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Varices are the main clinical manifestation of portal hypertension, and their bleeding is the predominant cause of mortality from this condition. Periumbilical varices are known as “caput medusae.” Reports of their bleeding are rare, with only three fatal cases described in the literature. The antemortem diagnosis is relatively simple, while the postmortem diagnosis is more complex. This paper is the first report of fatal hemorrhage from a caput medusae for which the diagnosis was made postmortem, thanks to a complete diagnostic process including scene and circumstances, medical history, and autopsy with detailed histology. The circumstantial analysis showed the presence of a large amount of blood at the scene, blood which originated from a small abdominal wound; an analysis of the subject's clinical data reported that he was affected by portal hypertension. The autopsy revealed some dilated and convoluted veins in the subcutaneous tissue of the umbilical region; a fistula between these veins and the abdominal wound was detected. The histological study confirmed the presence of periumbilical varices, one of them ruptured and connected with the overlying skin. The cause of death was attributed to a massive hemorrhage generated by a periumbilical varix in a patient affected by portal hypertension.  相似文献   
184.
The primary objective of this paper is to report on the successful implementation of forensic facial approximation in a real case in the forensic context. A three‐dimensional (3D) facial approximation protocol of the skull was performed with free software, applying techniques in a virtual environment that have already been consolidated in the literature. The skull was scanned with the photogrammetry technique, the digital replica was imported in the Blender software (Blender Foundation, Amsterdam) and individualized model sketches of the face were traced with the MakeHuman software (MakeHuman Org) according to the anthropological profile of the victim. The face created was imported in Blender, where it was adapted, modeled, and sculpted on the 3D skull and its soft tissue markers, using an American open‐source application of the technique in the digital environment. The face created in a virtual environment was recognized and legal identification procedures were started, resulting in the more agile delivery of the disappeared body to its next of kin. It is therefore concluded that facial approximation may not be a primary method of human identification, but it can be satisfactorily applied in the forensic field as an individual recognition resource. It has great value in narrowing the search, reducing the number of alleged victims, and leading to identification tests, therefore significantly reducing the number of genetic DNA (deoxyribonucleic acid) tests—which are considered costly for the State or Federation—and consequently reducing the waiting time before delivery of the body to its family.  相似文献   
185.
Misdiagnosed PAS confirmed at medicolegal autopsy Pulmonary artery sarcoma (PAS) is a rare disease and usually indistinguishable from acute or chronic thromboembolic disease of the pulmonary arteries. We present a case of pulmonary artery sarcoma in a 54‐year‐old male, who was clinically misdiagnosed as pulmonary thromboembolism. The patient died of disease; however, the actual diagnosis of PAS was made after a medicolegal autopsy. PAS can be a diagnostic challenge for both clinicians and pathologists. In an autopsy case with a clinical suspicion of pulmonary thromboembolism, if there is an abnormal gross appearance in the pulmonary artery, the forensic pathologist should have a high index of suspicion of PAS, which should be ruled out by a histopathologic examination.  相似文献   
186.
本研究评估了中国公民对警察的信任程度,并探讨了影响公众对警察信任程度的因素。就目前来看,针对中国公民对待警察的态度进行的实证研究寥寥无几。本研究以冲突理论为理论框架,通过收集中国8个城市的访谈数据,检验了性别、年龄、教育程度、收入、就业、感知政治影响力等冲突变量以及相关控制变量对中国警察公信力的影响。结果表明,这些变量对于中国公民对待警察的态度的解释力有限。青年以及政治权力较低的中国公民往往对警察的信任度较低。此外,中国公民对警察的态度还受到公共安全满意度、政府处理犯罪的能力、生活质量和政府官员腐败度的影响。同时本文也对未来研究的意义进行了讨论。  相似文献   
187.
Insulin glargine is a long-acting insulin analog that is converted after enzymatic cleavage of the arginine pair of the β-chain into its main metabolite M1 (21A-Gly-insulin), which is responsible for the hypoglycemic activity. In all the overdose cases described in the literature, only M1 concentrations have been reported, whereas insulin glargine was always absent or below the limit of quantitation. In this study, we present a case of suicide of a young nurse by injection of insulin glargine in which the parent molecule was found at a toxic concentration in blood. The determination and the discrimination of insulin glargine from human insulin and other synthetic analogs in the blood specimen were performed by liquid chromatography coupled to high-resolution mass spectrometry (Waters XEVO G2-XS QToF) and extraction after precipitation in the presence of bovine insulin (internal standard), with a mixture of acetonitrile/methanol +1% formic acid followed by purification on solid phase extraction cartridges C18. Glargine insulin tested highly positive in the blood with a concentration of 1.06 mg/L. Due to the difficulty in obtaining a M1 pure standard, the metabolite could not be dosed. This unique presence of the parent molecule, reported for the first time, can be explained by inter-individual variability in the rate of conversion to metabolite. Intravenous injection versus subcutaneous injection can also explain the presence of insulin glargine. Finally, the dose injected may have been so high that saturation of the proteolytic enzymes responsible for conversion to M1 should have occurred.  相似文献   
188.
“Bullet wipe” is the material deposited by a bullet on any surface with which it comes into contact after it is fired and may contain debris from the gun barrel, including particles of primer and metal fragments from previously fired bullets. X‐ray analysis is a non‐destructive method by which traces of metallic elements can be visually detected. The analysis of osseous defects for radiodense bullet wipe (RBW) assists in determining the presence or absence of perforating gunshot wounds, especially in fragmented, skeletonized remains. The aim of our current study was to determine the frequency of RBW around entrance firearms injuries that perforated bone. We prospectively analyzed entrance gunshot wounds for RBW over a three‐year period using digital X‐ray analysis (n = 59). We retrospectively reviewed the corresponding autopsy reports to determine the frequency of RBW by biologic sex, reported ancestry, age‐at‐death, location of wound, manner of death, range of fire, bullet caliber, and presence of bullet jacket. Data were analyzed by Fisher's exact test or Chi‐square test with significance levels accepted at p < 0.05. RBW was present in 66% (n = 39) of examined cases. Decedent characteristics did not significantly alter RBW distribution, including biologic sex (p = 0.75), reported ancestry (p = 0.49), and age‐at‐death (p = 0.43). Additionally, the location of the osseous entrance gunshot wound, manner of death, range of fire, and cartridge caliber did not affect RBW detection. All cases involving non‐jacketed rounds (n = 5) showed RBW (p = 0.30). To our knowledge, this study is the first to report the frequency of RBW detection from osseous entrance gunshot wounds.  相似文献   
189.
The Journal of Technology Transfer - For scale-intensive industries and science-based industries in Germany, we investigate the question whether firms combining internal R&amp;D and acquisition...  相似文献   
190.
Tasmania has a long history of failed attempts at restructuring local government boundaries yet managed a major reform process of 'modernisation' between 1990 and 1993 that incorporated major changes to council operations together with a restructuring of boundaries and a reduction from 46 to 29 councils. This process can be compared with a recent attempt to reduce further the number of local governments. In April 1997 the Liberal Premier announced reforms ('Directions for Tasmania') that led to a further reduction in the number of councils. This process collapsed following legal challenges and the proroguing of parliament prior to the 1998 state election. The defeat of the Liberal government saw the abandonment of the proposed amalgamations and establishment of 'partnerships' between the new ALP state government and councils. This paper compares the 1990–93 and 1997–98 reform processes and evaluates the outcomes of the amalgamations in 1990–93. It argues that the success of amalgamation and reform in local government has been strongly influenced by the degree of local government involvement and support in the reform process, lessons that have wider application.  相似文献   
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