A Review of Alcohol‐Impaired Driving: The Role of Blood Alcohol Concentration and Complexity of the Driving Task

The operation of a motor vehicle requires the integrity of sensory, motor, and intellectual faculties. Impairment of these faculties following the consumption of alcohol has been studied extensively through laboratory, closed‐course and on‐road driving, and epidemiological studies. The scientific literature was reviewed critically, with a focus on low‐to‐moderate blood alcohol concentrations (BAC ≤ 0.100%), to identify the most reliable determinants of alcohol‐impaired driving. Variables such as age, gender, driving skill, and tolerance were shown to have limited impact on impairment. It was concluded the most relevant variables are BAC and complexity of the driving task. The scientific literature provides a high degree of confidence to support the conclusion that a BAC of 0.050% impairs faculties required in the operation of a motor vehicle. Whether impairment is apparent depends upon the complexity of the driving task, which applies to both study design and actual driving.     

GC/MS衍生化法检测血中4-溴-2,5-二甲氧基苯乙胺

目的建立人体全血中4-溴-2,5-二甲氧基苯乙胺的衍生化GC/MS分析方法。方法血液样品经去离子水稀释4倍,8000r/min高速离心20min后,加入Na H2PO4缓冲溶液(p H值为6.0)2m L,混匀。将上述混合液加入用甲醇、Na H2PO4缓冲溶液(p H值为6.0)活化的Bond Elut Centify?固相萃取柱后,依次采用1.0M乙酸溶液、去离子水、甲醇、二氯甲烷/异丙醇/氨水(78/20/2,V/V/V)混合洗脱液进行提取、分离、净化处理,40℃空气流下挥干,三氟乙酸酐衍生化,GC/MS检测4-溴-2,5-二甲氧基苯乙胺和4-苯基丁胺衍生物。采用标准品衍生化产物的标准质谱图定性分析,选择m/z 242(4-溴-2,5-二甲氧基苯乙胺)、m/z 91(4-苯基丁胺)作为定量离子进行定量分析。结果血液中4-溴-2,5-二甲氧基苯乙胺的最低检出限为6ng/m L,在0.02~10μg/m L浓度范围内,线性关系良好(=0.9993),日内精密度和日间精密度均小于10%,平均提取回收率约为69%。结论该方法操作简便、灵敏度高,适用于全血中4-溴-2,5-二甲氧基苯乙胺检测。     

气相色谱-串联质谱法分析尿和血中除草剂百草枯

目的建立尿和血中百草枯的离子交换固相萃取-气相色谱-串联质谱分析方法。方法尿样加内标乙基百草枯,用732阳离子交换树脂提取;血样加内标乙基百草枯,用三氯乙酸凝聚蛋白质后取上清液用732阳离子交换树脂提取。提取物用硼氢化钠在水溶液中碱性条件下还原,还原物用有机溶剂提取进行气相色谱-串联质谱法分析。结果尿和血中百草枯的提取率分别为76％和74％,检测限分别为2ng／mL和10ng／mL,尿添加百草枯100ng／mL和血添加百草枯500ng／mL水平的回收率分别为99．6±5．6％和99．3±7．6％（Mean±CV）。结论本文建立的分析方法灵敏度高,能够满足中毒致死案件检验及临床毒物检验的需要。     

不同温度下血样中毒鼠强的稳定性

目的探讨不同保存温度下血样中毒鼠强的稳定性。方法配制毒鼠强质量浓度为0.5μg/mL的血液样品,分别置于45℃、25℃和4℃环境中保存,在配制当天及存放3、12、18和39d用气相色谱-质谱联用法测定其质量浓度,运用SPSS统计软件对结果进行统计分析。结果45℃、25℃下血样存放3d毒鼠强质量浓度基本不变,存放4～12d毒鼠强质量浓度有明显下降,存放12d后毒鼠强质量浓度缓慢下降;4℃下血样存放12d毒鼠强质量浓度基本不变,存放13～18d毒鼠强质量浓度有明显下降,存放18d后毒鼠强样品质量浓度缓慢下降。结论血样中毒鼠强质量浓度在最初的3d内稳定,此后浓度下降。保存温度对血样中毒鼠强质量浓度有影响。     

Elevated morphine concentrations determined during infant death investigations: artifacts of withdrawal of care

Abstract:  Three cases are reported of elevated postmortem blood morphine concentrations (189–3036 ng/mL) that were observed during the course of death investigations involving three children ranging in age from 1 week to 2 years, all of whom underwent withdrawal of life support. In all three cases, the presence of opiates in postmortem blood was indicated by immunoassay (ELISA) and quantitative confirmatory analysis of free morphine concentrations in postmortem blood was performed by solid-phase extraction followed by gas chromatography/mass spectrometry (GC/MS) in the selected ion monitoring mode. While the practice of withdrawing life support from terminally ill patients, with the accompanying administration of narcotics/analgesics has been reported in the medical literature, it has not been adequately described in the forensic literature. The implications of this practice on the forensic toxicological interpretation of morphine findings are discussed. To our knowledge, this is the first report of postmortem morphine concentrations arising directly from administration in conjunction with withdrawal of care in pediatric patients.     

Dominance of pre-analytical over analytical variation for measurement of methadone and its main metabolite in postmortem femoral blood

On the basis of simultaneously sampled postmortem blood specimens from the left and right femoral veins the pre-analytical variation of methadone measurements was evaluated and compared to the analytical variation. The material consisted of a series of 27 duplicate samples from routine autopsy cases comprising mainly drug addicts. A chiral LC-MS/MS method was used for measurement of the R- and S-enantiomers of methadone and its main metabolite 2-ethyl-1,5-dimethyl-3,3-diphenylpyrrolinium (EDDP). The analytical CV% was determined to be in the range 3-4% for methadone enantiomers and 4-6% for EDDP enantiomers. The total measurement uncertainty (CV(T)) was estimated from the pre-analytical variation (CV(PA)), analytical variation proper (CV(A)), and variation related to calibration (traceability) (CV(Cal)) according to the relationship CV(T) = [CV(2)(PA) + CV(2)(A) + CV(2)(cal)](0.5). Uncertainty related to calibration concerned a component related to the purity of drug reference compound and a contribution from the production of calibrator solutions (CV(Cal)<1%). Pre-analytical sampling variation was estimated from the duplicate measurements of blood samples after subtraction of the analytical component. The pre-analytical variation amounted to a CV% of 19-21% for R- and S-methadone and 30-38% for R- and S-EDDP, i.e. considerably larger than the other components. Due to the squared addition principle, the resulting total uncertainty (CV(T)) became largely identical to the CV(PA), i.e. 19-21% for R- and S-methadone and 31-38% for R- and S-EDDP enantiomers. Accordingly, CV(T) exceeded CV(A) by a factor 5 or more. Dominance of the pre-analytical component of variation may also be likely for other compounds measured in postmortem blood samples. Thus, the width of the 95%-uncertainty interval (+/-2CV(T)) for a postmortem measurement is largely determined by the pre-analytical component of variation. This should be kept in mind when judging on the uncertainty of postmortem measurement results.     

Hair analysis for cocaine: factors in laboratory contamination studies and their relevance to proficiency sample preparation and hair testing practices

Since the introduction in 2001 of a urine-based detection method for recombinant erythropoietin (rHuEPO), transfusion-doping practices have regained interest. To address this problem, an efficient antidoping test designed to obtain direct proof of allogeneic blood transfusion was developed and validated. This test, based on flow cytometry analysis of red blood cell (RBCs) phenotypes, was used to determine the absence or the presence of numerous RBCs populations in a blood sample. A such, it may constitute a direct proof of an abnormal blood population resulting from homologous transfusion. Single-blind and single-site studies were carried out to validate this method as a forensic quality standard analysis and to allow objective interpretation of real cases. The analysis of 140 blood samples containing different percentages (0-5%) of a minor RBCs population were carried on by four independent analysts. Robustness, sensitivity, specificity, precision and stability were assessed. ISO-accredited controls samples were used to demonstrate that the method was robust, stable and precise. No false positive results were observed, resulting in a 100% specificity of the method. Most samples containing a 1.5% minor RBCs population were unambiguously detected, yielding a 78.1% sensitivity. These samples mimicked blood collected from an athlete 3 months after a homologous blood transfusion event where 10% of the total RBCs present in the recipient originated in the donor. The observed false negative results could be explained by differences in antigen expression between the donor and the recipient. False negatives were more numerous with smaller minor RBCs populations. The method described here fulfils the ISO-17025 accreditation and validation requirements. The controls and the methodology are solid enough to determine with certainty whether a sample contains one or more RBCs populations. This variable is currently the best indicator for homologous blood transfusion doping.     

芦黄参花胶囊联合福辛普利治疗糖尿病肾病60例

目的 观察中西医结合疗法治疗糖尿病肾病（diabetic nephropathy,DN)的疗效及建立其综合疗效评价体系。方法 纳入Mogensen Ⅲ、Ⅳ期DN患者120例,将其随机分为治疗组（芦黄参花胶囊和福辛普利联合治疗）和对照组（单用福辛普利治疗）,疗程为3个月。比较两组的临床疗效及中医证候疗效,观察治疗前后DN患者尿白蛋白排泄率（urinary albumin excretion rate,UAER）、肾功能、血压、血糖、血脂水平,采用世界卫生组织生存质量量表简表评价患者治疗前后的生存质量。结果 对于Mogensen Ⅲ、Ⅳ期DN患者,治疗组临床疗效及中医证候疗效均显著高于对照组（P<0.05）;治疗组在降低Mogensen Ⅲ期DN患者UAER及血清肌酐、尿素氮水平,提高Mogensen Ⅲ、Ⅳ期DN患者生理健康、心理健康、总的生存质量和满意度评分方面显著优于对照组（P<0.05,或P<0.01）。两组均未见明显不良反应。结论 芦黄参花胶囊和福辛普利联合治疗可有效降低早期DN患者尿蛋白,改善肾功能,提高患者的生存质量,本研究可为DN的防治提供新的疗效评价体系。     

天舒胶囊联合西比灵治疗血瘀型偏头痛临床观察

目的 观察天舒胶囊联合西比灵治疗血瘀型偏头痛的临床疗效。方法 选择诊断为偏头痛患者60例,按序号奇偶数分成治疗组30例、对照组30例,治疗组采用天舒胶囊联合西比灵胶囊,对照组仅采用西比灵胶囊,疗程为30 d,疗程结束后1个月比较患者偏头痛积分、疼痛指数、证候积分及生活质量指数等变化。结果 两组患者偏头痛积分、疼痛指数、证候积分及生活质量指数均有显著改善,治疗组优于对照组（P<0.05）;两组患者偏头痛、疼痛、证候等疗效分布比较,差异均有统计学意义（P<0.05）,治疗组优于对照组。结论 天舒胶囊联合西比灵能显著改善血瘀型偏头痛患者的偏头痛积分、疼痛指数、证候积分及生活质量指数。     

益肾通络汤联合达英-35治疗肾虚血瘀型多囊卵巢综合征临床观察

目的 观察益肾通络汤联合达英-35治疗肾虚血瘀型多囊卵巢综合征（polycysti covary syndrome,PCOS）的临床疗效。方法 将30例肾虚血瘀型PCOS患者随机分为治疗组和对照组各15例,两组均常规给予达英-35治疗,治疗组在对照组的基础上加用益肾通络汤,疗程均为6个月。治疗前后分别检测血清雌二醇（estradiol,E2）、睾酮（testosterone,T）、促黄体生成素（luteinizing hormone,LH）、血清促卵泡素（follicle stimulating hormone,FSH）,以及空腹胰岛素（fasting insulin,FINS）水平和体质量指数（body mass index,BMI）,观察两组患者证候疗效。结果 治疗组证候疗效明显优于对照组（P＜0.05）。益肾通络汤联合达英-35能明显降低LH、T、FSH、FINS、BMI水平,提高E2水平;两组治疗前后T、LH、FSH、E2、FINS、BMI差值比较,差异均有统计学意义（P＜0.05）。治疗组改善多毛、痤疮体征的有效率均明显高于对照组（P＜0.05）。结论 益肾通络汤联合达英-35能通过调节垂体-卵巢轴相关激素水平,提高临床证候疗效,显著改善PCOS患者BMI、多毛、痤疮的体征,且安全性较好。