Flunitrazepam: an evaluation of use, abuse and toxicity.

The benzodiazepine flunitrazepam is extensively prescribed to patients with insomnia in many countries, but has also become popular among alcohol- and drug abusers. Several reports indicate that it is used as a date rape drug and suggest that it may precipitate violent behavior. Furthermore, flunitrazepam is involved in many fatal intoxications in Sweden. This study was designed and conducted to explore the negative consequences of flunitrazepam abuse in Sweden, and to assess the trends in its use and abuse. The occurrence of flunitrazepam in cases referred to the Department of Forensic Chemistry in Link?ping, Sweden 1992-1998, was investigated in detail. The detections were studied separately for different groups; medicolegal death investigations, drug abuse cases, driving under influence cases, and other medicolegal cases. These data were further compared with the sales, and seizures by the Swedish Customs and the Swedish Police. During 1992-1998, 641 fatalities occurred, where the cause of death was attributed to intoxication with flunitrazepam solely (130) or in combination with other drugs, or concomitant conditions (511). In 78% of all driving under influence cases, where flunitrazepam was detected, the analyses also disclosed the presence of illicit drugs. A similar association was seen in drug abuse cases. The seizures reported by the Swedish Customs revealed a substantial and increasing illegal trade. Cases, where flunitrazepam seemingly induced violent behavior were identified, and one of these is described in some detail. It is concluded that the abuse pattern and the toxicity of flunitrazepam should be kept in mind by forensic investigators and that this panorama also should be considered when decisions about the registration and classification of flunitrazepam are made in different countries.     

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。     

Carisoprodol, meprobamate, and driving impairment

This paper considers the pharmacology of the centrally acting muscle relaxant carisoprodol, and its metabolite meprobamate, which is also administered as an anxiolytic in its own right. Literature implicating these drugs in impaired driving is also reviewed. A series of 104 incidents in which these drugs were detected in the blood of drivers involved in accidents or arrested for impaired driving was considered, with respect to the analytical toxicology results, patterns of drug use in these subjects, the driving behaviors exhibited, and the symptoms observed in the drivers. Symptomatology and driving impairment were consistent with other CNS depressants, most notably alcohol. Reported driving behaviors included erratic lane travel, weaving, driving slowly, swerving, stopping in traffic, and hitting parked cars and other stationary objects. Drivers on contact by the police displayed poor balance and coordination, horizontal gaze nystagmus, bloodshot eyes, unsteadiness, slurred speech, slow responses, tendency to doze off or fall asleep, difficulty standing, walking or exiting their vehicles, and disorientation. Many of these cases had alcohol or other centrally acting drugs present also, making difficult the attribution of the documented impairment specifically to carisoprodol and meprobamate. In 21 cases, however, no other drugs were detected, and similar symptoms were present. Impairment appeared to be possible at any concentration of these two drugs; however, the most severe driving impairment and most overt symptoms of intoxication were noted when the combined concentration exceeded 10 mg/L, a level still within the normal therapeutic range.     

Transfer of DNA without contact from used clothing,pillowcases and towels by shaking agitation

DNA is frequently retrieved from commonly used objects or surfaces with no apparent biological stains. This DNA may have come from one or more individuals who directly deposited their DNA, or indirectly transferred the DNA of others, when physically contacting the sampled object or surface. Furthermore, contactless indirect DNA transfer of this ‘touch DNA’ from fabric substrates was recently demonstrated to be possible in a controlled laboratory environment. The circumstances and extent to which this form of contactless DNA transfer occurs are largely unknown. This study investigated indirect DNA transfer without contact by applying a gentle shaking agitation to used clothing, pillowcases and towels, with known usage and history, of 10 volunteers above the collection zone of the secondary surface. DNA transfer frequently occurred and was possible from all three investigated items. It occurred at levels that often produced informative profiles where transferred profiles closely resembled the profiles generated from the primary item. The outcomes of this study contribute to expanding the understanding of indirect DNA transfer without contact. However, this field would benefit from investigating a wider range of agitations and/or item types with various histories of use to determine the level of transfer and its detectability under different conditions.     

From the waist up: developing psychomotor skills for the court room

A vital aspect of successful advocacy is effective engagement by the advocate with the Bench (and jury). However, rarely are these skills naturally occurring or at least the natural (untailored) psychomotor repertoire is not necessarily well adapted to advocacy. More often these skills are developed or refined to the specific requirements of advocacy by mooting practice. Assisting future advocates to develop effective psychomotor skills therefore is a core component of any mooting programme. This article explains the relevance of the psychomotor domain to advocacy and identifies the matters that must be addressed with mooters in order for them appropriately to develop these skills. In so doing, it positions the mooting psychomotor domain in context with the cognitive and affective domains.     

Authoritarianism,religiosity and reactions to deviance

A modified F-Scale and a deviance-control scale were administered to a sample of 116 police science students and a random representative sample of 91 state university students. No overall relationship was found between respondents' preference to control deviance and their authoritarianism, nor did the F-Scale discriminate between the two groups. However, the police sample favored the control of deviance significantly more. Evidence of response bias to the F-Scale was also found. It was concluded that the source of the criminal sanction usually typified as moral indignation, was more a cognitively based evaluation than an emotionally based reaction.     

Fatal paradoxical air embolism diagnosed by postmortem imaging and autopsy

The recognition and visualization of an arterial gas embolism are difficult. We report a case of sudden death caused by paradoxical air embolism of coronary and cerebral arteries, diagnosed by the pre autopsy computed tomography (CT) scanning. A 54-year-old woman suddenly died after the self-removal of the jugular vein catheter. Postmortem imaging examination using CT scanning showed multiple gas embolisms in the cerebral arteries, pulmonary artery, right atrium and ventricle, left ventricle, aorta, and coronary arteries. These findings suggested that the occurrence of acute ischemia of the brain and heart caused by massive air inflow to the artery. Conventional autopsy revealed a patent foramen ovale of the heart. These results indicated that the patient died of paradoxical air embolization of the coronary and cerebral arteries through a patent foramen ovale because of right-to-left shunting. The use of postmortem imaging as an aid for conventional autopsy has proved to be of advantage in the case of gas embolism.     

The Effect of Flunitrazepam (Rohypnol®) on the Development of Chrysomya megacephala (Fabricius, 1794) (Diptera: Calliphoridae) and its Implications for Forensic Entomology

This study investigated the potential effects of flunitrazepam (known as “date rape drug”) on the developmental cycle of Chrysomya megacephala, an important forensic species, and their possible implications for the calculation of the PMI. A 1050 C. megacephala eggs were divided into five groups with seven replications each. The eggs were placed on artificial diet prepared with four drug concentrations of flunitrazepam (4, 8, 16, and 32 ng/g), besides the control group (prepared with water). Were evaluated the potential effects on development time, weight gain, and mortality during the cycles. The drug had no significant effect on development time or mortality although it did affect the weight of the pupae and adults (Kruskal–Wallis, p < 0.05). The result can be deduced that the determination of the postmortem interval is not affected.     

Zaleplon and driving impairment

Zaleplon, a sedative-hypnotic, was identified in the blood of a subject arrested for impaired driving. Symptoms reported were those of central nervous system (CNS) depression. The zaleplon concentration was determined to be 0.13 microg/mL. Symptoms included slow movements and reactions, poor coordination, and lack of balance. Although no quantitative relationship between blood concentrations and degree of driving impairment is currently possible, it is reasonable to conclude that because of its specific activity as a sedative-hypnotic, blood concentrations consistent with doses exceeding therapeutic concentrations of zaleplon have the potential to cause impairment of psychomotor function, and would impair a person's level of consciousness and driving ability.     

Zolpidem and driving impairment

Zolpidem, a non-benzodiazepine hypnotic, was identified in the blood of 29 subjects arrested for impaired driving. Zolpidem concentrations ranged from 0.05 to 1.4 mg/L (mean 0.29 mg/L, median 0.19 mg/L). In the subjects whose cases we reviewed where zolpidem was present with other drugs and/or alcohol, symptoms reported were generally those of CNS depression. Symptoms included slow movements and reactions, slow and slurred speech, poor coordination, lack of balance, flaccid muscle tone, and horizontal and vertical gaze nystagmus. In five separate cases, where zolpidem was the only drug detected (0.08-1.40 mg/L, mean 0.65 mg/L, median 0.47 mg/L), signs of impairment included slow and slurred speech, slow reflexes, disorientation, lack of balance and coordination, and "blacking out." Although no quantitative relationship between blood concentrations and degree of driving impairment is currently possible, it is reasonable to conclude that because of its specific activity as a sleep inducer, blood concentrations consistent with therapeutic doses of zolpidem have the potential to affect driving in a negative way, and that concentrations above the normal therapeutic range would further impair a person's level of consciousness and driving ability.     

《人体损伤致残程度分级》与GEPI对足踝伤残评定的比较

目的本文通过对《人体损伤致残程度分级》和GEPI有关下肢足踝评定的内容进行比较研究,为《人体损伤致残程度分级》的修订提供建议。方法从条款分布、两个标准适用时的具体评定方法等方面对二者进行比较,并以GEPI足踝评定的残损值为参照,计算、分析《人体损伤致残程度分级》下肢条款致残率合理性。结果在跟骨骨折和踝关节创伤性关节炎评定方面,两个标准存在良好的对应性;在踝关节功能评定方面,除关节强直固定于非功能位的致残率略高于GEPI外,《人体损伤致残程度分级》其他条款与GEPI均具有良好的对应性。而在足弓结构破坏和足趾功能评定方面,两个标准对应性差,《人体损伤致残程度分级》评定的致残率明显高于GEPI。结论通过两个标准下肢足踝评定的比较,可以发现目前《人体损伤致残程度分级》的不足之处,提示在足弓结构破坏和足趾功能评定方面可能存在问题,需要进一步完善。     

3,4-Methylenedioxymethamphetamine (MDMA, ecstasy) and driving impairment.

3,4-Methylenedioxymethamphetamine, or MDMA, is increasing in popularity in the United States as a drug of abuse. It has stimulant and empathogenic mood altering properties with the potential to affect psychomotor skills and impact driving. This report reviews the literature relating to the relevant psychomotor effects of the drug, the relationship between dose and blood concentrations, and studies and case reports on specific effects of the drug on driving. The latter reports include both laboratory driving simulator studies and anecdotal reports, and case series. We also report details of eighteen cases of apparent MDMA impaired driving, including six drivers whose blood tested positive for MDMA alone. Most subjects displayed muscle twitching and body tremors, dilated pupils, slow pupillary reaction to light, elevated pulse and blood pressure, lack of balance and coordination, and most were perspiring profusely. Five of the six subjects were given field sobriety tests (one leg stand, walk and turn test), and all five performed poorly. There was no clear correlation between the blood concentration of MDMA and the specific demeanor of the subject. These findings are consistent with other reports, and lead to the conclusion that MDMA use is not consistent with safe driving, and that impairment of various types may persist for a considerable time after last use.     

《损伤程度》与《致残分级》关于脊柱四肢评定条款的比较

本文对《人体损伤程度鉴定标准》和《人体损伤致残程度分级》有关脊柱四肢评定方面的条款进行比较研究。从结构破坏、功能障碍、结构破坏合并功能障碍等方面分析两者的异同,为损伤程度和致残程度评定提供借鉴。     

GHB and driving impairment.

Gamma hydroxybutyrate (GHB) was identified in the blood of 13 subjects arrested for impaired driving. GHB concentrations ranged from 26 to 155 mg/L (mean 87 mg/L, median 95 mg/L). In eight cases, GHB was the only drug detected, and signs of impairment were consistent with those of a CNS depressant, including erratic driving (weaving, swerving, ignoring road signs), confusion, incoherent speech, unresponsiveness, lack of balance, unsteady coordination, poor performances on field sobriety tests, and varying states of wakefulness. Given the ability of GHB to induce sleep and unconsciousness, it is evident from these cases that recreational use of the drug has the potential to impair a person's driving ability.     

慢性疼痛与残疾评定——以《永久性残损评定指南》为背景

疼痛是一种具有感觉、情感、认知和社会成分的不愉快经历,慢性疼痛可对个体日常生活造成影响.本文以美国《永久性残损评定指南》为背景,对慢性疼痛的概念、神经机制、生物-心理-社会模型及负面影响进行概述,并简要介绍了《永久性残损评定指南》第6版中疼痛伤残评定的原则、方法及争议等内容.以期为慢性疼痛纳入我国残疾评定体系提供方向与...