硅藻定量分析在溺死诊断中的应用

目的 对水中尸体硅藻检验案例进行回顾性分析,探讨硅藻定量分析在溺死诊断中的应用价值。方法 收集水中尸体共490例,根据死因分为溺死组和死后入水组,采用微波消解-真空抽滤-自动扫描电子显微镜法对肺、肝、肾组织及水样进行硅藻定量分析,并计算肺组织与水样硅藻含量的比值（CL/CD值）。结果溺死组肺、肝和肾组织同时检出的有400例（85.5%）,肺、肝、肾组织和水样中硅藻含量分别为（113 235.9±317 868.1）、（26.7±75.6）、（23.3±52.2）和（12 113.3±21 760.0）个/10 g,硅藻种类数分别为（7.5±2.8）、（2.6±1.9）、（2.9±2.1）、（8.9±3.0）种。溺死组和死后入水组CL/CD值分别为（100.6±830.7）、（0.3±0.4）。结论 硅藻定量分析可为溺死诊断提供支持性证据,引入CL/CD值这一参数进行分析,能更准确地作出溺死的诊断。     

肺血液坠积现象判断溺死的辅助作用

目的 研究溺死和非溺死尸体中肺血液坠积现象,评估该现象在辅助溺死法医病理学死因判断中的价值。方法 收集广州市2011年1月—2021年6月以来经系统尸体检验明确死因的案件235例,按照尸体发现位置分为水中尸体组（97例）和非水中尸体组（138例）,水中尸体组又分为水中溺死组（90例）和水中非溺死组（7例）,非水中尸体组分为非水中溺死组（1例）、非水中非溺死组（137例）,经3名资深法医病理学家独立对案件尸体解剖照片进行阅片,判断肺组织是否出现血液坠积,统计肺血液坠积现象的检出率。结果 水中溺死组（90例）肺血液坠积现象检出率为0,阴性率为100%;水中非溺死组（7例）肺血液坠积现象检出率为100%,阴性率为0,两组检出率差异有统计学意义（P<0.05）;水中尸体组肺血液坠积现象检出率为7.22%,非水中尸体组（剔除2例后剩余136例）肺血液坠积现象检出率为87.50%,差异有统计学意义（P<0.05）。结论肺血液坠积现象阴性是溺死的特征性尸体征象,可辅助溺死的法医病理学诊断。     

PMCT的溺死诊断价值研究

目的 对溺死组和非溺死组PMCT影像学测量数据进行统计分析，筛选出可用于诊断溺死的可靠性指标，以辅助诊断溺死。方法 以175例北京水域溺死的尸体为溺死组，91例非溺死尸体为非溺死组，经全身多层螺旋CT扫描后采集影像学数据，进行对比分析。结果 上颌窦积液CT值溺死组明显低于非溺死组（p <0.05）；气管内积液CT值溺死组明显低于非溺死组（p <0.05）；左心室液体CT值溺死组明显低于非溺死组（p <0.05）；左心房液体CT值溺死组明显低于非溺死组（p <0.05）；胃内容物CT值溺死组明显低于非溺死组（p <0.05）。结论 溺死组上颌窦、气管内常见积液，且溺死组上颌窦积液CT值、气管内积液CT值、左心室和左心房液体CT值和胃内容物CT值明显低于非溺死组，综合分析可作为诊断溺死的可靠指标，PMCT对诊断溺死具有辅助价值。     

溺死尸体器官硅藻检出率季节性差异

目的 研究溺水死亡者肺、肝、肾、骨髓等器官淡水硅藻检出率可能存在的季节性差异,为法医学解决水中尸体死因鉴定提供技术帮助与科学证据.方法 收集2009～2011年1、4、7、10月沈阳市浑河中溺死尸体每月(组)各5例;45只家兔分相应月份生前、死后入水组及对照组,分别于当月发现水中尸体后第2天入水,取人及兔肺、肝、肾、股骨骨髓及现场水样备检,应用酶消化法检测各组器官中硅藻数量、种属并与现场水样比对.结果 各组溺死尸体肺中均检出多量硅藻且种属与现场水样一致,春、秋及冬季溺死尸体肝、肾中仅可检出少量体积较小的小环藻等中心纲硅藻,夏季肝、肾及骨髓中均未检出硅藻;各组溺死家兔肺中均检出少量小环藻等中心纲硅藻,肝、肾及骨髓中未检出硅藻.结论 硅藻种群的季节性变化及不同种群硅藻体积的差异可能造成肝、肾等大循环器官中硅藻检出率的季节性差异;仅肺中检出硅藻,肝、肾中硅藻检验结果阴性并不能排除溺死可能.     

溺死家兔内脏花粉检验的研究

用醋酸酥法破机，显微镜下观察内脏组织中花粉。12只溺死家兔的肺边缘组织检出率为100％（肺组织含花粉500粒／g左右），肝为50％，肾为33．3％；溺死后1天，1周、2周三组解剖，肺边缘组织花粉计数值无明显差异，证明花粉具有很强的抗腐败能力，可以作为水中高度腐败尸体死因鉴定依据之一。同时，水体沉积物花粉港能够反映入水地点的植被状况，为判断和认定溺死者的入水地点提供依据；此法尤其适用于冰水等硅藻和浮游生物很少的水体中的生前入水溺死的诊断。     

112例他杀溺死案件的回顾性研究

水中尸体的检验是法医尸检的常见内容,主要解决死因及死亡性质问题。即是否溺死及溺死性质判断等问题。部分案例尚需鉴定尸体身源、入水地点、尸体损伤等问题,从而为查清案情提供科学依据。目前对水中尸体鉴定死因是否溺死并不难,即使是高度腐败甚至白骨化尸体,通过硅藻检验也可鉴定是否溺死。但溺死的性质判断常是一大难题,单纯通过尸体检查常常难以确证,尤其是高度腐败甚至白骨化尸体,必须结合案情调查、现场勘查等情况综合判断。本文通过对1 1 2例已查破的他杀溺死案一回顾性研究,探求他杀溺死案件的特点,以供参考。1　材料与方法1 1　…     

溺死法医学鉴定的研究新进展

综述了近年来在硅藻检验、水中浮游生物叶绿素（A）检测、血液化学和组织化学检验等方面的最新文献报道,并对各种溺死检验方法的优缺点进行了评价：在硅藻检验中,硝酸乙醇法、破机罐法及微波消解法,可缩短检验时间,提高办案效率;酶消化法及PCR法硅藻检出率高,适用于可疑水样中硅藻密度低等情况。早期器官组织中浮游生物叶绿素（A）、血液和组织中其他生化指标,可作为鉴定溺死的重要参考。微量元素锶检测可用于鉴定海水中溺死。另外,硅藻及其他浮游生物遗传多态性片断PCR,可望成为新的、灵敏的溺死检测方法。     

微波消解法检验硅藻的实验研究

按常规，水中尸体的法医学检验鉴定必须要做硅藻检验，以确定生前入水溺死或抛尸入水伪装溺死，同时可根据检出硅藻种类判断溺死水域现场。目前，仍沿用传统的有机消化法（硫酸-硝酸破击法）[1-2]。我们自1999年起，应用光纤压力自控密闭微波消解系统（微波消解法）进行了5例溺死案例的硅藻检验，获得较好效果，并与传统的有机消化法进行了比较研究。目前，尚未查见应用微波消解法系统研究人体组织内硅藻检验的实验报道。1材料与方法1.1检材分组检材为2000年8月份吉林地区某较大型水库中发现的溺死尸体。实验组：新鲜的和冷冻的肺边缘组织检…     

溺死的虚拟解剖形态特征

目的 探究虚拟解剖技术在溺死尸体上获取关键证据信息的能力及其在溺死诊断中的应用价值。方法 以7例溺死尸体为主要研究对象,在传统尸体解剖前行计算机断层扫描采集尸体影像数据,通过影像阅片观察特征性表现并结合虚拟测量指标,与15例非溺死尸体作为对照组进行对比分析。结果 溺死者死后影像可见呼吸道较多积液、肺部呈弥漫性较均匀的毛玻璃样改变;溺死者鼻窦（上颌窦及蝶窦）内积液量为（10.24±4.70）mL,对照组量为（2.02±2.45）mL;溺死者鼻窦内积液、左心房血液、胃内容物CT均值分别为（15.91±17.20）、（52.57±9.24）、（10.33±12.81）HU,较非溺死者低（P<0.05）。结论 将多项特征性影像表现与虚拟测量指标综合考虑,有助于溺死诊断,虚拟解剖技术目前可作为一种辅助溺死法医学鉴定的手段。     

服毒合并溺死1例

服毒合并溺死１例黄劳动，邓昭科（广东省台山市公安局；台山５２９２００）在法医学尸体检验中，服毒自杀、投毒他杀都比较常见．水中尸体则意外溺死和自杀溺死、灾害事故较常见，他杀溺死和移尸水中也偶可见到，但水中尸体为服毒合并溺死者尚属罕见．现报告一例如下。１...     

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.     

Comparison between lung weight and blood strontium in bodies found in seawater

This paper examines the use of lung weight increase as an indicator of seawater drowning compared to the amount of Sr absorbed by the blood. The study population was limited to male victims older than 20 years. Significant differences between cases of drowning and "non-drowning" were detected in terms of the lung-heart weight ratio (L/H) (p<0.001) or lung-body weight ratio (L/B) (p=0.005). However, using lung weight (L), L/H or L/B to distinguish between seawater drownings and saltwater non-drownings some overlap was produced. The factor rendering least overlap was L/B, which also appeared to be non-dependent on the victim's age. Our findings suggest that a value of L/B higher than 19.5 g/kg could be a useful indicator of death by drowning, but that when a lower value is found, additional drowning diagnoses would be needed to establish the manner of death.     

Detection of diatoms in bone marrow (femur) of nondrowned (author's transl)

Diatoms in the bone marrow (femur) of 16 nondrowned bodies were detected by a modern method of ultrafiltration. The rate of diatoms were found to be in the same range as in cases of drowning. The results deny the proof of diatoms even in bone marrow to be useful any longer for the diagnosis of death from drowning.     

Study of the diagnostic value of iron in fresh water drowning

The aim of our study was to test the diagnostic value of iron (Fe) in fresh water drowning by investigating the postmortem levels of hemodilution in drowning cases compared to control cases. Twenty-six typical fresh water drowning cases were selected from 128 immersion cases autopsied in our Department of Forensic Pathology between 1998 and 2004. The exclusion criteria were a long postmortem interval and other causes of death than drowning. For all selected cases, the diagnosis of drowning was based on the presence of autopsy findings and positive diatom test. A control population of 12 cases was also selected. For each drowning and control case, iron blood levels were measured in the left ventricle (LV) and right ventricle (RV) of the heart. The mean difference of iron concentration (RVFe-LVFe) between the drowning group and the control group was statistically compared. Furthermore, iron measurements were performed in 19 drowning cases showing advanced putrefaction. The mean difference of iron concentration was significantly higher in the drowning cases compared with controls (P<0.001). All drowning cases showed hemodilution. No overlap was found in the RVFe-LVFe levels between the two groups. Resuscitation attempts seemed to have no effect on the results. In cases of drowning showing advanced putrefaction, the iron test was not reliable because biochemical iron measurement was often prevented by no sufficient blood in the heart or postmortem clots. In conclusion, according to our results, iron seems to be a good biochemical marker in fresh water drowning with a short postmortem interval.     

硅藻定量检验和种属鉴定的实验研究

本实验用家兔18只,分为溺死组、死后(抛尸)入水组及对照组,每组各6只。采用消化—光镜法作肺、肝、肾硅藻计数(定量)及种属鉴定检验,同时作水样检验及空白对照。结果:(一)进一步证实生前硅藻可经空气源性进入肺脏并存积于大循环内脏(肝、肾)的概念;(二)提示水中尸体肺脏如有大量硅藻检出,仅此即可作为诊断溺死的可靠依据;空气源性吸入及检验过程中的污染并不影响该检验结果对鉴定溺死的判断。种属分析溺死组肺与水样的主要硅藻种属相符,而肝、肾中硅藻计数及种属分析均无诊断意义。     

Diatoms in forensic expertise of drowning--a Macedonian experience

Results obtained by examination of 22 human cases suspected for drowning, one human case of death other than drowning and several tests on laboratory rats were used as a basis for evaluation of diatom method as supportive in forensic expertise of drowning. The recovery of diatoms from various examined organs, their qualitative and quantitative composition, if properly treated without the possibility of contamination, can be a reliable proof of the time and place of drowning. The priority of organ examination (external microflora determination, lungs, brain, heart (and/or blood), stomach, liver and kidney, and finally bone marrow) is discussed and established as well as the basic future research on cases suspected of drowning, but also on non-drowned victims and laboratory animals.     

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。     

浮游生物PCR检测及其在溺死鉴定中的研究进展

溺死鉴定是法医学中的重点和难点之一,目前在相关法医学案件中,主要采用法医病理学尸检与传统硅藻检验等方法综合分析进行鉴定。传统硅藻检验存在灵敏性较低,易于污染等不足。采用PCR法检测尸体不同脏器组织中是否存在水中浮游生物的DNA标记,适用范围广,信息量丰富,灵敏性和特异性较高,有较好的法医学应用前景,有望成为鉴定溺死的新方法。本文对相关研究进展进行综述,为相关研究和实践参考。     

The Diagnostic Value of Quantitative Assessment of Diatom Test for Drowning: An Analysis of 128 Water‐related Death Cases using Microwave Digestion‐Vacuum Filtration‐Automated Scanning Electron Microscopy

The value of diatom test for the diagnosis of drowning remains controversial. The conventional forensic diatom test with low sensitivity is not a useful tool to provide accurate information about diatom in the tissues and organs. To improve the sensitivity of the diatom test, we developed a novel method called the Microwave Digestion‐Vacuum Filtration‐Automated Scanning Electron Microscopy (MD‐VF‐Auto SEM) method which resulted in a high recovery of diatoms. In this article, we analyzed 128 water‐related death cases. Our results showed that the MD‐VF‐Auto SEM method could achieve a much higher positive rate (0.97) in drowning cases. Large amounts of diatoms are retained, even concentrated, in the lung tissues during the intense breathing movement in drowning process. This might be useful for the diagnosis of drowning. Our research indicates that the MD‐VF‐Auto SEM method would be a valuable methodology in the study of diatom test for the forensic community.