Animal-related fatalities--part II: characteristic autopsy findings and variable causes of death associated with envenomation, poisoning, anaphylaxis, asphyxiation, and sepsis

In addition to blunt and sharp trauma, animal-related fatalities may result from envenomation, poisoning, anaphylaxis, asphyxiation, and sepsis. Although the majority of envenomation deaths are caused by hornets, bees, and wasps, the mechanism of death is most often anaphylaxis. Envenomation resulting from the injection of a poison or toxin into a victim occurs with snakes, spiders, and scorpions on land. Marine animal envenomation may result from stings and bites from jellyfish, octopus, stonefish, cone fish, stingrays, and sea snakes. At autopsy, the findings may be extremely subtle, and so a history of exposure is required. Poisoning may also occur from ingesting certain fish, with three main forms of neurotoxin poisoning involving ciguatera, tetrodotoxin ingestion, and paralytic shellfish poisoning. Asphyxiation may follow upper airway occlusion or neck/chest compression by animals, and sepsis may follow bites. Autopsy analysis of cases requires extensive toxinological, toxicological, and biochemical analyses of body fluids.     

A Fatal Case of Anaphylactic Shock During Paragliding

Abstract: The growth in popularity of flying ultralight aircraft and paragliding has been associated with an increased involvement of Emergency Medical Services because of various types of trauma suffered from both inexperienced and skilled individuals. This case presentation reports on a paraglider pilot, who was seen spinning “unusually” rapidly toward the ground, without visible attempts to regain control of the aircraft. Besides the bilateral mydriasis and the absence of any ECG activity, there was a significant swelling of face, lips, neck, and tongue. Upon opening the mouth, a dead bee was found over the tongue, underneath the palate. A fatal anaphylactic shock was the likely cause of death of the pilot while still “in mid‐air.” This case is certainly different from the commonly reported accidents during paragliding. An updated review of the medical literature shows no reported cases of fatal anaphylactic shock during the practice of paragliding.     

A proposed dissection procedure for vertebral arteries in forensic pathology

Vertebral artery removing constitutes a significant forensic pathology challenge. Dissection techniques during head-neck autopsy are based on anterior approach, a difficult method, which is unable to assess the transverse part of the artery. This work presents an original and simple method for dissecting vertebral arteries by a posterior approach, opening the vertebroarterial canal through the spinal canal without any special equipment. Once the spinal cord is removed, the transversarium foramens are opened by an internal cut at the pedicle and an external cut at the transverse process. This enables us to visualize vertebral arteries in its entirety. The method improves both the examination of the upper extracranial segment of the vertebral artery and the neuropathological study when arterial injury is suspected. Applying this method routinely is both feasible and useful in suspected cases of vertebral artery trauma and could contribute to assess more precisely the actual incidence of this injury.     

急性乙醇中毒和外伤在蛛网膜下腔出血致死机制中的作用

目的研究人脑在急性乙醇中毒状态下tPA、MMP-2、MMP-9及AEG-1表达水平与乙醇浓度的关系,分析乙醇与外伤在蛛网膜下腔出血死亡机制中的作用。方法选取15例实际案例,提取脑组织进行组织病理学检查、心血进行乙醇浓度检测,用免疫组织化学法观察人脑干、大脑、小脑tPA、MMP-2、MMP-9及AEG-1表达水平。结果急性乙醇中毒外伤组和急性乙醇中毒组的脑组织肿胀。除小脑tPA外,tPA、MMP-2、MMP-9及AEG-1表达水平在饮酒者较未饮酒者在脑干、大脑、小脑均有升高(P0.05),MMP-2、MMP-9和AEG-1表达水平与心血乙醇浓度存在正相关(P0.05,r0.6)。结论急性乙醇中毒状态下人脑tPA、MMP-2、MMP-9、AEG-1表达较未饮酒者均显著增强,MMP-2、MMP-9及AEG-1表达水平与乙醇浓度存在相关性,乙醇对脑细胞有毒性作用。     

线粒体缺氧性损伤及其法医学意义

线粒体是真核细胞中特殊的细胞器,主要功能是进行氧化磷酸化合成细胞活动所需的能量,机体所摄入的氧气绝大部分都在线粒体中被消耗。机械性窒息的精准诊断是法医病理学实践中的难点之一,法医病理学工作者一直致力于寻找一种可靠、敏感的标志物用于机械性窒息的确诊。线粒体对于缺氧环境极为敏感,其损伤标志物或可作为诊断机械性窒息的依据。本文旨在综述缺氧环境下线粒体损伤的研究进展,并探索将线粒体损伤标志物用于法医病理学实践的可能性。     

道路交通事故中脑外伤所致人格改变与精神伤残评定

目的探索道路交通事故中颅脑损伤所致轻度精神伤残者人格改变的主要表现形式及其在伤残评定中的价值。方法运用《脑外伤后人格改变评定量表》量化评定道路交通事故所致颅脑外伤者后遗人格改变状况,并探讨人格改变与颅脑损伤程度、精神伤残程度的相关性。结果 271例样本中239例(88.2%)存在人格改变,其中178例(65.7%)为轻度,46例(17.0%)为中度,15例(5.5%)为重度。人格改变程度在不同颅脑损伤程度之间的构成比差异无统计学意义(P0.05),但各组之间量表总分差异具有统计学意义(P0.05),两两比较显示中型与重型颅脑损伤之间差异无统计学意义。人格改变程度越明显,精神伤残等级越高,轻度精神伤残不同等级者人格改变评定量表总分差异具有统计学意义(P0.05),除七级与八级之间差异无统计学意义外,其余各组之间差异均具有统计学意义(P0.05)。结论交通事故中提出精神伤残评定的脑外伤者中人格改变发生比例较高,人格改变严重程度与精神伤残程度相关,《脑外伤后人格改变评定量表》能有效量化评定交通事故中脑外伤所致人格改变程度,量表总分与颅脑损伤程度具有相关性。     

Forensic occupational therapy to reduce risk of reoffending: a survey of practice in the United Kingdom

Forensic services are required to reduce an individual’s risk of reoffending. Despite being integral to forensic mental health services, the contribution of forensic occupational therapy to achieving this aim is unclear. This study describes current forensic occupational therapy practice to reduce reoffending risk in the United Kingdom. Responses to a cross-sectional survey consisting of multiple choice and free-text questions were analysed using frequency counts and percentages, and thematic analysis respectively. Of the 58 participants, 83% actively addressed reoffending risk. Participants informed practice with occupation-focused theories, models and assessment tools. Five themes described forensic occupational therapy to reduce reoffending risk: an occupational perspective of risk assessment and formulation; volitional realignment; increasing protective factors; community integration; and enhancing understanding of forensic occupational therapy. Forensic occupational therapists perceive their practice to contribute to reducing reoffending risk, but are yet to establish routine outcome measurement in this area. Implications for practice and future research are discussed.     

我国警察因公伤亡的成因及对策研究

本文从结构层面(警务战略)、流程层面(警务管理)、操作层面(警察操作行为)对警察因公伤亡成因进行深入分析,认为结构层面和流程层面因素对警察的执法认知、执法行为、执法环境有着关键的、本质的影响,是导致警察因公伤亡的主要原因。减少警察因公伤亡须从警务战略和警务管理着手。     

农民工的进城方式与职业流动——两代农民工的比较分析

利用社会关系网络结伴外出、依靠"亲友介绍"工作是两代农民工初次外出与求职的共同特点,不同之处在于第一代农民工进城主要追求经济利益,新生代农民工则主要追求个人发展,农民工外出倾向于低龄化,童工现象比较严重。农民工进城之后,"跳槽"频繁,就业层次低,多数农民工的职业流动只是一种"平移",并没有带来职业地位的提升。相比较而言,新生代农民工就业层次比第一代农民工高。