54例氯化琥珀胆碱中毒案件的法医学分析

目的观察分析氯化琥珀胆碱中毒案件的法医学表现,以期提高氯化琥珀胆碱中毒的检验鉴定。方法收集54例氯化琥珀胆碱中毒案例,通过病理学、毒理学变化及案件特点进行回顾性分析,观察氯化琥珀胆碱中毒的检验鉴定规律。结果氯化琥珀胆碱中毒的病理学表现以急性肺淤血、肺水肿等一般猝死改变为主,部分死者心肌排列紊乱及断裂。死者心血中均检见琥珀胆碱成分,皮肤组织部分检见琥珀胆碱成分。结论氯化琥珀胆碱中毒具有死亡快、手段隐蔽、难以抢救、易漏检等特点。对于猝死案件、死因可疑案件应将氯化琥珀胆碱作为常规检验指标,防止此类案件的未检或漏检。     

The relationship of methanol and formate concentrations in fatalities where methanol is detected

An automated headspace gas chromatography method was developed for the determination of formate (formic acid) in postmortem specimens, based on the in situ sulfuric acid-methanol methylation of formic acid to methyl formate. Diisopropyl ether was used as an internal standard. The method was applied to over 150 postmortem cases where methanol was detected. Of the 153 cases presented, 107 deaths were attributed to acute methanol toxicity. In the vast majority of the remaining 46 deaths, the methanol was determined to be present as a postmortem or perimortem artifact, or was otherwise incidental to the cause of death. Of the 76 victims who were found dead and blood was collected by the medical examiner, all but one had a postmortem blood formate concentration greater than 0.50 g/L (mean 0.85 g/L; n = 74). The sole exception involved suicidal ingestion of methanol where the blood methanol concentration was 7.9 g/L (790 mg/100 mL) and blood formate 0.12 g/L. In 97% (72/74) of the cases where blood was available, the blood formate was between 0.60 and 1.40 g/L. In 31 of the 153 cases, the victim was hospitalized and blood obtained on admission or soon after was analyzed for methanol and formate during the subsequent death investigation; the vast majority (27/30) had antemortem blood formate concentrations greater than 0.50 g/L. Cases with samples taken prior to death with blood formate concentrations less than 0.5 g/L can readily be explained by active treatment such as dialysis. The blood formate method has also been useful in confirming probable perimortem or postmortem contamination of one of more fluids or tissues with methanol (e.g., windshield washer fluid or embalming fluid), where methanol ingestion was unlikely.     

Simultaneous Determination of 13 Anticoagulant Rodenticidesin Human Blood by Liquid Chromatography–Tandem Mass Spectrometry and its Application in Three Poisoning Cases

Anticoagulant rodenticides are widely used for rodent control around the world. A rapid and sensitive method was developed and validated for the simultaneous determination of 13 anticoagulant rodenticides (coumafuryl, pindone, valone, warfarin, coumatetralyl, coumachlor, diphacinone, dicumarol, chlorophacinone, bromadiolone, difenacoum, flocoumafen, and brodifacoum) in human blood by liquid chromatography–tandem mass spectrometry. After liquid–liquid extraction, the anticoagulant rodenticides were separated on an Eclipse Plus C18 column. Linearities were observed for each analyte in blood ranging from 0.5 to 50 ng/mL, with correlation coefficients over 0.99. The limits of detection ranged from 0.01 to 0.2 ng/mL, and the limits of quantification were 0.5 ng/mL for all analytes. The intraday and interday precisions were <15%, and accuracies ranged from 80.3% to 111.0%. This validated method with high sensitivity has been applied in three anticoagulant rodenticide poisoning cases and has been used successfully in monitoring blood concentrations for months.     

阿普唑仑在家兔体内的分布研究

建立生物检材内阿普唑仑的薄层扫描定性定量检测方法，研究阿普唑仑在染毒家兔体内的分布情况。家兔按21mg/Kg剂量灌胃染毒后4h，其体内肝、脾、肾、肺、心、脑、血、胆汁和尿内阿普唑仑的浓度分别为19．6±6．1、3．3±0．5、3．5±0．3、0．4±0．1、0．4±0．1、1．6±1．8、4．0±1．3、20．4±8．5和8.6±2．4（ug／g或ug／ml）。阿普唑仑在染毒家兔体内的分布不均匀，血、胆汁和尿是阿普唑仑中毒死者毒物分析较好的检材。     

Electroretinogram and Histopathologic Changes of the Retina after Methanol Intoxication

In order to study the functional and structural alterations of the retina in SD rat model after methanol intoxication,35 rats were divided randomly into five groups administrated with saline,3-day high dose,7-day high dose,3-day low dose and 7-day low dose methanol separately.The retinal function of each group was assessed by flash electroretinogram(F-ERG) 3 and 7 days after methanol poisoning.The microstructure and ultrastructure of the retina were observed at the same time.The high-dose methanol intoxication induced irreversible retinal functional and structural damages 3 days after poisoning,which included prolonged latency and reduced amplitude of the Max-reaction of F-ERG.These injuries were aggravated 7 days after poisoning.Meanwhile,the latency and amplitude of the Cone-reaction of F-ERG were also affected 3 days after poisoning,but there were no further worsening tendency 7 days after poisoning.The retinal histological analysis showed cellular edema,heteromorphy and disarrangement,tissular loosen of the inner nuclear layer and photoreceptors layer.The mitochondrial damage began at the photoreceptors layer and developed further into the inner nuclear layer.The low-dose methanol intoxication only caused transient damage of the retina.Our results showed that the function and structure of the photoreceptor and inner nuclear layer were the primary target of methanol intoxication and that the rod cells were more sensitive to methanol intoxication than the cone cells.The mitochondrial damage developed from outer layer to inner layer of the retina.     

论刑法第十七条中“投毒罪”的含义

现有的刑法学界通说认为，应当将《刑法》第十七条中规定的“投毒罪”解释为投放危险物质罪。但除投放有化学毒性的物质外，相对负刑事责任年龄阶段的未成年人很难对投放放射性、传染病病原体等危险物质有正确的认识。一次实证调查问卷的结果，也支持了这一观点，这一年龄阶段的未成年人很多时候对投放放射性物质、传染病病原体物质缺乏正确的认识；如果不得到专业人员的帮助和指导，他们也无法实施投放放射性物质、传染病病原体物质的行为。将《刑法》第十七条中的“投毒罪”解释为投放有化学毒性物质的犯罪行为，不存在法律漏洞，并且符合实质正义。     

氟硝西泮滥用及检测研究进展

具有镇静催眠作用的氟硝西泮曾在世界范围内被滥用,常被用于自杀、谋杀、迷奸、迷抢等案(事)件。近年其又成为俱乐部滥用药物之一。该药物在体内主要经肝脏代谢为7-氨基氟硝西泮和N-去甲基氟硝西泮,且7-氨基氟硝西泮的血药浓度常常大于血液中的母体药物浓度,大约90%的代谢产物经尿液排出,10%经粪便排出。目前报道的相关分析方法主要是对于血液、尿液、毛发、酒水饮品等检材经LLE、SPE、LPME等净化萃取后,采用毛细管电泳法、色谱法、质谱法及各种技术的联用,检测母体药物及相关代谢产物。本文对氟硝西泮的滥用、体内代谢以及样品的提取净化、仪器分析等进行总结,为相关案(事)件的办理提供参考。     

一起服毒自杀案件不同结果的分析

两例服毒者在同一地点、同一时间服毒,同时送往医院抢救,袁某服了一种药物抢救无效死亡。而张某服了两种大于袁某两倍剂量的药物,同时饮用了白酒,却经抢救脱险。本案例对二者服毒后产生的不同结果进行了分析。     

Toxicant Exposure and Mental Health—Individual, Social, and Public Health Considerations

Abstract:  Thoughts and moods are the result of biological processes; disordered thoughts and moods may be the result of disordered biological processes. As brain dysfunction can manifest with emotional symptoms or behavioral signs, the etiology of some mental health afflictions and some abnormal conduct is pathophysiological rather than pathopsychological. Various studies confirm that some chemical toxicants which modify brain physiology have the potential to affect mood, cognitive function, and to provoke socially undesirable outcomes. With pervasive concern about myriad chemical agents in the environment and resultant toxicant bioaccumulation, human exposure assessment has become a clinically relevant area of medical investigation. Adverse exposure and toxicant body burden should routinely be explored as an etiological determinant in assorted health afflictions including disordered thinking, moods, and behavior. The impact of toxicant bioaccumulation in a patient with neuropsychiatric symptoms is presented for consideration as an example of the potential benefit of recognizing and implementing exposure assessment.     

慢性乙醇中毒脑β-淀粉样前体蛋白与外伤性蛛网膜下腔出血死亡的关系

目的观察大鼠慢性乙醇中毒下脑组织轻微伤后β-淀粉样前体蛋白(β-amyloid precursor protein,β-APP)的表达,探讨乙醇中毒与外伤性蛛网膜下腔出血(traumatic subarachnoid haemorrhage,TSAH)死亡的相关性。方法雄性SD大鼠60只,随机分为灌水组、灌水打击组、灌酒组、灌酒打击组。灌酒组以食用酒连续灌胃4周,打击组予脑震荡打击,各组大鼠脑组织行HE、免疫组织化学染色,组织病理图像系统量化分析检测结果。结果灌水组脑无异常;灌水打击组全脑神经元轻度水样变性;灌酒组脑表面可见血管纹理,神经纤维排列稍疏松、间隙增大;灌酒打击组脑表面弥漫性淤血,脑干周围多见厚层斑片状TSAH,轴索不规则断裂。灌酒组额叶、海马、小脑、脑干β-APP IOD值高于灌水打击组及灌酒打击组。结论慢性乙醇中毒脑组织的耐受性明显下降,轻微损伤情况下即可引起致死性TSAH和神经病理学变化。