When benefitting a patient increases the risk for harm for third persons — The case of treating pedophilic Parkinsonian patients with deep brain stimulation

This paper investigates the question whether it is ethically justified to treat Parkinsonian patients with known or suspected pedophilia with deep brain stimulation — given increasing evidence that this treatment might cause impulse control disorders, disinhibition, and hypersexuality. This specific question is not as exotic as it looks at a first glance. First, the same issue is raised for all other types of sexual orientation or behavior which imply a high risk for harming other persons, e.g. sexual sadism. Second, there are also several (psychotropic) drugs as well as legal and illegal leisure drugs which bear severe risks for other persons. We show that Beauchamp and Childress' biomedical ethics fails to derive a veto against medical interventions which produce risks for third persons by making the patients dangerous to others. Therefore, our case discussion reveals a blind spot of the ethics of principles. Although the first intuition might be to forbid the application of deep brain stimulation to pedophilic patients, we argue against such a simple way out, since in some patients the reduction of dopaminergic drugs allowed by deep brain stimulation of the nucleus subthalamicus improves impulsive control disorders, including hypersexuality. Therefore, we propose a strategy consisting of three steps: (1) risk assessment, (2) shared decision-making, and (3) risk management and safeguards.     

Glamorizing sick bodies: how commercial advertising has changed the representation of HIV/AIDS

As a consequence of pharmaceutical advancements, HIV is no longer described in terms of the absence of health or presence of illness, and advertisements promoting anti-AIDS medications commercialize idealized and desirable bodies. The present study discusses representations of HIV/AIDS in commercial advertising and their change over time. The article traces the shift in AIDS/HIV representations in commercial advertising from the early 1990s, when images of decay and disease represented AIDS, to nowadays, when the wider availability of antiretroviral medications and their ability to prolong life produced new representations of HIV-afflicted bodies. Claiming that HIV individuals can lead a normal life where everything is possible, advertising has re-established the definition of a sick body. On the other hand, this marketing approach has important social implications because such representations minimize the seriousness of HIV infection and fail to take into account the real dangers of contracting HIV and to accurately represent the life with HIV and AIDS.     

Sudden Unexpected Death Due to Graves' Disease During Physical Altercation

We report a case of a 30‐year‐old woman who suddenly collapsed after having a physical altercation with her husband. Despite immediate resuscitation, she died on arrival at the hospital. The victim's parents requested an autopsy because they believed that their daughter was killed by her husband. Postmortem examination revealed that the victim had a diffusely enlarged thyroid gland and cardiomegaly with left ventricular hypertrophy. There was no evidence of significant trauma on the body. Further postmortem thyroid function tests and review of her medical history indicated that her death was due to Graves' disease. To the best of our knowledge, this is the first case reported of sudden death due to cardiac arrhythmia from Graves' disease induced by physical and emotional stress associated with the criminal activity of another person. The autopsy findings are described. In addition, the literature is reviewed and the significance of postmortem evaluation of thyroid hormones in the cases of sudden death is discussed.     

Carbon Monoxide Poisoning and Death in a Large Enclosed Ventilated Area

A 55‐year‐old man with a medical history of tobacco use suddenly collapsed while power washing an empty indoor pool in a hotel. The decedent was transported to the local hospital where he was pronounced. A postmortem examination revealed atherosclerotic heart disease and bilateral pulmonary edema and congestion. A postmortem blood carbon monoxide (CO) level was 27% saturation, and a CO performed on hospital admission blood was 49% saturation. CO poisoning is a common cause of toxicological morbidity and mortality in the United States. The circumstances most often occur in an enclosed environment and may be intentional or unintentional. CO poisoning has been reported in open, well‐ventilated spaces, but rarely results in death. A warning label was present on the engine clearly stating the dangers of CO emission. However, there was a false sense of security due to the large size of the pool room and the presence of industrial blowers that were being used for ventilation.     

GFP标记的重组新城疫病毒HN基因乳酸菌表达载体的构建及原核表达

为构建具有示踪特性的新城疫病毒(NDV)HN基因乳酸菌穿梭表达载体,采用PCR方法扩增NDV HN基因与绿色荧光蛋白(GFP)基因,将两基因克隆至乳酸菌表达载体pW425et中,转化入表达宿主菌BL21(DE3)后利用IPTG诱导表达。用荧光显微镜检查重组菌的绿色荧光效应,采用SDS-PAGE和Western-blotting检测其在大肠杆菌中的表达情况。结果显示,NDV HN和GFP基因与表达载体pW425et正确重组。荧光显微镜下可见阳性重组菌落的绿色荧光,且该重组菌传代30代次以上,荧光效应依然稳定。SDS-PAGE显示表达出约63ku的条带,与已知表达的HN蛋白大小相符。Western-blotting进一步证实该蛋白能被NDV阳性血清所识别,具有反应原性。构建了GFP标记的重组NDV HN基因乳酸菌穿梭表达载体且能在大肠杆菌中表达。     

职业病鉴定制度的“诉讼化”改革

现行职业病鉴定制度具有＂仿诉讼化＂的特点,但仍然在公正性、便民性、权利性和救济性等方面存在一定的制度弊端,今后需要沿着＂诉讼化＂方向深化改革,切实保障劳动者公正获取职业病诊断和鉴定的权利。     

Death of a Female Prostitute Due to Intestinal Obstruction by an Unknown Substance

A young adult black female, known to be a prostitute and suspected of smuggling narcotics, was found dead in her apartment in a state of early decomposition. Oval‐shaped gray‐white masses of exogenous origin protruded from the anus. The autopsy showed dilatation of the folds of the large intestine, which were almost completely filled with these oval‐shaped gray‐white masses of foreign material. The uterus was enlarged with multiple large leiomyomas. Toxicological tests of blood and the foreign material revealed no toxicologically relevant substances. Kaolin was detected in a sample of the foreign material from the large intestine. The immediate cause of death was intestinal obstruction due to the formation of a kaolin bezoar with simultaneous compression of the large intestine by the enlarged myomatous uterus. Subsequent revelation of a habit the deceased had brought from her native country led to the conclusion that this exotic custom was responsible for her death.     

An Analysis of The Morbidity and Mortality of Diabetes Mellitus in a Forensic Context

To investigate the spectrum of diseases seen in diabetes mellitus in a forensic context, all autopsy reports of diabetic individuals who presented to Forensic Science, South Australia (FSSA), over a 5‐year period from 2005 to 2009 were studied. The leading cause of death was cardiovascular disease (55.0%), followed by unnatural deaths (15.4%) and infections (9.4%). In type 1 diabetics, principal causes of death included cardiovascular disease (44.7%), acute metabolic complications (18.7%), unnatural deaths (17.9%), and infections (8.9%). However, frequencies of these diseases differed in type 2 diabetics, with cardiovascular events responsible for 56.6% of cases, followed by unnatural deaths (15.0%) and infections (10.9%). A larger number of male deaths were seen in all disease categories, except respiratory and gastrointestinal where the frequencies were similar to females. Cardiovascular disease was the leading overall cause of death across all ages except in those under the age of 30 where metabolic complications were more common.     

Ebstein Anomaly and Sudden Childhood Death

A 13‐year‐old girl is reported who died suddenly and unexpectedly in her sleep from previously undiagnosed Ebstein anomaly. At autopsy, there was dilatation of the right atrium with marked dilatation of the right auricle and apical displacement of the tricuspid valve into the right ventricular cavity with atrialization of the upper portion of the right ventricle. There were also prominent dysplastic changes in both the septal and posterior leaflets of the tricuspid valve with thickening of the valve and fusion of leaflets to the wall of the ventricle. Histology of the myocardium showed focal, minor microscopic areas of interstitial fibrosis with marked fibrous dysplasia and thickening of the tricuspid valve. Lethal arrhythmias occur in this condition because of the geographical relationship of the conduction system to the abnormal anatomical structures. As adolescents who died suddenly are often minimally symptomatic, cases will rarely present de novo to forensic autopsy.     

妨害传染病防治罪的几个构成要件问题

妨害传染病防治罪的客体应当表述为"国家对传染病防治的管理制度";其客观要件"引起甲类传染病传播或者有传播严重危险"包括实害犯与危险犯两种形态;其主观要件应为过失,故意则不能构成。