等分析,探讨老年人死亡的特点,为降低老年人的死亡率提供参考.方法:对2007年1月至2011年12月老年人尸检案例资料进行回顾性分析.结果:37例老年人尸检案例中男性25例,女性12例,平均年龄65.68岁.心血管系统疾病死亡13例,脑血管疾病死亡9例,有明显诱因的死亡案例为22例.结论:老年人主要的死因为心、脑血管疾病,防治心、脑血管疾病对降低老年人的死亡率有重要意义.

目的:探讨人工心肺复苏电除颤术后缝隙连接蛋白40 (Connexin40,Cx40)在窦房结(SAN)中的表达.方法:从2008年至2010年成人尸体解剖案例中,筛选出20例,将其中心肺复苏过程中接受过电除颤者设为A组(n=7);仅施行标准人工心肺复苏术而未接受电除颤者设为B组(n=8);另选取5例正常窦房结组织设为对照组(C组,n=5).窦房结取材,常规制片,分别行MASSON染色及免疫组化Cx40染色,用图像分析系统分析每高倍视野窦房结间质比例及窦房结中Cx40表达的IOD值,统计软件对所得数据进行分析.结果:A组窦房结间质比例与B组比较、A组与C组比较,差异均有统计学意义(P＜0.05);B组与C组比较,差异无统计学意义(P＞0.05);A组SAN中Cx40表达IOD值与B组比较、A组与C组比较,差异均有统计学意义(P＜0.05);B组与C组比较,差异无统计学意义(P＞0.05).结论:电除颤术后SAN间质胶原纤维和弹力纤维网状结构松散,部分断裂,水肿,SAN的自我保护功能部分受损;SAN中Cx40表达降低,GJ通道功能受损.

1案例资料 1.1简要案情 某女,25岁.2009年11月24日因“停经39周+5,伴发热3天”入院.入院当天行剖宫术产出一女婴.产后第2天,体温39.0℃,呼吸28次/min.胸部CT报告:双侧中下肺感染性病变,心影增大.心电图报告:室上性心动过速,非特异性ST-T异常.血液检查:白细胞15×109/L,淋巴细胞15％,总蛋白62g/L,白蛋白33g/L,谷草转氨酶54U/L.术后病情迅速恶化,行气管切开、抗感染等治疗抢救,效果不佳,于产后70h死亡.

Objective:To analyze the distribution of age and cause of death in medical tangles,and to compare the accuracy of clinical diagnosis.Methods:A total of 123 forensic autopsy cases of medical tangles during January 2004 to December 2009 from forensic medicine department of medical school of Wuhan University were analyzed and compared retrospectively.Methods:The ratios of autopsy in county and city hospitals or clinics were higher;most cases were 30-50 years old;cardiovascular diseases and pneumonia was the most common in the adult and underage cases respectively,and misdiagnosis and miss-diagnosis rates in these cases were also the highest;drug adverse reaction rate was the highest in clinic.Conclusion:The autopsy results are helpful for evaluating the final diagnosis in medical tangle cases.Diseases of cardiovascular system for adult and pneumonia for children are the most fatal causes and tend to be misdiagnozed,and the diagnosis and treatment for these diseases should be cautious.

1案例1.1简要案情某孕妇,39岁,孕8产1,在怀孕期间多次产检均未见明显异常.某日因“受凉后出现咳嗽4d,孕40+3周”入某县妇幼保健院待产.入院检查:体温、心率、呼吸和血压均正常,胎位左枕前(LOA),胎心143次/min,先露浮,胎头跨耻征阳性,无官缩.B超检查:脐带绕颈一周.入院诊断:头盆不称,孕8产1,头先露(LOA),妊娠合并上呼吸道感染,脐带绕颈.

他杀是故意杀人或伤害致人死亡的通称,系有意或无意伤害人命的一种严重危害社会治安、藐视他人生命的行为,其损伤特征比较复杂,是一种严重的社会问题.本研究通过对武汉市武昌区2000～2006年发生的288例他杀案件资料的收集整理,对他杀案件发生时间、地点及受害人性别、年龄、死亡原因等方面进行统计学分析,从法医学角度掌握他杀案件在该辖区内发生的规律性,从而为预防、预测和减少他杀案件的发生提供一些参考依据.