论濒危民俗文化知识产权行政保护管理机制——基于制度分析视角

目前,我国许多民间文化艺术形式正面临着割裂消失、甚至被异化的危险境地;中国传统的口头、形体和其他种类的艺术形式,譬如刺绣、印染、剪纸、雕刻、中医药、针灸等民俗文化遗产的生存发展和保护都面临困境。我国正式加入《保护非物质文化遗产公约》后,应当加强保护民俗文化遗产的行政管理机制,提高对民俗文化遗产保护和知识产权行政管理保护水平。     

Fatal nonatherosclerotic myocardial infarction in a young man with allergic bronchial asthma

A 34-year-old man with allergic asthma died an (instantaneous) sudden cardiac death as a result of multiple myocardial infarcts. These occurred in the absence of coronary atherosclerosis. The major mechanism by which the infarcts occurred was recurrent coronary artery spasm. The latter can occur spontaneously, asthma patients being particularly prone to it. However, various medications prescribed by different physicians may also have played a role.     

Fatal bilateral pneumothoraces after electroacupuncture treatment: A case report and literature review

Acupuncture is practiced as a complementary medicine worldwide. Although it is considered a safe practice, pneumothorax is one of its most common serious complications. However, there have been few reports of deaths due to pneumothorax after acupuncture treatment, especially focused on electroacupuncture. We report an autopsy case of a man in his 60s who went into cardiopulmonary arrest and died immediately after receiving electroacupuncture. Postmortem computed tomography (PMCT) showed bilateral pneumothoraces, as well as the presence of numerous gold threads embedded subcutaneously. An autopsy revealed two ecchymoses in the right thoracic cavity and a pinhole injury on the lower lobe of the right lung, suggesting that the needles had penetrated the lung. There were marked emphysematous changes in the lung, suggesting that rupture of bullae might also have contributed to bilateral pneumothoraces and fatal outcome. The acupuncture needles may have been drawn deeper into the body than at the time of insertion due to electrical pulses and muscle contraction, indicating the need for careful determination of treatment indications and technical safety measures, such as fail-safe mechanisms. This is the first case report of fatal bilateral pneumothoraces after electroacupuncture reported in the English literature. This case sheds light on the safety of electroacupuncture and the need for special care when administering it to patients with pulmonary disease who may be at a higher risk of pneumothorax. This is also the first report of three-dimensional reconstructed PMCT images showing the whole-body distribution of embedded gold acupuncture threads, which is unusual.     

Sudden death of a young asthmatic patient--allergic granulomatous angiitis (Churg-Strauss syndrome)

Churg-Strauss syndrome has three main criterions: 1) severe asthma with fever attacks, 2) extra- and intravascular granulomatous proliferations of epitheloid and giant cells, 3) inflammatory infiltrates rich in eosinophilic leukocytes. All these features were given in the case of a 19-year-old woman, who died suddenly. This paper deals with the morphological findings of the forensic autopsy.     

An Autopsy Case of Acute Massive Hematochezia Caused by Superior Mesenteric Vein Thrombosis: A First Report in Forensic Medicine

Superior mesenteric vein thrombosis (SMVT) is an uncommon cause of intestinal ischemia and massive gastrointestinal bleeding. This report describes a man with alcoholic liver cirrhosis, who died of massive hematochezia due to SMVT. A medicolegal autopsy disclosed a thrombus at the superior mesenteric vein and hemorrhagic infarction of the bowel wall, an area also within the territory of the superior mesenteric vein. Liver cirrhosis, an enlarged spleen, and esophageal varices without rupture were also observed, but ulcers and variceal bleeding were not. Other organs showed no significant findings. His blood alcohol level was 0.14% w/v. Thus, this man died from severe hematochezia associated with SMVT due to liver cirrhosis and alcohol dehydration, which can lead to coagulopathy and rapid progress of thrombus formation. This is the first report on an alternate cause for massive gastrointestinal hemorrhage with a cirrhotic patient in a forensic autopsy.     

Differential accumulation of pulmonary and cardiac mast cell-subsets and eosinophils between fatal anaphylaxis and asthma death: a postmortem comparative study

The distribution profile of infiltrated mast cell-subpopulations and eosinophils in the lung and heart sections of the patients who died of severe allergic hyperresponsiveness, was investigated. Four study groups were designed comprising 9 cases who died in systemic anaphylaxis (Group I), 10 asthmatic individuals whose death were assigned to acute and severe bronchial asthma (Group II), 10 asthmatic cases who died from non-immunological diseases (Group III). Twenty consecutive autopsies of non-allergic subjects who died of unnatural causes (Group IV) served as control group in this study. Utilizing antibodies against human tryptase and chymase and a double immunohistochemical staining method, we distinguished successfully all three subsets of mast cells (MC), MC-TC (containing both tryptase and chymase), MC-T (containing only tryptase) and MC-C (containing only chymase) types, subdivided on the basis of the protease compositions of their secretory granules. In order to immunostaining eosinophils, we used antibody to major basic protein as a marker. We also measured postmortem blood tryptase, specific and total serum IgE. The intriguing finding of this study was the marked differences of cellular composition in the lung between fatal anaphylaxis and asthma death. Significant augmentation of MCs infiltrated in lung and heart sections of anaphylaxis patients and drastic infiltration of bronchial eosinophils in asthmatic death and consequent release of their related inflammatory mediators might explain the differential expression of the associated symptoms in these two groups. The anaphylactic deaths did show neither emphysema nor significant mucous bronchial secretions whereas all asthmatic deaths did. The degree of pulmonary congestion and edema was also more severe in anaphylaxis. This corresponded with the histological findings and the location and number of mast cell-subsets and eosinophils in the different compartments of the lungs. We have demonstrated that the third type of mast cell MC-C is only found in the lungs in anaphylactic deaths. The practical consequence of our study will be that it is now possible to confirm a suspicion of anaphylaxis death not only by measurements of serum mast cell tryptase, but also by immunohistochemical methods.     

A Fatality Following Ingestion of the Designer Drug Meta‐Chlorophenylpiperazine (mCPP) in an Asthmatic—HPLC‐MS/MS Detection in Biofluids and Hair

A 20‐year‐old man, a cocaine addict and regular ecstasy user, with a medical history of allergic asthma died after ingesting half a tablet earlier the same day. The white tablet, stamped with a “smiling sun” logo looked very much like an ecstasy tablet and was sold as such. He experienced a severe asthma attack just after ingesting the half tablet and it evolved over the next few hours into fatal cardiorespiratory arrest. Biological samples, taken after embalming, were analyzed by high‐performance liquid chromatography tandem mass spectrometry (HPLC‐MS/MS). Analysis revealed meta‐chlorophenylpiperazine (mCPP) in concentrations of 45.8 mg in a similar tablet obtained later from the drug dealer, 5.1 ng/mL in the bile, 0.3 ng/g in the liver, 15.0 ng/mL in the urine, and its absence in a hair sample (<0.02 ng/mg), which indicated he was not a regular user (whereas strong concentrations of MDMA and cocaine were found in the hair). Interrogated by the police after his arrest, the dealer said that he had sold the victim and for the very first time two tablets with the same “smiling sun” logo. The tablet used for analysis was from the same brand as the one ingested by the victim. The autopsy excluded other causes of death, while the histological analyses showed a large number of polynuclear eosinophils in the bronchial walls, confirming the asthmatic pathology. None of the other organs examined (larynx, liver, heart, adrenal glands, and kidneys) showed any distinctive signs, and in particular no inflammatory infiltrate. The death was the result of an asthma attack in an asthmatic person, violently decompensated following ingestion of approximately 20 mg of mCPP.     

Sudden death due to cerebral leukemic hemorrhage occurring after acupuncture treatment for gingival bleeding

A 45-year-old woman who experienced stomalgia and gingival bleeding for several days died unexpectedly after acupuncture treatment. At autopsy, trivial injuries on the liver and the stomach and mild hemoperitoneum due to improper acupuncture were found. Also,acute lymphoblastic leukemia and hyperleukocytosis were diagnosed by postmortem examinations. Intracranial hemorrhage due to undiagnosed acute lymphoblastic leukemia was identified as the cause of death.Moreover, the relationship between therapeutic misadventure and death was also determined. We suggest that undiagnosed leukemia should be considered as a differential diagnosis when sudden death occurs owing to intracranial hemorrhage. If therapeutic misadventure was involved,it is also of great importance to assess the relationship between that and death in forensic expertise.     

Suicide by self-removal of a pacemaker

A 70-year-old man extracted his own pacemaker and subclavian port used for delivery of chemotherapy, both implanted 2 weeks earlier. The patient died of septicemia within 6 days. This fatal outcome illustrates the risks of complications associated with severe psychiatric disorders after implantation of prosthetic devices.     

An unusual case of accidental hypothermia due to cold water immersion

Accidental deaths due to hypothermia most commonly result from exposure to low environmental temperature. Generally, a cold climatic condition is present in a severe environmental setting. A case report is presented of a 58-year-old man who died from accidental hypothermia associated with immersion in cold water while on a farm during warm weather. The importance of an adequate death scene investigation is discussed.     

3 fatalities after communal use of methamphetamine]

Two young men and a 17-year-old girl gathered in order to take methamphetamine, the quantity of which remained unknown. After a short time one of the men died on the scene; the other man, who was alcoholized in addition to having taken methamphetamine, fell over a railing from a height of several metres and suffered severe injuries before dying. The girl, who left for home by taxi, collapsed and died in a hospital about 2 hours later. Methamphetamine was detected in the blood of all three people. The autopsy results and the toxicological findings are reported and discussed with reference to the literature data.     

Heuristics in causal reasoning and their influence on eyewitness testimony

Abstract

In two experiments the effect of knowledge of the seriousness of an event's outcome on the estimated strength of its causes was studied. In experiment 1 participants (n=87) were shown a video of a homeless man being evicted from a police station by a police officer, during which the evictee fell. One group of participants were told that the homeless man subsequently died; the other group was told that he was uninjured. Participants who thought the homeless man had died more often blamed the policeman for the man's fall. Estimations of the force of the push were not directly related to the outcome of the event, but rather to the attribution of blame, with those who blamed the officer giving higher estimates of the force of the push. In experiment 2, before watching a revised version of the video, the participants (n=88) were assigned to one of four groups. Groups A and B were told that the homeless man had died; groups C and D were told that he had survived. In an effort to counter interference of blame attribution, groups A and C were told that the officer was to blame for the man's fall, and groups B and D that the officer was not to blame. The manipulation of guilt was not successful, but this time a significant relation between event outcome and push force was found, with those who thought the homeless man had died giving higher estimates of the force of the push than those who thought that the man had survived. As in experiment 1, those who thought the homeless man had died more often blamed the policeman and those who blamed the policeman again gave higher estimates of the force of the push. It appears then that the more tragic the outcome of a violent incident, the more blame witnesses tend to attribute to the perpetrator, and the more they tend to overestimate the amount of violence involved.     

Suicide by intravenous injection of sublimate solution

A 19-year-old drug-dependent man tried to commit suicide by intravenous self-injection of 5 ml concentrated mercury II chloride solution. He arrived at an intensive-care unit 2 h later with predominantly gastrointestinal symptoms and died 70 h later, despite hemodialysis and antidote therapy. The pathologic-anatomical picture was dominated by severe acute sublimate nephrosis and a coagulation disorder. The highest Hg content was found in the kidneys (5.69 mg%); in the gastrointestinal tract the Hg concentration lay between 1.12 and 3.26 mg%.     

Acupuncture in drug treatment: Exploring its role and impact on participant behavior in the drug court setting

The originators of the Miami drug court incorporated acupuncture into the substance abuse treatment regimen that has been widely imitated in hundreds of drug courts since 1989. Although there is some evidence to suggest that acupuncture may be an effective adjunct to treatment more generally, research has not yet examined its role and impact in the drug court setting. This paper describes an effort to study the impact of acupuncture on offender behavior and progress in treatment in the Clark County, (Las Vegas) Nevada Drug Court using a prospective modified experiment, where 336 new participants were randomly assigned to acupuncture and no-acupuncture conditions. However, significant treatment contamination hindered straightforward analysis, as nearly 40% of the control group received at least some acupuncture. To compensate for the treatment compliance problem, two-stage least-squares (2SLS) regression is employed with original group assignment as an instrumental variable and acupuncture exposure as a predictor. Results indicate no significant difference along a range of criminal justice and treatment outcomes, with the exception of one measure of treatment progress. The paper concludes with a discussion of the implications of the findings and the need to design studies that are better able to separate the effects of acupuncture from other treatment and court interventions.     

Fall from height--surprising autopsy diagnosis in primarily unclear initial situations

External post-mortem examination and first police assessments are often not consistent with subsequent autopsy results. This is all the more surprising the more serious the injuries found at autopsy are. Such discrepancies result especially from an absence of gross external injuries, as demonstrated by four examples. A 42-year-old, externally uninjured male was found at night time in a helpless condition in the street and died in spite of resuscitation. Autopsy showed severe polytrauma with traumatic brain injury and lesions of the thoracic and abdominal organs. A jump from the third floor was identified as the cause. At dawn, a twenty-year-old male was found dead on the grounds of the adjacent house. Because of the blood-covered head the police assumed a traumatic head injury by strike impact. The external examination revealed only abrasions on the forehead and to a minor extent on the back. At autopsy a midfacial fracture, a trauma of the thorax and abdomen and fractures of the spine and pelvis were detected. Afterwards investigations showed that the man, intoxicated by alcohol, had fallen from the flat roof of a multistoried house. A 77-year-old man was found unconscious on his terrace at day time; a cerebral seizure was assumed. He was transferred to emergency care where he died. The corpse was externally inconspicuous. Autopsy revealed serious traumatic injuries of the brain, thorax, abdomen and pelvis, which could be explained by a fall from the balcony. A 47-year-old homeless person without any external injuries was found dead in a barn. An alcohol intoxication was assumed. At autopsy severe injuries of the brain and cervical spine were found which were the result of a fall from a height of 5 m. Conclusion: On the basis of an external post-mortem examination alone gross blunt force trauma cannot be reliably excluded.     

Determination of ethylene glycol tissue content after fatal oral poisoning and pathologic findings

A 23-year-old comatose man who had drunk an unknown amount of ethylene glycol was admitted to the hospital 5 hours after ingestion. The initial plasma ethylene glycol concentration was 116.2 mg/100 ml. A severe metabolic acidosis was present. Despite aggressive therapy with ethanol, hemodialysis, and intensive care support, the patient died 27 hours after poisoning. The plasma ethylene glycol concentration immediately before death was 35.9 mg/100 ml. Brain edema and acute renal tubular necrosis were evident at postmortem examination. Oxalate crystals were identified in both organs. Ethylene glycol content or concentration was determined in tissues and biologic fluids.     

Airway obstruction by laryngeal masses in sudden and homicidal deaths

We present two cases of autopsy detection of laryngeal masses with medico-legal implications. The first is a 56-year-old man who died suddenly of asphyxia due to upper airway obstruction caused by a large glosso-epiglottic retention cyst and glottic oedema. Hypothesis of medical liability was raised, due to delayed tracheotomy as the result of repeated failed attempts at oral intubation by various physicians. Difficult oral intubation due to the presence of a laryngeal mass in an asphyxiating subject requires rapid tracheotomy. The second case deals with a 43-year-old woman who died of asphyxia due to airway obstruction, as a result of injury of a cavernous laryngeal haemangioma after homicidal manual strangulation, with severe haemorrhagic infiltration of the surrounding soft tissues. Damage to laryngeal/hypopharyngeal masses should be considered as a possible sign of manual strangulation, as well as neck skin bruises/abrasions and laryngeal haemorrhages.     

类胰蛋白酶与过敏性休克死亡的法医学鉴定

目的探讨类胰蛋白酶与过敏性休克的关系。方法从类胰蛋白酶的生物学特性、正常人分布、检测方法及其与过敏性休克的关系,并应用ELISA方法检测三例尸体血清类胰蛋白酶的浓度,对三例过敏性休克死亡的案例作回顾性分析。结果两例血清中类胰蛋白酶的含量分别为52ng/ml和121ng/ml(高于正常值10倍以上),另一例浓度为0.73ng/ml。结论诊断过敏性休克,类胰蛋白酶含量的检测是很有意义的,但不能单凭检测结果下结论。     

Postmortem revelation of sickle cell disease following fatal episode of acute bronchial asthma

A 19-year-old black male with previous history of mild bronchial asthma presented sudden dyspnea and died in a state of respiratory distress in spite of resuscitation attempts. Autopsy showed typical lesions of acute bronchial asthma in a context of long-standing asthma associated with a massive and disseminated intravascular sickling. Hemoglobin electrophoresis diagnosed heterozygous sickle cell disease. This rare case raises the problem of the accuracy of death certificate, especially the difficulties to distinguish postmortem lesions as the underlying cause of death or the contributory cause of death.     

Post-traumatic venous and systemic air embolism associated with spinal epidural emphysema: multi-slice computed tomography diagnosis

A 30-year-old man was admitted with chest trauma after a road traffic accident. The patient was paraplegic and suffered from transient monoparesia of the left arm. The chest X-ray revealed a severe right tension pneumothorax and thoracic spine fractures. Emergency right thoracic drainage was carried out followed by angiography. Unfortunately the patient died and an autopsy was not permitted. Consequently post-mortem multi-slice computed tomography (MSCT) was performed, revealing presence of air inside the right cerebral arteries, bilateral pneumothorax accompanied by a severe right tension pneumothorax, bilateral haematic pleural effusion, pneumomediastinum and bilateral lung contusions. Air was also observed within the right coronary artery, ascending aorta and right ventricle. Thoracic and cervical spinal epidural emphysema were diagnosed. Venous air embolism followed by arterial air embolism producing paradoxical embolism was diagnosed. To the best of our knowledge, this is the first case illustrating by post-mortem MSCT such simultaneous complications after chest trauma as spinal epidural emphysema and cerebral and coronary air embolism.