A promising microbiological test for the diagnosis of drowning

A number of biological and chemical tests have been developed over the years to determine whether a person was drowned. This study focuses on the potential of a microbiological test for detecting common bacterial markers of water faecal pollution such as faecal coliforms (FC) and faecal streptococci (FS) as possible indicators of drowning. A promising previous study was carried out on central and peripheral blood samples of 42 drowned victims (20 cases in saltwater and 22 cases in freshwater) and 30 not-drowned bodies. To improve the accuracy of our previous results and also in order to investigate a possible cause of a false positive due to pulmonary passive diffusion and subsequently endogenous or exogenous bacterial invasion of the blood in the post-mortem interval (PMI), the FC and FS test was applied to bodies submerged in water but died from causes other than drowning. In the present study, blood samples collected from the left ventricle (LV), right ventricle (RV), femoral artery (FA) and, femoral vein (FV) of 10 drowned victims (5 cases in freshwater and 5 cases in seawater) and 3 not-drowned individuals with bodies submerged in water for a while after death have been analysed. Preliminary results are in agreement with other reports dealing with diatoms and marine bacteria that suggest to exclude the hypothesis of a passive penetration of sufficient quantities of drowning medium into circulation after death or during the agonal period. Based on our results there is also no evidence of a relevant dissemination of endogenous micro-flora from the gastrointestinal tract affecting the FS and FC test. There are still several other factors that could influence the applicability of post-mortem FS and FC cultures for the diagnosis of drowning and they need further investigations. The present article provides only a glimpse of the potential of the FS and FC test as bacteriological method for the diagnosis of drowning.     

PCR-DGGE法检测浮游生物16S rDNA在溺死鉴定中的应用

目的建立并评估PCR-DGGE法检测浮游生物对溺死鉴定的应用价值。方法大白兔30只随机分为3组:溺死组(n=12),死后抛尸组(n=12)和对照组(n=6);溺死组和死后抛尸组又分为2个亚组:东湖水域组(n=6)和墨水湖水域组(n=6)。死后提取心血和肺、肝、肾、脑等组织,匀浆后,采用Percoll密度梯度离心法分离浮游生物并提取其DNA,PCR扩增浮游生物特异的16S rDNA片段后分别用琼脂糖凝胶电泳及DGGE检测分析。2个溺死案例检材同法检验。结果溺死组各组织器官中浮游生物检测多呈阳性:肺(100%)、肝(83%)、肾(75%)、心血(83%)、脑(42%);死后抛尸组仅2例肺组织(16.7%)检出阳性;对照组全部阴性。溺尸肺组织DGGE分型图谱与相应溺死点水样分型图谱相似,而与非溺死点水样分型结果差异显著。2实际案例均呈阳性。结论本方法不仅有助于定性诊断溺死,而且通过比较产物的多样性可以推断溺死地点,在法医学溺死鉴定中具有较大实用价值。     

非溺死尸体肺脏硅藻最大值在溺死鉴定中的应用初探

探讨非溺死尸体肺脏硅藻最大值（即空气吸入与检验污染之和的最大值）在溺死鉴定中的应用价值。用硝化-光镜法检测贵阳地区40例非溺死尸体肺脏硅藻含量的最大值，同时作了8例溺死尸体肺脏硅藻检验。非溺死组肺脏硅藻最大值2个／5g；溺死组有7例为56～463个／5g，1例是2个／5g。表明（1）水中尸体肺脏硅藻检验值大于最大值（2个／5g），可考虑为溺死；显著大于最大值（本文溺死组7例56～463个／5g）则可鉴定为溺死；（2）等于或小于最大值，提示干性溺死或抛尸入水，可结合尸检发现及案情鉴别。     

检测浮游生物叶绿素相关基因诊断溺死的实验研究

目的评估浮游生物叶绿素相关基因检测用于溺死诊断的价值。方法将18只大白兔随机分为溺死组（n=10）、死后抛尸组（n=6）和对照组（n=2）,各组分别取心血及肺、肝、肾、脑组织,分离浮游生物并提取其DNA,用PCR技术检测叶绿素相关基因EG（EG1和EG2）及SK（SK1和SK2）。同时用硝酸消化法检验肺和肝组织中的硅藻。结果溺死组心血及肺、肝、肾、脑组织中EG1分别检出9、10、9、7和8例阳性,EG2分别检出8、10、7、5和7例阳性;死后抛尸组仅在心血和肺组织中各检出1例EG1阳性;对照组各组织均未检出EG1和EG2。SK1、SK2除在溺死组心血、肺和肾有少数检出外（≤2例）,在其他组未检出扩增产物。硝酸消化法从溺死组肺、肝组织中分别有9例及3例检出硅藻,死后抛尸组仅在1例肺组织中检出。结论浮游生物叶绿素相关基因EG用于溺死诊断的阳性检出率要高于硝酸消化法,在溺死诊断中具有较高的应用价值。     

The use of bacteriological analysis of the blood in the diagnosis of death by drowning

Investigation of blood samples from the femoral vein of subjects drowned in water and died of other causes (control) was carried out. Penetration of microflora contained in water into the bloodflow of the drowned people was shown. Possibility of using bacteriologic analysis of the postmortal blood to diagnose death from drowning was stated. Ps. putida and Ps. fluorescens. that were not present in the blood of persons who had died of causes other than drowning were recommended as test bacteria. Selective media and methods to isolate the bacteria from the cadaveric blood were chosen.     

SEM/EDAX检测内脏异物元素成分诊断溺死

为探讨溺死诊断的依据和推断入水地点，用扫描电镜／X－射线谱仪（SEM／EDAX）检测19例溺死尸体及28只溺死兔的肺、肾、心、肝等组织异物颗粒及其元素成分和含量，并以陆地上死亡尸体14具及8只陆地上勒死兔（2只勒死后入水浸泡6天）作实验对照。结果发现，19例溺死尸体及28只溺死兔的肺边缘区呼吸性细支气管、肺泡管、肺泡囊及肺泡内均可见高能谱值的异物颗粒，其大小自数微米至数十微米不等，多为无定形异物颗粒或细小异物颗粒集落。其中元素成分为硅、铝、钙、铁、铬、钛、钼、铅、锡、铜、溴等，与入水地点溺液中所含元素成分相同；肾、心、肝组织异物颗粒检出率分别为77％、53％及47％，数量较少，颗粒较小，大小自1微米以下至十数微米。非溺死尸体及实验兔的肺、肾、心、肝组织未检出或偶尔检出异物颗粒，其元素成分多为铁、钙或硅等，可能是病理及生理性异物颗粒，如含铁血黄素、钙化灶等。用SEM／EDAX检测水中尸体组织中异物颗粒及其元素成分和含量，可以诊断溺死，推断入水区域，为明确案件性质和确定侦察范围提供科学依据。     

溺死相关浮游生物基因座的复合扩增体系

目的构建溺死相关浮游生物基因座的复合扩增体系,验证体系特异性并评估其在法医溺死诊断中的应用价值。方法针对溺死相关浮游生物同源基因序列,设计特异性引物,并用FAM、HEX、TAMRA、ROX、SIZ荧光染料分组标记,构建复合扩增体系;进行体系特异性验证;以16例实验猪样本评估体系检验效能;复合扩增体系、硅藻形态学MD-VF-Auto SEM检测法及硅藻rbc L基因PCR-CE检测法分别检测28例案件样本,比较分析应用效果。结果该复合扩增体系共包含14个基因座,可特异性扩增35种浮游藻类和3种浮游细菌,人、3种人体共生菌及8种浮游细菌均为阴性。以该体系检测溺死实验猪,阳性率为90%,非溺死实验猪均未检出;检测溺死案件样本,阳性率为96%,非溺死案件均未检出。复合扩增体系与MD-VF-Auto SEM法检测案件尸体肺、肝和肾的阳性率均不具有统计学差异(P>0.05),但其与硅藻rbcL基因PCR-CE法检测案件肝和肾的阳性率均具有统计学差异(P<0.05)。结论本文针对多种溺死相关浮游生物14个基因建立的复合扩增体系,具备多种靶物种的特异性遗传标记,且所需检材量小,提高了检测效能,在法医溺死鉴定中具有良好的应用前景。     

Serum strontium estimation as a diagnostic criterion of the type of drowning water

The estimation of serum strontium in rabbits before and after death by drowning, in soft or hard water, or by barbiturate intoxication is highly promising as a method in medicolegal practice. It not only diagnoses drowning but also indicates the type of drowning water. Atomic absorption spectrophotometry is a good method for the estimation.     

扫描电镜/能谱观察溺死和死后入水的法医学应用研究

目的探讨扫描电镜/能谱分析在溺死的法医学鉴定中的作用。方法实验选用20例已知生前入水尸体,11例已知的死后入水尸体和2例陆地死亡尸体。在每个肺叶各取3个切面,每个切面用扫描电镜取样台胶面与肺叶的切面充分接触,另在落水地点取水样一份,进行对比。扫描电镜取样台胶在切面上充分接触后封闭取材盒,真空干燥后,直接在扫描电镜下进行观察。结果20例生前入水尸体在肺组织中均检出异物颗粒,并且与对照水样中检出的异物颗粒相吻合;而死后入水的尸体和在陆地上死亡的尸体肺组织中均未检出明显的异物颗粒,3者比较P<0.0001。在肺组织支气管切面中,生前入水的20例中有15例检出异物颗粒,在边缘肺切面及中间切面中分别有13例检出异物颗粒,统计学无明显差异。结论本实验建立的肺脏内异物颗粒取材方法准确可靠实用。对综合判断案件的性质,判断溺死尸体入水地点的具有积极意义。较好地解决了实验室检验中的污染问题。腐败尸体对检测结果无影响。     

A delayed drowning death with histological findings of shock

A delayed drowning death case with histological findings of shock was described. The person was sustained by continuous positive-pressure respiration and died 2 days after resuscitation from drowning. The histological findings were intravascular microthrombi, hyaline bodies and fibrin thrombi in the brain, multiple megakaryocytes in the pulmonary capillaries, hyaline membranes of the lung, multiple small hyaline bodies in the liver sinusoids, and erosion of the mucous membrane of the stomach as well as histological findings of shock kidney. Drowning and systemic hypotension during resuscitation seemed to cause irreversible oxygen debt of the organs and the tissues to lead to shock.     

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.     

溺死的法医学鉴定

溺死的鉴定一直是基层法医鉴定工作中的难点,这是由于大部分溺死案例的特征性尸检所见很少,同时国际上很多学者对溺死的实验室检验存有疑义。本文查阅了国内外相关文献并结合作者多年来对溺死案例的实际鉴定经验,对溺死的法医学鉴定作出较系统的综述。     

Selective culturing and genus-specific PCR detection for identification of Aeromonas in tissue samples to assist the medico-legal diagnosis of death by drowning

The detection of autochthonous aquatic bacteria in tissue samples from drowning cases is increasingly considered as an alternative approach to assist the medico-legal diagnosis of death by drowning. Bacteria belonging to the genus Aeromonas may be suitable candidates for this application as they are ubiquitous in natural aquatic environments but are generally not part of the human microbiota. The research aims of this study were (i) to develop a sensitive, specific and rapid screening and confirmation method for Aeromonas species in tissue samples and (ii) to evaluate aseptic sternal puncture as a post-mortem sample technique and bone marrow as an alternative matrix to provide evidence of death by drowning. The presence of Aeromonas in tissue samples was verified by cultivation using the selective media Ampicillin Dextrin Agar (ADA) and Ryan's Aeromonas Medium. The use of ADA medium was found most optimal for the sensitive, inexpensive and quick detection of aeromonads in human tissue samples. Positive culture plates were confirmed by harvesting all colonies for DNA extraction and subsequent PCR amplification using Aeromonas genus-specific primers. Aeromonads were detected in lung swab, blood and bone marrow of drowned bodies (n=3), but were negative in these three matrices for all negative controls (n=90) tested. Bone marrow proved to be a suitable alternative matrix and can be sampled post-mortem by an aseptic sternal puncture. In conclusion, this study confirms previous indications that aeromonads in cultures from blood of water bodies can be considered a potential marker for drowning. Given the fact that the number of immersed bodies (drowned and non-drowned) included in this study is statistically not significant, however, more tissue samples need to be investigated to confirm the validity of these methods to aid the diagnosis of death by wet drowning.     

实时荧光定量PCR检测硅藻UPA基因在溺死诊断中的研究

目的建立硅藻UPA条形码基因的实时荧光定量PCR检测方法,探讨其在溺死诊断中的应用价值。方法对Gene Bank中登录的硅藻UPA基因序列进行比对获得同源序列,据其设计硅藻门通用引物。对2种人体常见共生菌(大肠杆菌、双歧杆菌)、3种浮游细菌、15种浮游藻类、32具尸体(其中生前溺水死亡28例,死后抛尸1例,陆地死亡3例)的组织样本(肺、肝、肾)及尸体发现地水样提取DNA,采用设计的引物进行特异性、灵敏度、重复性试验,分析检材中硅藻检出情况,统计硅藻阳性率,以上述组织样本的微波消解-真空抽滤-自动扫描电镜法检测结果对建立的q PCR检测方法进行比较评估,比较该方法与PCR-毛细管电泳检测法的灵敏度。结果引物UPA99仅对硅藻标准株(针杆藻、舟形藻、直链藻、小环藻、菱形藻)DNA具有扩增,扩增产物熔解曲线平稳,峰尖且窄,熔解温度为(87±1)℃。以p MD18-T重组质粒为标准品,检测区间为1.56×10~2-1.56×10^-5ng/μL,建立实时q PCR方法的灵敏度为1.56×10^-5ng/μL,而PCR-CE方法的灵敏度为1.56×10-3ng/μL。批间及批内变异系数均低于2%,具有较高的重复性和稳定性。对于生前溺水尸体肺、肝、肾的检出率依次为89.3%,71.4%,64.3%。结论基于硅藻UPA基因设计通用引物,建立的q PCR硅藻检验法特异性高、灵敏度高、重复性好,应用于溺死诊断具有较好的应用前景。     

溺死鉴定中硅藻检验的应用

在法医学检案中,溺死诊断以及入水地点的判定一直是重点和难点之一,硅藻检验被认为是一种相对可靠的诊断溺死的方法,而根据硅藻的群落特征推断其入水区域具有一定的可信度。对不同水域内硅藻进行研究,可为溺死鉴定及入水区域的判定提供参考。本文就硅藻相关的生物学特性、检验方法等相关的国内外研究进展进行综述,供法医学工作者在相关科研和检案实践中参考。     

微波消解-扫描电镜联用法在溺死诊断中的应用

目的探讨微波消解-扫描电镜联用法在溺死诊断中的应用价值。方法收集已知死因的尸体标本105例,其中水中尸体85例(生前溺死70例,死后抛尸入水15例),陆地自然死亡尸体20例。水中死亡案例同时收集落水处水样。分别用微波消解-扫描电镜联用法(方法 A)和硝酸破机-光镜联用法(方法 B)对上述尸体的离体肺、肝、肾、骨髓组织及水样进行硅藻定性、定量检测。结果①溺死尸体的肺、肝、肾、骨髓中及落水处水样硅藻检出率:A法分别为100%、94.3%、92.9%、82.9%、100%,硅藻检验阳性率为100%;B法分别为90%、62.9%、51.4%、28.6%、92.9%,硅藻检验阳性率为65.7%。②两种方法检出的硅藻种类与落水处水样中硅藻的种类均一致。③两种方法在死后入水尸体离体的肺中也检出少量硅藻(<3个/2g肺组织),但在死后入水尸体的其它脏器及陆地自然死亡尸体脏器中均未检出硅藻。结论微波消解-扫描电镜联用法较硝酸破机-光镜联用法对尸体离体组织脏器中的硅藻检出率高,方法灵敏,定性准确。     

Postmortem chest computed tomography for the diagnosis of drowning:a feasibility study

It may be difficult to distinguish the cause of death in drowning cases without specific findings. The aim of this study was to explore the forensic value of thoracic postmortem computed tomography (PMCT) using routine images and three-dimensional (3D) image reconstructions. The imaging data of PMCT examinations of six drowning cadavers, aged 21–54 years, were analyzed. Twelve victims of sudden death from coronary artery disease (CAD) were chosen as a control group. After 3D bilateral lung images were reconstructed using image processing software, an interactive medical image control system was used to measure and analyze parameters including lung volume, lung volume ratio, mean CT value of the whole lung, and lung CT value distribution curves. Lung volume and lung volume ratio were used to assess the shape changes of the lung. Lung CT value distribution curves showed the corresponding number of pixels of the different CT values in the lung image. Lung volume was not significantly larger in drowning cases (mean 2 958 cm³) than in controls (mean 2 342 cm³). Lung volume ratio values in the drowning group (mean 0.3156) were greater than those in the control group (mean 0.2763); (P = 0.02). There was no significant difference between the drowning and control group in the mean CT value of the whole lung. There were differences between lung CT value distribution curves in drowning victims and controls, with drowning victims showing a single peak and CAD cases showing a bimodal distribution. Thoracic PMCT is helpful for the forensic medical diagnosis of drowning. Lung volume ratio and lung CT value distribution are potential indicators to distinguish between drowning and CAD.