青壮年猝死综合征心肌细胞内纤维连接蛋白免疫组化观察初探

本文应用免疫组化ＬＳＡＢ法首次对５例青壮年碎死综合征和１１例非心性死亡对照组进行心肌细胞内纤维连接蛋白的研究。发现青壮年猝死综合征５例中有３例心肌细胞内纤维连接蛋白阳性。１１例非心性死、对照组心肌细胞内纤维连接蛋白均呈阴性。说明上述３例青壮年猝死综合征的心肌细胞已发生不可逆损伤，实属早期心肌梗死。该研究为青壮年猝死综合征的死因研究提供了一个新的方向和手段。     

脑死亡若干法律问题研究

脑死亡是刑法学中与人的生命保护界限密切相关的问题。脑死亡的新观念虽然面临挑战 ,但其科学合理性毋庸置疑。脑死亡的时间应当以全脑机能不可逆性丧失时为准。脑死亡的概念与判定标准 ,有必要在器官移植法中予以规定。     

Legal aid for coroners' inquests

Inquests held into deaths perform important functions, not only in determining the facts relevant to the death, but also in investigating and making recommendations on matters of public safety. Coronial legislation allows a number of parties to appear at inquests but a right of appearance without the possibility of legal representation is an illusory right. There are persuasive arguments for allocating funding for grants of legal aid to persons appearing at inquests and particularly to families. However, the demands on public legal aid funds are overwhelming and there are many competing needs. Historically, legal aid has not been available at inquests. Justifications for this are considered and whether government legal aid funding for advice and representation should be available to individuals involved in coroners' inquests and in what circumstances. The nature of the inquest process, indications of need for legal assistance, the level of assistance currently provided, defining what is the "public interest" for legal aid purposes in an inquest and the detriment suffered by individuals or the community if assistance is not available, are examined.     

论农地的公益性及农地征收中的公益衡量

我国的农地是农民集体与集体成员的财产而不是公共财产,但同时却承载着法律保护的公共利益,如经济安全、环境保护与社会稳定.因此,农地征收内含着目的公益与客体公益的冲突与平衡问题.鉴于我国现行农地征收制度与实践对农地公益保护的不足,建议未来的集体土地征收立法改进农地公益保护模式,提高农地征收的公益标准,仅将重大公益作为农地征收的目的要件,严格控制重大公益的范围,并健全公益审查程序,以实现农地公益与征收公益的平衡.     

网络经济中相关市场的界定

在网络经济条件下,相关市场的界定要全面考虑产品、地域和时间三个维度。网络效应使得市场对价格的敏感度降低,导致传统SSNIP测试法失效,而应用产品性能测试法和盈利模式测试法能更有效地界定相关产品市场。双边市场特征要求把网络平台两端的市场视为一个整体进行相关市场的测度。网络的普遍存在和全球可达性使得相关地域市场极为广阔,但也因网络接入和网络内容服务的不同性质使其呈现出相异的边界。时间成为网络经济中需要普遍考虑的维度,坚持长远发展原则和可预期范围内原则,结合网络产品的生命周期和知识产权保护期限,最终对相关时间市场的范围作出合理的界定。     

Value of bacteriologic studies within the scope of forensic autopsies

The various questions regarding bacteriological investigations within the scope of forensic autopsies are discussed in the light of our own cases and with regard to the relevant literature: estimate of the age of the corpse on the basis of decomposition changes caused by bacteria; determination of so-called bacteriograms from the point of view of criminalistics; supplementary investigations of the cause of death. Iatrogenic infections (e.g., gangrene) are gone into in more detail, as is so-called infantile botulism within the scope of the "sudden infant death syndrome". Finally, it is pointed out that when doing forensic autopsies, thought should also be given to illnesses that have only been known for a few years, examples being legionnaires' disease and the toxic shock syndrome ("tampon sickness").     

Further observations on the speed of death in hanging

Given that most fatal hangings are suicidal and occur in locations that have been selected to conceal this activity (thus maximizing the chances of a lethal outcome), there has been very little corroboration of the speed with which unconsciousness and death may occur. A 35-year-old male is reported who committed suicide by hanging immediately after talking to his spouse. Police investigations confirmed her reliability as a witness indicating that lethal anoxia in this case had occurred within a very short time (most likely in less than 1 min) of suspension. The speed with which death may result from hanging not only gives an insight into fatal pathophysiological mechanisms, but also provides useful information for situations where a lethal outcome is to be avoided, or is not intended. For example, individuals at risk of suicide who are being monitored in institutional facilities need to be constantly under direct visual surveillance as significant hypoxia can be rapidly induced, parents and caregivers with infants and children in potentially unsafe sleeping environments need to realize how swiftly death or irreversible anoxic brain damage may occur from neck compression, and those who engage in recreational asphyxia should be informed just how quickly a fatal outcome may ensue.     

Criteria for the interpretation of cocaine levels in human biological samples and their relation to the cause of death

The determination that cocaine is directly responsible for the immediate cause of death should be considered only when there is a reasonably complete understanding of the circumstances or facts surrounding the death. Another, more obvious and immediate cause of death must be absent, or, at least cocaine must be shown to be a significant contributing factor in the chain of medical findings that lead directly to the immediate cause of death. Not all death investigation requires the sequential steps described in this paper, but these steps must be considered early on in the investigation whenever there is scene, investigational, medical or a historical basis to believe that cocaine is directly related to the cause of death. A relatively high profile death when cocaine is known to be involved, or a death involving unusual behavior on the part of the deceased with police involvement are examples where these considerations may well apply. Information needs to be obtained as soon as possible to have the highest chance of successfully documenting the toxicologic basis for the diagnosis. These facts would include, but would not necessarily be limited to, a scene investigation (whenever possible), a careful review of the investigative reports from all involved agencies, the initial core temperature of the body as well as that of the environment at the time of the collapse or death, the past medical history of the individual, and the results of a complete forensic autopsy and toxicologic studies. Knowledge of and an understanding of the current relevant forensic literature on this subject should be available to the reviewer prior to any interpretation of the significance of cocaine upon a specific death.     

Interleukin-6 and C-reactive protein serum levels in sepsis-related fatalities during the early postmortem period

Postmortem interleukin-6 (IL-6) and C-reactive protein (CRP) serum levels were investigated prospectively in sepsis-related fatalities and non-septic fatalities by using a linear regression model. At least three blood samples were collected between 0.3 and 139 h postmortem from sepsis-related fatalities (n=8) and non-septic fatalities (n=16). In addition, one antemortem blood sample was collected shortly before death from the septic patients. Antemortem and postmortem IL-6 and CRP levels were highly elevated in all individuals included in the sepsis group. An excessive postmortem increase of IL-6 serum levels associated with progressive time after death was observed in five out of the eight septic patients. Both, IL-6 and CRP serum concentrations seem to be suitable biochemical postmortem markers of sepsis. The determination of IL-6 serum levels above 1500 pg/ml in peripheral venous blood obtained in the early postmortem interval can be considered as a diagnostic hint towards an underlying septic condition. A more precise postmortem discrimination between sepsis and non-septic underlying causes of death is provided by the postmortem measurement of serum CRP in peripheral venous blood: on condition that at least two postmortem CRP values have been determined at different time points postmortem, the CRP level of a deceased at the time of death can be calculated by using linear regression analysis. When assessing postmortem IL-6 and CRP concentrations as biochemical postmortem markers of sepsis, various clinical conditions, such as a preceding trauma or burn injury going along with elevated IL-6 and/or CRP levels prior to death as a result of the systemic inflammatory response syndrome (SIRS) should be taken into consideration, thus adding relevant information for the practical interpretation of the results.     

Prospects for the use of bacteriological method to establish the fact of death by drowning

Bacteriological studies of cadaveric blood for the presence of Pseudomonas putida and Pseudomonas fluorescence have demonstrated that identification of these microorganisms may be considered as an evidence of death by drowning. These bacteria are typical "aqueous" organisms non-pathogenic for man. They do not grow at a temperature of 41 degrees C and therefore are usually absent in normal human microflora. It is concluded that the establishment of the fact and location of death by drowning based on the analysis of plankton composition should be supplemented by identification of various forms of Pseudomonas in cadaveric blood.     

The neurological determination of death: what does it really mean?

The recent Canadian forum's recommendations regarding "neurological determination of death" claim to have determined a "Canadian definition, criteria, and minimum testing requirements for neurological determination of death." In this review the problems with this statement are discussed. The criterion of neurological determination of death does not fulfill the definition of death, because there is continued integration of the organism as a whole. The tests for neurological determination of death do not fulfill the criterion of neurological determination of death because they do not show the irreversible loss of all critical brain functions. The forum has provided no coherent argument for why neurological determination of death should be considered death. I suggest that one cannot invoke expert opinion to clarify a criterion of death, and tests for this criterion of death, without a clear concept of what death is. The forum has clarified tests for what they call "neurological determination of death," but this is not death itself; rather, it is a neurologically devastating state. Whether this state of "neurological determination of death" is enough to justify the morality of harvesting organs prior to death is the real question. A potential solution to this question is discussed.     

故意杀人罪的死刑裁量基准——“丁汉忠案”的文本梳理和法理审视

目前我国有关故意杀人罪中死刑裁量因素的审查难有真切、统一的基准,而在司法实践中对相关刑法条文含义的理解和阐释较为草率;最高人民法院的指导性案例体现的裁判趣旨未得到充分领会;各量刑因素的作用莫衷一是、标准不一,“估堆”量刑的困境萦绕其间,因而须探索故意杀人罪中相对合理的死刑裁量基准。具体而言,须区分各量刑因素的轻重、位阶,建构以责任刑为主、预防刑为辅的死刑裁量基准。至于是否入围死刑圈主要是仰仗责任刑阶段的判断。若责任刑阶段均是从严因素,基本会入围死刑圈的审查。死刑圈内的三种准刑种如何抉择,取决于对行为人的人身危险性判断。在预防刑阶段若均是从宽因素,一般死缓的判决即可满足要求;若从宽因素和从严因素交错,死缓限制减刑的判决基本可满足要求;若只有从严因素,则有判决死刑立即执行的可能。     

The Whole-Brain Concept of Death Remains Optimum Public Policy

"Brain death," the determination of human death by showing the irreversible loss of all clinical functions of the brain, has become a worldwide practice. A biophilosophical account of brain death requires four sequential tasks: (1) agreeing on the paradigm of death, a set of preconditions that frame the discussion; (2) determining the definition of death by making explicit the consensual concept of death; (3) determining the criterion of death that proves the definition has been fulfilled by being both necessary and sufficient for death; and (4) determining the tests of death for physicians to employ at the patient's bedside to demonstrate that the criterion of death has been fulfilled. The best definition of death is "the cessation of functioning of the organism as a whole." The whole-brain criterion is the only criterion that is both necessary and sufficient for death. Brain death tests are used only in the unusual case in which a patient's ventilation is being supported. Brain death critics have identified weaknesses in its formulation. But despite its shortcomings, the whole-brain death formulation comprises a concept and public policy that make intuitive and practical sense and that has been well accepted by many societies.     

Is routine histopathologic examination beneficial in all medicolegal autopsies?

Postmortem examinations are performed for a number of reasons. Medical autopsies are performed at the request of and with the consent of the next of kin of a decedent and are often requested to determine the extent of a disease process or to evaluate therapy. In contrast, medicolegal autopsies are performed by a forensic pathologist primarily to determine cause and manner of death but also to document trauma, diagnose potentially infectious diseases and report them to the appropriate agencies, provide information to families about potentially inheritable diseases, provide information to family members and investigative agencies, and testify in court. As medicolegal and hospital autopsies differ in their purpose, so do they differ in procedure. Medicolegal autopsies often include histologic analysis, but not always, as with medical autopsies. We designed a prospective study to address the question of whether or not routine histologic examination is useful in medicolegal cases, defining a routine case as one where histology would not normally be performed and where the cause and manner of death were readily apparent during the gross autopsy. We reviewed brain, heart, liver, kidney, and lung sections on 189 routine forensic cases and compared the results to the gross anatomic findings. Of the 189 cases, in only 1 case did microscopic examination affect the cause of death and in no case did microscopic examination affect the manner of death. Thus, we feel that routine microscopic examination (performing histologic examination in all cases regardless of cause and manner of death) in forensic autopsy is unnecessary. Microscopic examination should be used, as needed, in certain circumstances but is not necessary as a matter of routine.     

试论企业市场支配地位之认定

市场支配地位的认定在各国反垄断法的企业合并监控制度中居于核心的地位.市场支配地位包括独占、准独占、突出的市场地位和寡占等类型.市场支配地位的认定应当遵循以下程序与规则:首先,界定企业的相关市场;其次,应当衡量该市场的集中度水平;再次,还应当充分考虑市场进入、市场容量、市场技术创新等相关因素.综合考量上述多种因素之后才能准确认定企业是否具有市场支配地位.     

The Evanston initial decision: is there a future for patient flow analysis?

This Article analyzes the October 2005 Initial Decision of the Federal Trade Commission Administrative Law Judge ordering Evanston Northwestern Healthcare Corporation to divest Highland Park Hospital on the grounds that the January 2000 merger of the entities violated Section 7 of the Clayton Act. In particular, this Article focuses on the ALJ's discussion of the use of patient flow analysis and the Elzinga-Hogarty test in defining relevant markets in hospital merger cases. Despite the ALJ's explicit rejection of the Elzinga-Hogarty Test and patient flow analysis as irrelevant and inappropriate in defining markets in the highly differentiated Hospital market, the author concludes that the ALJ's rejection of patient flow analysis likely was a response to misplaced and over-reliance on patient flow analysis by a number of courts in past prospective government challenges to hospital mergers as evidenced by the fact that the ALJ's analysis of competition and competitive effects relied upon, and thereby implicity endorsed, the use of patient flow analysis for certain purposes. Finally, the author concludes that patient flowanalysis, when used appropriately, should continue to be used as a preliminary step in geographic market definition and competitive effects analysis.     

Current issues in medical liability

Currently, liability discussions are being dominated by AIDS and the legal problems associated with birth and death. The introduction of routine AIDS tests without the knowledge of those concerned is disputed heatedly and, in fact, may well constitute bodily assault and render those responsible liable to prosecution. In AIDS cases, the apparent breach of the Hippocratic oath of secrecy by Physicians can be justified on the grounds of both the extraordinary circumstances prevailing and conflicting duties. The transmission of AIDS could give rise to prosecution for causing bodily injury or manslaughter. The drawing up of a law to protect embryos is designed to establish legal constraints in the fields of reproduction and gene technology. In reframing section 168 StGB, which provides protection to the dead embryo, legislators assume that the head of a medical clinic is the lawful custodian of the corpse of a person who has died in his institution. This should help to resolve many of the problems arising from post-mortem examinations. The questions of euthanasia and medical assistance in cases of suicide were raised at the 1986 Conference of German Lawyers. Whereas medical treatment that could be considered as interference with the natural process of dying may be withdrawn in the case of irreversible terminal suffering, active euthanasia, i.e. the deliberate killing of a terminal patient, was rejected. With regard to noninterference in a suicide attempt by a third party, the free decision of the person wishing to commit suicide should be respected. In general, however, the maxim in dubio pro vita should be respected and where any doubt exists, an attempt should be made to save the person's life.     

Cardiac Inhibitory Reflex as a Cause/Mechanism of Death

The role of cardiac inhibitory reflex as a potential cause of death is still a matter of debate. This study reports two cases of death under unusual circumstances. Case 1 corresponds to a man found hanging where the role of ligature compression of the carotid sinus became relevant as a possible explanation of death. In Case 2, the participation of a vasovagal syncope was clearly triggered by the laryngoscopic procedure. It is proposed that cardiac inhibitory reflex should be taken into account in those cases of unexpected death, which fulfills the following three criteria: (i) The investigation of the circumstances of the death is consistent with a hypothesis of cardiac arrest. (ii) A typical triggering peripheral stimulus is present. (iii) The performance of a complete autopsy cannot rule out the participation of a cardiac inhibitory reflex in the cause of death.     

死刑程序的正当化

死刑程序正当化的要求应高于非死刑案件,主要表现在对死刑的适用应有更严格的程序,对于面对死刑的人应赋予更多的诉讼权利。《公民权利和政治权利国际公约》以及《关于保护死刑犯权利的保障措施》从审判程序、诉讼权利、证明标准等方面确立了死刑案件程序正当化的最低标准。参照这一标准,并针对我国有关死刑程序的立法与司法现状,应采取相应的改革措施,即死刑案件的审理程序可分为定罪程序和量刑程序,应完善死刑复核程序和执行程序,应区分死刑案件和非死刑案件的证明标准,还要加强面对死刑的人强制辩护权的保护。