《北京市院前医疗急救服务条例》修订前后对比分析

《北京市院前医疗急救服务条例》是北京市地方性法规,于2017年3月1日正式实施.2021年5月27日,北京市十五届人大常委会第三十一次会议表决通过了修改后的《北京市院前医疗急救服务条例》.     

Hyperosmolarity Induces Armanni‐Ebstein‐like Renal Tubular Epithelial Swelling and Cytoplasmic Vacuolization

Armanni–Ebstein lesions have been considered pathognomonic for diabetes mellitus and appear as markedly swollen renal tubular epithelial cells with cytoplasmic clearing and glycogen accumulation. However, the extent to which hyperosmolarity contributes to the Armanni–Ebstein phenotype is unclear. Ten sheep were injected intravenously with 20% mannitol at 11 mOsm/kg, and subsequent histological evaluation of the kidneys showed variable degrees of osmotic nephrosis and cytoplasmic clearing of renal tubular epithelial cells similar to that seen with Armanni–Ebstein lesions. However, although morphological changes similar to Armanni–Ebstein lesions could be produced, no intracytoplasmic glycogen was demonstrated with periodic Acid–Schiff (PAS) stain. This suggests that while hyperosmolarity may contribute to the development of an Armanni–Ebstein phenotype, glycogen accumulation may result from the more complex metabolic effects of glucose on renal tubular epithelial cells. Thus, when Armanni/Ebstein‐like vacuolizations are seen at autopsy, a confirmatory PAS stain is recommended because of the potential effect of hyperosmolar states.     

Armanni–Ebstein Lesions in Terminal Hyperglycemia

Armanni–Ebstein lesions (AEL) occur in deaths related to uncontrolled diabetes mellitus. To investigate the relationship between AEL and terminal hyperglycemia, we retrospectively reviewed 71 cases with vitreous glucose levels ≥11.1 mmol/L; 27 (38%) cases had AEL (vitreous glucose 14.0–77.3 mmol/L); and 44 cases (62%) did not (vitreous glucose 11.1–91.9 mmol/L). There was no significant difference (p = 0.271) in vitreous glucose levels between the cases with AEL (mean 39.2, SD 16.7 mmol/L) and those without (mean 34.2, SD 19.8 mmol/L). Similarly, there was no difference in the degree of dehydration, renal failure, or osmolality. However, there was a significantly higher level of β‐hydroxybutyrate among the cases with AEL compared to those without (p = 0.007), suggesting that ketoacidosis may facilitate the development of AEL. Given the possible synergistic role of β‐hydroxybutyrate, the correlation between AEL and terminal hyperglycemia in animal studies may not be applicable to humans. AEL may also possibly occur with sublethal elevations in glucose.     

Basal Vacuolization in Renal Tubular Epithelial Cells at Autopsy and Their Relation to Ketoacidosis

Basal vacuolization of renal tubular epithelial cells is a useful postmortem marker for ketoacidosis. To investigate its incidence and relationship to the severity of ketoacidosis, 158 autopsy cases with elevated β‐hydroxybutyrate (>1 mmol/L) over a 7‐year‐period were retrospectively reviewed. Sixty‐eight cases (43%) exhibited basal vacuolizations (vitreous β‐hydroxybutyrate: 1.16–29.35 mmol/L, mean 10.28 mmol/L), and 90 cases (57%) did not (vitreous β‐hydroxybutyrate: 1.03–13.7 mmol/L, mean 2.84 mmol/L). Quantitative analysis revealed on average a fourfold elevation in β‐hydroxybutyrate in cases with basal vacuolizations compared to those without; 10.3% of cases with β‐hydroxybutyrate concentrations between 1.01 and 2.00 mmol/L had basal vacuolizations, and this incidence increased to 33.3% with concentrations between 4.01 and 6.00 mmol/L. A marked increase in incidence to >70% was observed with concentrations >6.00 mmol/L, and basal vacuoles were invariably present (100%) with concentrations >14.01 mmol/L. This study demonstrates that basal vacuolizations are a sensitive marker for significant ketoacidosis and reaffirms its use as an indicator for likely cases of fatal ketoacidosis at autopsy.     

基于Ion Torrent PGM~(TM)测序系统的人mtDNA全测序分析

目的应用Ion Torrent PGM~(TM)测序系统对人线粒体DNA(mitochondria DNA,mtDNA)全序列进行分析检测,研究不同组织间mt DNA序列差异情况。方法通过法医尸体检验采集6名无关个体的组织样本,包括胸腔血液、头发、肋软骨、指甲、骨骼肌和口腔上皮。使用4对引物对线粒体全序列进行扩增,应用Ion Shear~(TM)Plus Reagents试剂盒和Ion Plus Fragment Library试剂盒等构建文库,并在Ion Torrent PGM~(TM)测序系统上进行线粒体基因组全序列测序,并针对异质性位点和在HVⅠ区域突变位点,进行Sanger测序验证。结果所有样本的全基因组mtDNA都扩增成功,6名无关个体分属于6种不同的单倍型,同一个体不同组织之间mtDNA存在异质性差异。异质性位点和HVⅠ区域突变位点采用Sanger测序结果均得到验证。通过Kappa统计方法进行一致性检验后发现,相同个体不同组织的mtDNA序列检验结果仍具有较好的一致性。结论本研究所采用的人线粒体基因组全序列的测序检验方法,可以检测出同一个体不同组织间mtDNA的异质性差异,该差异具有较高的一致性,该结果对mtDNA在法庭科学中的应用具有指导作用。     

第三层次有罪判决证明标准的技术性构建——基于现代证明科学进路的探索

现代法治社会对案件事实进行精确认定以实现惩罚犯罪和保障无辜这一双重目标的需求,以及出于对事实裁判者的主观规制与提高证明标准可操作适用性之考量,使得第三层次有罪判决证明标准之构建成为迫切必要.现代证明科学的兴起与发展,为构建第三层次的有罪判决证明标准提供了全新的视野与路径.基于证明科学进路,通过探寻并确立庭审证据分析与证据评价之科学有效方法和规则,能够找到满足证据分析与证据评价的科学且精细化之指标,运用这些指标最终能够塑造出第三层次有罪判决证明标准这样一个"动态模具".该标准在性质上属于或然性标准,具体包含四项科学且精细化的指标.裁判者通过运用有效的方法能够合理判断庭审证明是否符合这四项指标,并据此获得精确且正当可接受的裁判事实.     

违法性判断的独立性 兼及我国犯罪构成理论的改造

<正>在目前处于通说地位的我国刑法学中,犯罪客体要件、客观方面要件、主体要件、主观方面要件一旦齐备,犯罪即告成立。因此,对行为是否符合分则规定的罪状以及行为是否具有违法性、行为人是否可以被谴责的判断同时展开,同时结束。这样,对构成要件的评价就既是形式评价也是实质评价。对行为的违法性判断隐含或者从属于对构成要件的判断。     

缅怀前辈开创未来--纪念我的父亲陈云同志

今天,我来到莫斯科,与俄罗斯的朋友们一起缅怀、追思我的父亲陈云同志,心情非常激动.我代表陈云同志的家人,感谢俄中友协组织的"陈云同志诞辰100周年纪念会",并对大家的光临表示衷心的感谢! 我的父亲陈云同志离开我们已经十年了,作为伟大的无产阶级革命家、政治家和中国社会主义经济建设的开创者和奠基人之一,他将一生都融入了中国的革命事业,尤其在中国经济建设和改革开放的探索上,倾注了毕生心血.     

加强职务犯罪侦查和侦查监督的几个问题

职务犯罪的社会危害性很大,也是官员腐败的重要部分。当前,职务犯罪出现了“高职位、高智能、高技术、群体犯罪”的特点,给职务犯罪的侦破增加了难度。为了有效惩治职务犯罪,负责职务犯罪侦查和侦查监督的机关必须加强对职务犯罪的侦查和侦查监督的力度,确保职务犯罪侦查质量。在这方面,当前有以下几个法律和实践问题值得深入研究。一、明确界定职务犯罪的范围和侦查的重点当前,在我国法学界和司法界对职务犯罪的范围有不同的理解:第一种意见认为,职务犯罪是国家