限制性体位窒息死亡的法医学鉴定

限制性体位窒息是一种特殊类型的窒息,其死亡机理、过程复杂,体表损伤轻微,尸体表现缺乏特异性,鉴定难度大,目前还没有一个客观、准确、公认的鉴定标准,通过文献复习总结有关体位性窒息的研究成果,结合窒息死亡的组织病理改变和鉴定实践,提出限制性体位窒息的检验鉴定要点,在确定有长时间限定在某一影响呼吸的体位,且自己不能解脱;有明显的窒息尸体征象;排除损伤、疾病致死;常见毒物检测阴性;膈肌Fn免疫荧光检测阳性或透射电镜检查证明有膈肌损伤的可以诊断。如果合并有损伤或疾病,还应该有肺SP-A检查阳性或HIF1-α免疫组化染色核阳性表达。某些特定部位的损伤检查有助于分析体位关系。     

大鼠限制性体位窒息模型中膈肌Fn和HSP70的免疫荧光组化观察

目的观察Fn和HSP70在限制性体位窒息死亡的大鼠膈肌中的表达情况,进一步探讨限制性体位窒息死亡的机理。方法分组建立限制性体位窒息死亡大鼠模型,采用免疫荧光组织化学方法研究大鼠膈肌的Fn和HSP70的表达情况,并将荧光照片进行灰度值分析,比较抗原在不同组别间的表达差异。结果在Fn检测中,限制性体位窒息死亡组大鼠的膈肌肌内膜上有明亮荧光,肌纤维间隙的荧光强度明显大于对照组。在HSP70检测中,肌纤维内的荧光强度随着体位性限制程度的加重而明显增加。结论采用免疫荧光组织化学检测膈肌Fn和HSP70抗原的表达,对判断限制性体位窒息死亡者膈肌的损伤是一种有意义的手段。     

悬挂双前肢致死兔的膈肌超微结构的研究

目的研究悬挂体位下窒息死亡动物的膈肌超微结构变化。方法取悬挂双前肢体位家兔的膈肌和腓肠肌组织,以勒颈致死家兔的膈肌和腓肠肌组织为对照,采用透射电镜方法观察其超微结构的变化。结果悬挂组膈肌的细胞核、细胞质、细胞膜均有缺氧损伤的征象,其中肌纤维内的肌原纤维、线粒体病变尤为严重;勒颈组膈肌的改变与悬挂组膈肌相类似,但程度上较轻微;悬挂组腓肠肌轻微病变,但肌原纤维无明显改变;勒颈组腓肠肌无明显改变。结论悬挂体位造成了膈肌纤维超微结构的损伤,形成了机体缺氧的病理基础,可导致死亡;本实验的结果可为限制性体位窒息死亡的法医学鉴定标准提供实验性的形态学依据。     

窒息相关案件的死因纠错分析3例

导致死亡发生的疾病、暴力或衰老等因素即为死亡原因,简称"死因"。确定死因是法医病理学的首要任务,然而在法医实践中,死因鉴定错误时有发生[1],造成不良社会影响[2-3]。对于死因鉴定错误的案例,国内外以个案报道为主,缺乏对鉴定错误成因的系统分析。机械性窒息是法医实践中常见的死因,尸体征象表现为颜面部发绀、瘀点性出血和器官淤血等,称为窒息征象。其不具有特异性,不同尸体变化较大,与窒息相关的案例容易产生误判。本文选取某地经办的3例窒息相关死因鉴定前后不符的案件进行纠错分析,为避免死因鉴定错误提供参考。     

特殊体位致窒息死亡1例

体位性窒息（positional asphyxia）是因长时间被限制于某种异常体位,使呼吸功能受阻及静脉回流受阻而发生窒息死亡。本文报道1例相关案例。     

监禁中猝死综合征

监禁中猝死综合征是由于高度紧张或躁动状态下,以及其他因素诸如酒精或其他药物的使用、犯人自身的生理情况、特定的强制性体位等因素共同作用下,发生被监禁人员死亡。由于其发生意外,缺乏特征性的尸检结果和毒物分析结果,而成为法医病理学工作者在法医鉴定实践工作中遇到的一个难题。本文总结了相关的危险因素,如犯人的精神状况、药物的使用、被擒拿时所处的体位以及肥胖等,为有效地预防此类事件的发生和法医鉴定工作提供参考。     

监禁中猝死综合征

监禁中猝死综合征是由于高度紧张或躁动状态下,以及其他因素诸如酒精或其他药物的使用、犯人自身的生理情况、特定的强制性体位等因素共同作用下,发生被监禁人员死亡.由于其发生意外,缺乏特征性的尸检结果和毒物分析结果,而成为法医病理学工作者在法医鉴定实践工作中遇到的一个难题.本文总结了相关的危险因素,如犯人的精神状况、药物的使用、被擒拿时所处的体位以及肥胖等,为有效地预防此类事件的发生和法医鉴定工作提供参考.     

2例体位性窒息死亡的法医学鉴定

体位性窒息 (ｐｏｓｉｔｉｏｎａｌａｓｐｈｙｘｉａ)死亡是一种特殊类型的罕见的机械性窒息死亡 ,指由于被强迫固定在一个特殊体位 ,造成呼吸运动障碍或致使上呼吸道阻塞导致的窒息死 ,具有明显的窒息死的一般特征。本文作者曾鉴定 2例 ,报道如下。1　案例资料例 1　尹某 ,男 ,2 3岁 ,因敲诈勒索被抓获 ,期间有打斗 ,后发现其神态有异 ,急送医院抢救 ,发现已经死亡。死后 2 7ｈ解剖。体表检查见两眼睑结膜有较多出血点。外耳道及口、鼻腔均未见异常。颜面部皮肤见多处小擦、挫伤。颌下皮肤见两处挫伤 ,分别为 1 5ｃｍ× 0 5ｃｍ、 1 2ｃｍ…     

“过劳死”的司法鉴定理论及实践探讨

"过劳死"是由于过度工作而引起的死亡,近年来随着人们工作、生活节奏不断加快,其现象频繁发生、见诸报端。该病最早在1969年见于日本报道,后在20世纪80年代末引起世界性关注。"过劳死"并非临床诊断定义,其隶属社会医学名词,其概念的界定于受害者能否获得劳动赔偿金及额度有关。通过对"过劳死"的近年来国内外流行病学调查整理、总结;并归纳、探究各文献报道的与"过劳死"发病密切相关的,诸如心脑血管疾病、工作压力及个人体质(疾病危险因素)等病因;同时,列举若干相关案例报道;最后,对"过劳死"的法律赔偿体系相关问题进行探讨,希望通过本文完善目前国内关于"过劳死"的研究。     

静脉推注大剂量庆大霉素急性中毒死亡1例

本文通过初步实验研究,结合一案例,探讨了庆大霉素静脉推注所产生的急性毒性作用及致死机理。初步研究的结果表明,大剂量静脉推注庆大霉素能引起一系列急性毒性反应,并可导致死亡。生化检测及病理检验均有一些改变,有助于法医检案中对此类死亡的鉴定。     

论社会发展进步与犯罪构成要件的敛缩

犯罪是一种法律社会现象,因此,对之既可以进行规范分析即刑法学研究,也可以进行社会学分析即刑法社会学研究。立于既有的规范研究的基础之上,本文采用刑法社会学的视角,具体论析了社会发展进步与犯罪构成要件的敛缩问题。     

Positional asphyxia: reflection on 2 cases

Positional asphyxia, a fatal condition arising because of the adoption of particular body positions, causing mechanical interference with pulmonary ventilation, can occur in various circumstances that are likely to come under the observation of the specialist in legal medicine (work, car accidents, torture, kidnapping, etc.). It is difficult to diagnose the cause of death in such cases because they generally present with an aspecific anatomopathologic picture. In some situations, positional asphyxia can be hard to distinguish from asphyxia because of chest compression. The main difference is in the way the event occurred: whether the particular position causing the asphyxia had been adopted by choice or by compulsion or necessity when an extrinsic mechanical action would result in traumatic asphyxia. The diagnosis of positional asphyxia is essentially based on 3 criteria: the body position must obstruct normal gas exchange, it must be impossible to move to another position, and other causes of natural or violent death must be excluded. To illustrate the main physiopathologic and diagnostic causes of positional asphyxia, the authors report 2 cases taken from the records of events that came under the observation of the Medico-Legal Sector of Bari University Hospital throughout the last 10 years.     

2633例机械性窒息法医尸检资料回顾性研究

本文根据湖北省部分地区1957～1986年间尸检记录,收集并分析了2633例机械性窒息死的出现率、案情性质、城市与乡村的差别等问题,为法医学实践提供了可供参考的资料。     

Asphyxial death during prone restraint revisited: a report of 21 cases

Determining the cause of death when a restrained person suddenly dies is a problem for death investigators. Twenty-one cases of death during prone restraint are reported as examples of the common elements and range of variation in these apparently asphyxial events. A reasonable diagnosis of restraint asphyxia can usually be made after ruling out other causes and collecting supportive participant and witness statements in a timely fashion. Common elements in this syndrome include prone restraint with pressure on the upper torso; handcuffing, leg restraint, or hogtying; acute psychosis and agitation, often stimulant drug induced; physical exertion and struggle; and obesity. Establishing a temporal association between the restraint and the sudden loss of consciousness/death is critical to making a correct determination of cause of death.     

危险评估与控制——新刑罚学的主张

在我们的社会中,少部分犯罪分子实施了大部分犯罪。如果能够“标定”出这些犯罪分子,并对他们加以控制,全社会的犯罪将会得到有效控制,而且犯罪控制成本将大大降低。所谓“标定”就是危险评估。经过长期探索,危险评估已经出现很多工具。如何使危险评估既保持较高的信度与效度,同时又提高可操作性,是危险评估研究与实践需要解决的重要问题。危险控制的措施主要有：延长具有高度危险罪犯的监禁期;构建罪犯的“危险”回应机制;确立“危险罪犯”标定与控制制度;性犯罪登记、公告制度。     

Infant death scene investigation and the assessment of potential risk factors for asphyxia: a review of 209 sudden unexpected infant deaths

At the Wayne County Medical Examiner Office (WCMEO) in Detroit, Michigan, from 2001 to 2004, thorough scene investigations were performed on 209 sudden and unexpected infant deaths, ages 3 days to 12 months. The 209 cases were reviewed to assess the position of the infant at the time of discovery and identify potential risk factors for asphyxia including bed sharing, witnessed overlay, wedging, strangulation, prone position, obstruction of the nose and mouth, coverage of the head by bedding and sleeping on a couch. Overall, one or more potential risk factors were identified in 178 of 209 cases (85.2%). The increasing awareness of infant positions at death has led to a dramatic reduction in the diagnosis of sudden infant death syndrome at the WCMEO. This study suggests that asphyxia plays a greater role in many sudden infant deaths than has been historically attributed to it.     

Household furniture tip-over deaths of young children

The potential for the injury or death of a child resulting from the tip-over of a piece of household furniture or a domestic appliance has not been previously well recognized. We reviewed nine accidental deaths of young children that resulted from avoidable residential hazards and/or lapses in supervision of the children by their caregivers. The offending household items included televisions, bedroom dressers, a kitchen stove, and a lounge chair. The causes of death were mechanical asphyxia, blunt trauma, and combined blunt head trauma and asphyxia. All of the deaths could have been prevented by appropriate anchoring of the piece of furniture and/or closer supervision of the child. A thorough multidisciplinary investigation is essential in establishing the cause and manner of death in such cases and in identifying risk factors that may aid in the prevention of future childhood deaths.     

Fatal accidental hanging by a high-chair waist strap in a 2-year-old girl

High chairs are commonly used to feed children after 6 months. Related injuries are oftentime minor and rarely leading to death. We describe a case of a 2-year-old female child who used to jump alone on her high chair and also had the habit to fasten the straps by herself. Her mother found her hanging by the waist straps. A thorough investigation showed that she climbed her high chair and fastened the waist straps but not the crotch one. The girl slid down into the seat, trapping her neck in the waist straps and thus resulting in hanging. In here, we concluded that the victim's death was caused by asphyxia, itself, caused by accidental hanging. The present case is of a special interest because of the rare similar cases reported. This case suggests that a correct restraint use and a close supervision would have prevented such a fatal issue.