原发性脑干损伤神经元凋亡及caspase3的表达

目的观察原发性脑干损伤（PBSI）致死者脑干神经元凋亡及caspase3的表达情况,探讨其法医学意义。方法选择法医学检案中30例确定为原发性脑干损伤致死者脑干,按伤后不同存活时间（t≤5min、5min〈t≤15min、15min〈t≤1h、1h〈t≤24h）分为4组,以5例非脑干损伤死亡者脑干为对照组;分别运用常规HE、免疫组化和TUNEL染色检测中脑、桥脑及延脑重要核团内神经元凋亡及caspase3的表达情况。结果原发性脑干损伤后15min～24h出现明显神经元细胞凋亡（23.2%～35.9%）和caspase3阳性表达（28%～54%）,并呈现随损伤时间进行性增加的趋势,与对照组有显著性差异（P〈0.01）。结论原发性脑干损伤早期即出现神经元凋亡及caspase3表达增加,并随损伤时间的延长呈进行性增加,可据此辅助诊断原发性脑干损伤死亡。     

固相萃取-液相色谱-串联质谱法测定全血中多塞平

目的建立固相萃取-液相色谱-串联质谱（SPE-LC-MS/MS）分析全血中多塞平的方法。方法以阿米替林为内标,全血样品经固相萃取处理后,通过液相色谱-串联质谱技术进行检测（电喷雾离子源正离子方式,多反应监测模式）。监测离子对m/z多塞平为280→107、280→235、280→220,阿米替林为278→233。多塞平和阿米替林的保留时间分别为15.15min和16.94min。结果全血中多塞平在0.005～1.00μg/mL质量浓度范围内呈线性关系,线性方程为y=3.2047x＋0.0339,相关系数（r）=0.9996,检出限为0.001μg/mL;平均提取回收率为78.0%～82.9%,日内精密度〈2.55%,日间精密度〈5.90%。结论本方法快速简便、灵敏、重现性好,适用于全血中多塞平的检测。     

气相色谱法快速分析人血、尿中地芬尼多

目的建立人血、尿中地芬尼多的气相色谱快速分析方法。方法用氯仿提取血、尿中的地芬尼多,采用气相色谱法进行定性、定量分析。以正常人血浆、尿液为空白样本,分别添加标准地芬尼多及SKF525（内标物）对方法进行考察和优化,并对1例大剂量误服地芬尼多中毒者体液浓度进行快速测定和检测。结果所建方法分析血、尿中地芬尼多的线性范围均为5.0～200.0μg/mL;最低检测限均为1.0μg/mL（S/N≥3）;日内、日间精密度RSD≤5.6%（n=5）;回收率：血≤（106.23±2.05）%;尿≤（104.19±5.51）%。结论该分析方法操作便捷、实用,适用于地芬尼多的临床血药浓度快速监测和法医毒物鉴定。     

保存温度与时间对生物样品中氯胺酮稳定性的影响

目的研究不同温度和时间条件保存时生物样品中氯胺酮的稳定性。方法家兔以氯胺酮150mg/kg灌胃,30min后处死,取其血、肝、肾、脑,分别在室温（18～24℃）和冷冻（-20℃）条件下保存,并用气相色谱-质谱法定性分析、气相色谱-氮磷检测器法测定不同时间各样品中氯胺酮含量。结果血、肝、肾、脑冷冻保存至第30天氯胺酮含量均降低（P〈0.05）;室温条件下各样品中氯胺酮含量自第5天起均升高（P〈0.05）。结论生物样品在冷冻条件下保存时氯胺酮稳定性较好,怀疑氯胺酮中毒或死亡的检材应冷冻保存,尽快检测。     

LC-MS/MS分析人全血中五氟利多

目的建立人体全血中五氟利多浓度的液相色谱-质谱联用法（LC-MS/MS）分析方法。方法全血中五氟利多和利培酮（内标）经正己烷液-液提取后,采用Capcell Pak C18色谱柱（250mm×2.0mm5,μm）进行分离,流动相为乙腈：20mmol/L乙酸胺和0.1%甲酸溶液（75∶25,V/V）,流速为0.2mL/min,然后以MS/MS电喷雾正电离的多反应监测扫描方式（MRM）测定。用于定量分析的离子为m/z 524→109（五氟利多）和m/z 411→191（内标）。结果五氟利多的最低检测限为0.2ng/mL,在0.4～400ng/mL浓度范围内线性良好（r=0.9994）,低、中、高浓度（1ng/mL、10ng/mL、100ng/mL）准确度分别为97%,108%和95%,日内和日间RSD均小于15%。结论该方法简便、快速、灵敏,适用于全血中五氟利多浓度的测定。     

甲胺磷在犬体内的死后分布

目的建立甲胺磷的犬灌胃染毒致死模型,观察甲胺磷在犬体内的死后分布规律。方法犬经8倍LD50（7.4mg/kg）剂量甲胺磷灌胃后,观察其中毒症状,死亡后即刻解剖,分别取心、肝、脾、肺、肾、脑、右上肢肌、右下肢肌、胸肌、胃组织、心血、胆汁、玻璃体液和尿液,GC/MS和GC法检测其中甲胺磷含量。结果犬8倍LD50甲胺磷灌胃染毒后20min内出现中毒症状（,53.3±14.1）min死亡。各组织脏器及体液中甲胺磷含量由高到低分别为胃（99.84±0.87）μg/g、脾（46.87±28.67）μg/g、肝（43.82±22.74）μg/g、肾（43.79±29.04）μg/g、心血（35.36±13.98）μg/mL、肺（35.25±18.59）μg/g、尿34.81μg/mL、胸肌（19.23±17.18）μg/g、右上肢（16.92±8.98）μg/g、心（15.09±6.11）μg/g、右下肢（12.83±7.63）μg/g、脑（10.91±4.13）μg/g、胆汁（6.75±1.45）μg/mL、玻璃体液（6.22±4.97）μg/mL。结论甲胺磷在犬体内死后分布不均,胃、脾、肝、肾、心血、肺、尿检材中含量较高,可作为疑似甲胺磷中毒毒物分析的检材。     

创伤性脑损伤大鼠水通道蛋白4表达变化及法医学意义

目的观察大鼠颅脑损伤后不同时间内水通道蛋白4（AQP4）mRNA表达的变化，探讨AQP4在脑损伤经过时间推断中的意义。方法利用液压冲击法制作不同程度大鼠颅脑损伤模型，在伤后不同时间（0．5、2、6、12、24、48、72h），应用RT-PCR法检测脑组织AQP4 mRNA表达，同时以非损伤组做对照。结果不同程度颅脑损伤后0．5h脑组织AQP4 mRNA表达均开始上调（P〈0．01），6、12h依次增高，24h达到高峰，差异均有统计学意义（P〈0．01），72h时仍维持较高水平（P〈0．01）；0．5h时轻度、中度、重度脑损伤时AQP4 mRNA的表达差异两两之间无统计学意义（P〉0．05），2、6、12、24、48、72h轻度、中度、重度脑损伤时AQP4 mRNA的表达差异两两之间有统计学意义（P〈0．01）。结论颅脑损伤后AQP4 mRNA呈现出时序性变化，其变化规律可望成为法医学推断早期脑损伤时间的指标之一。     

液相色谱-串联质谱法测定血液、尿液中乙基葡萄糖醛酸苷

目的建立血液、尿液中乙基葡萄糖醛酸苷（ethyl glucuronide,EtG）的液相色谱-串联质谱（LC-MS/MS）检测方法。方法血液、尿液用乙腈沉淀蛋白,离心后取上清液用LC-MS/MS检测。结果血液、尿液中EtG的检出限均为0.05μg/mL,线性范围均为0.10～5.00μg/mL（r〉0.999）,检测方法准确度为95%～109%,日间及日内精密度〈12%。对送检案例血液中EtG进行检测,效果良好。结论本方法适用于血液、尿液中EtG的检测。     

生物检材中芬太尼和舒芬太尼的HPLC-MS/MS分析

目的建立血、肝组织中芬太尼和舒芬太尼的HPLC-MS/MS分析方法。方法采用Oasis（MCX固相萃取柱进行提取,以XTerraTMRP18柱（2.1mm×100mm,3.5μm）色谱柱分离,以乙腈∶5mmol/L醋酸铵水溶液（氨水调pH=9.5）（65∶35）为流动相,流速为0.2mL/min。结果血及肝组织添加样品的线性范围为10ng/mL～500ng/mL,最小检出限为0.1ng/mL。结论本方法准确、快速,可用于生物检材血、肝组织中芬太尼和舒芬太尼的定性定量分析。     

大鼠急性心肌缺血后脑钠肽、c-fos基因的表达及法医学意义

目的研究大鼠在急性心肌缺血（acute myocardial ischemia,AMI）后目的基因脑钠肽（brain natriuretic peptide,BNP）和c-fos的mRNA表达变化与AMI发生后所经历时间的关系,为法医病理学鉴定心源性猝死提供依据。方法用结扎法制作大鼠AMI动物模型,结扎成功后观察时间组为10、30、60min和3h,用RT-qPCR、普通PCR检测目的基因BNP和c-fos的mRNA表达变化,同时行HE染色。比较不同时间组间的结果差异。结果RT-qPCR结果显示,BNP在3h组的表达量高于正常组、10min组、30min组及60min组,有显著性差异（P〈0.05）,c-fos除正常组与10min组之间、30min组与3h组之间无显著性差异（P≥0.05）以外,其他各组间均有显著性差异（P〈0.05）,并以60min组c-fos基因的表达量最多。普通PCR未见目的基因不同时间的组间差异。HE染色仅在实验组3h组偶见局部嗜酸性增强、肌纤维呈波浪状等改变。结论c-fos基因可能作为缺血发生30min后的辅助诊断指标。RT-qPCR方法较适合早期AMI的诊断。     

交通事故致胸、腰椎损伤致残等级评定447例分析

目的探讨车祸致胸、腰椎损伤程度与伤残程度的关系,总结伤残评定经验,探寻其规律性。方法选择胸、腰椎损伤的鉴定447例,重新审查诊断,分析治疗措施,评价胸腰部活动度丧失程度及神经功能障碍情况,分析损伤程度与后遗障碍之间的关系,综合评定伤残。结果胸、腰椎损伤类型及数量并不决定其胸、腰部活动障碍程度及神经损伤后遗症严重程度;椎体损伤的部位与胸腰部活动度障碍关系密切;神经损伤主要集中在T1至L2段脊柱损伤;椎体损伤医院误诊率较高。结论伤残评定应分析损伤与后遗症严重程度的因果关系,以损伤所致后遗症为评残依据,重点关注脊柱功能的丧失程度。     

Research Progress on Function Evaluation Standard and Method of Lower Extremity ImpairmentCSCD

The lower extremity impairment can be caused by illness, accident, work-related injury, traffic accident and fighting, etc. The injuries of lower extremity joint, nerve, muscle and tendon may lead to lower extremity dysfunction. So far, there is no unified standard for international and domestic function evaluation of lower extremity impairment, the evaluation standards in the same field are also different, and function evaluation of lower extremity impairment has no complete research system. However, the degree of lower extremity impairment has great influence on personal damage compensation. Therefore, the function evaluation of lower extremity impairment often becomes a dispute issue in forensic medicine identification. This article summarizes the function evaluation standards, methods and status quo of lower extremity impairment, so as to provide a new insight into the research on standardization of lower extremity impairment. © 2018 by the Editorial Department of Journal of Forensic Medicine.     

Survey of methods for the rating of psychiatric impairment in Australia

One of the enduring clinical issues in the assessment of plaintiffs in personal injury and workers' compensation claims, as well as applicants for social security and disablement benefits, is that of the evaluation of impairment and work incapacity. Many writers on this topic confuse the concepts of impairment and disability, and similar confusion is reflected in a number of the rating methods that purport to evaluate impairment but in reality assess disability. In Australia there are 20 distinct statutory schemes for workers' compensation, motor accident compensation, and social security and other benefits, which utilise a variety of methods for the rating of psychiatric impairment. Recent legislative changes designed to restrict access to personal injury compensation at common law, which in two Australian State jurisdictions require the use of impairment rating scales, also specify the rating methods to be used in the assessment of psychiatric impairment. This article discusses the concepts of impairment and disability as defined by the World Health Organisation, and reviews the various methods for the rating of psychiatric impairment that are specified by statute in the federal and State jurisdictions in Australia.     

肩关节损伤致肢体功能障碍程度评价方法比较

目的探讨能客观反映肩关节功能障碍对肢体功能影响的评价方法。方法通过用我国《道路交通事故受伤人员伤残评定》（简称＂《道标》＂）的权重指数法与美国《永久残损评定指南》（Guides to the Evaluation of Permanent Impairment,GEPI）（简称GEPI法）,对133例肩关节损伤后伤残评定案例进行回顾性评价;并用两种评价方法对肩关节不同运动方向及不同活动度对上肢功能影响进行全方位的比较。结果 133例肩关节功能障碍案例,权重指数法达到伤残的总比例高于GEPI法;但在功能丧失不同比例段两者有差异。差异的原因在于,在GEPI法中,肩关节不同运动方向所占的权重不同,前屈上举与外展上举对于肩关节功能相对重要,并考虑关节功能位对肢体障碍程度的影响;而权重指数法,上肢功能的关系与关节活动度呈简单的线性关系,与关节活动方向及功能位无关。结论 GEPI法比权重指数法能更能客观地反映肩关节功能障碍对肢体功能丧失的影响程度。     

Forensic medical expertise of injuries in the anorectal region and rectum unrelated to attempts at sexual abuse

The results of analysis of 46 commission forensic medical expertises are presented based on the materials concerning injuries and changes in the anorectal region and rectum unrelated to attempts at sexual abuse. The materials were collected and stored by the Primorskoye territorial Bureau of forensic medical expertise during 5 years, from 2005 to 2009. All injuries and changes were categorized into several groups in terms of their origin, viz. car accidents, inadequate medical care, insertion of foreign bodies, falls on sharp and protruding objects, gunshot wounds, chemical and thermal burns, sports training, etc. The occurrence of the injuries is illustrated by the examples from forensic medical practice. It is concluded that experts describing injuries and changes in the anorectal region and rectum must act in conformity with the order of the Russian Ministry of Health No 346 dated October 21, 2010) and use instrumental methods and terminology accepted in modern proctology. The severity of harm to health in subjects presenting with injuries and changes in the anorectal region and rectum should be evaluated in terms of both the degree of the threat to life and the outcome of the treatment with special reference to the duration of health impairment, severity of the trauma, and its consequences (anorectal dysfunction).     

肘关节损伤致上肢功能障碍程度评价方法的比较

目的 比较我国<道路交通事故受伤人员伤残评定>(简称<道标>)与美国<永久残损评定指南>(简称GEPI)对肘关节活动功能障碍致上肢功能丧失程度的评价结果.方法 对70例肘关节活动功能障碍者分别用上述两种方法评价上肢功能丧失程度,并对两种方法评价结果进行分析比较.结果 两种方法评价结果的差异具有统计学意义.当肘关节屈伸活...     

道路交通事故眼损伤伤残评定的标准化和规范化

GB18667-2002《道路交通事故受伤人员伤残评定》标准（以下简称“标准”）中有关眼损伤的条款较为原则和笼统。随着“标准”的广泛应用,加之法医学和临床眼科学技术的不断进步,对眼损伤后遗症的检验技术和认识水平已有较大的提高。建议采用视力表投影仪代替国际视力表进行行为视力检查,存在屈光不正的应了解屈光度后再检查其矫正视力;疑有伪盲或伪装视力降低时,可行伪盲试验或伪装视力降低的检验,视觉电生理技术是测试伪盲或伪装视力降低的有效方法。运用电脑视野计可进行视野检查,动态视野检查结果可通过视野有效值换算为残存视野半径（或直径）;视野检查存在一定的干扰因素,分析时应密切结合原发损伤及其他检查结果。对于遗留复视等双眼视障碍的,可采用同视机等检查方法,检验结果应考察功能障碍与眼肌等原发性损伤的符合性。泪器损伤后遗留溢泪症状的,应采用相应的检查方法证实泪道狭窄或梗阻。眼睑下垂及眼睑畸形分为轻度及重度;眼睑畸形包括闭合不全、眼睑缺损及眼睑外翻等情形。影响视力的外伤性白内障符合“标准”相关条款的规定。根据现行“标准”对道路交通事故所致眼损伤进行伤残评定,应进行视觉功能检测、眼球结构检查、伪盲试验及视觉电生理检测,最后综合病史材料及既往情况综合分析,得出评定结果。统一对现行“标准”的理解,规范检测手段和结果评价原则,有助于道路交通事故眼损伤伤残评定的标准化和规范化。     

Motor Vehicle Collisions and Their Consequences—Part II: Predictors of Impairment and Disability

A significant number of persons involved in motor vehicle collisions (MVCs) evidence persistent changes in physical, psychosocial, and cognitive functioning consequent to physical injury. While post-injury impairment and disability can sometimes be predicted with knowledge of injury type and injury severity, post-injury experiences of pain, psychological distress, cognitive dysfunction, and role disruption have been determined to contribute to injury-related impairment and disability. This article represents the second part of a two-part review of MVCs and their consequences. In part I of the review, research findings related to physical, psychosocial, and cognitive changes that occur consequent to injury-causing MVCs are described. In this article, measures used to document the severity of physical injuries are reviewed, along with the most widely accepted definitions of impairment and disability. Models that have been proposed to explain the progression from injury to impairment and disability are reviewed, including a more recently proposed model created specifically to guide the assessment and management of MVC-related outcomes. The greater part of this article is devoted to the review of findings related to physical, psychological, and cognitive predictors of post-MVC impairment and disability. The relation of these predictors to post-MVC impairment and disability is described across three specific injury contexts: (1) whiplash-associated disorders, (2) traumatic brain injury, and (3) polytrauma. In each context, findings related to recovery of function in the form of return to work are summarized, along with findings related to the contribution of compensation to injury-related symptoms and impairments. Although not characterized as a physical injury, chronic pain serves frequently as the post-injury symptom that persists beyond all injury management and rehabilitation efforts and that contributes significantly to MVC-related functional impairment, disability, and emotional distress. It is appropriate, therefore, to include in this review a discussion of those MVC studies that specifically address impairment and disability occurring in relation to chronic pain. The article ends with the identification of ongoing research challenges and future directions for both the study of MVCs and their associated sequelae and clinical practice with persons who are experiencing the consequences of MVC-related injuries.     

Fatalities by ingestion of propylene glycol

Propylene glycol (PG), a widely used solvent and lubricant, is thought to have low toxicity when ingested. Three cases were identified where PG, either alone or in combination with other chemical agents, contributed to death. The decedent in whom PG was the sole agent was a 32-year-old schizophrenic man with cardiomegaly and renal impairment. The blood PG concentration was 4410 mg/L at least 9.5 h following ingestion.