Sudden Cardiac Deaths in Adults with Congenital Heart Disease with Structural Abnormalities: A Retrospective Review of Cases in the Cook County Medical Examiner's Office

Sudden cardiac death is a significant cause of mortality in adults with congenital heart disease (CHD). The Cook County Medical Examiner's Office database was queried for cases of CHD as a cause of death in the period between July 2008 and April 2019. Twenty-two cases were identified, including 11 decedents with simple defects and 10 decedents with complex defects. All of the subjects were in apparent good health at the time of death. In the absence of other obvious causes of death, simple defects were considered cases of sudden cardiac death. Significant cardiac morphological changes were common in complex defects. While 16 cases had known, diagnosed/treated CHD, 5 cases had no diagnosis prior to autopsy. In these cases, the ability to recognize CHD (sometimes subtle) helped in determining the causes of death. Therefore, forensic pathologists must be able to properly recognize various forms of CHD and request consultations, when needed.     

Importance and Approach to Manner of Death Opinions in Opioid-Related Deaths

The majority of opioid-related deaths are accidental. However, the number of opioid-related suicidal deaths is likely under recognized. Presented here is a case of suicide by heroin overdose. The manner of death would have likely been deemed accidental if not for critical information shared by the decedent’s family during follow-up telephone interviews between the forensic pathologist and the decedent’s family, which included text messages that were sent by the decedent just before his death that were not known at the time of the initial medicolegal death scene investigation. This case highlights that when a forensic pathologist establishes an engaged relationship with the decedent’s family, the information elucidated can prove to be invaluable in reaching an informed opinion about the manner of death. For overdose cases, identifying an accurate manner of death allows the design of public health efforts that adequately address the health risks in the community. For aid in the determination of the manner of death for overdose cases, we propose a five-step checklist that may assist forensic pathologists and medicolegal death investigators when approaching similar cases.     

Evaluation of Agonal Cardiac Function for Sudden Cardiac Death in Forensic Medicine with Postmortem Brain Natriuretic Peptide (BNP) and NT-proBNP: A Meta-analysis

Sudden cardiac death (SCD) is an unexpected death caused by a sudden loss of cardiac function, which is currently a global public health problem. Evaluation of the agonal cardiac function of the deceased is a quite important task for the diagnosis of SCD in forensic medicine. Brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are currently considered as significant biomarkers for the diagnosis of heart failure in both clinical and forensic practices. To investigate the postmortem evaluation roles of postmortem BNP and NT-proBNP levels for SCD, the present study meta-analyzed eight related studies from Embase, Cochrane Library, PubMed, China Biomedical Literature Database, China National Knowledge Infrastructure, and Wanfang Data. Newcastle–Ottawa Quality Assessment Scale was used to assess the quality of the included literature, and the meta-analysis was performed by RevMan 5.3.5 software. Postmortem NT-proBNP in pericardial fluid showed higher levels in the SCD group than that of the non-SCD group with the weighted mean difference = 3665.74, 95% confidence interval: 1812.89–5518.59, and p = 0.0001. However, postmortem levels of BNP in pericardial fluid and NT-proBNP in serum revealed no statistical difference between SCD and non-SCD subjects. The results of present meta-analysis demonstrated that postmortem NT-proBNP in the pericardial fluid could be used as an ancillary indicator for evaluation of agonal cardiac function in forensic medicine.     

Artifacts Caused by Leaf-Cutting Ants of the Genus Atta (Hymenoptera: Formicidae): Postmortem Bite Injuries and the Tearing of Clothes

Ants are one of the first insects to find an exposed cadaver and can be present during all stages of decomposition. Although these organisms are not commonly used in postmortem interval estimates, they are to be taken into account on criminal investigations involving human corpses, since they can leave bite marks that can be mistaken for antemortem or perimortem injuries, which could be misleading when ascertaining the occurrence of abuse or physical altercation during a crime. A few studies report the action of ants on human cadavers and even though leaf-cutting ants of the genus Atta are frequently encountered in succession studies that use animal carcasses, there are no records of these fungus-growing species on human corpses. Atta is a genus restricted to the New World, ranging from northern Argentina to southern United States and acts as one of the most conspicuous neotropical herbivores. In this study, we report three cases of violent death that illustrate the impact of ants, especially those of the genus Atta, in a forensic setting. We compare the patterns displayed by postmortem bite injuries caused by leaf-cutter ants and other common species with less robust mandibles. We also present the capability of Atta ants to create artifacts by cutting victim’s clothes in a crime scene, contributing to the knowledge of ant-mediated confounding factors in crime scene investigation.     

Positional Asphyxia in Opioid-Related Deaths: Is It Being Overlooked?

The contribution of positional asphyxia in opioid-related deaths is currently unknown. Diagnostic criteria for positional asphyxia include finding the decedent in a position that does not allow for adequate respiration and an inability to extricate themselves from the position due to various conditions. Our primary objective was to assess whether positional asphyxia and the resulting airway compromise were a contributing factor to death due to the toxic effects of opioids. We evaluated 225 deaths where the death scene investigation contained adequate information to evaluate for positional asphyxia and performed a Pearson chi-square test to determine if the proportion of deaths found in an airway compromising position was higher when opioid(s) caused the death. The proportion of decedents found in a potential airway compromising position was greater when the death was related to opioid use (p < 0.0001). Further, narrowing the dataset to decedents who were definitely in an airway compromising position [Yes (24.49%) vs. No (11.02%)] showed a statistically significant association between positional asphyxia and deaths related to opioid use (p = 0.0021). Carefully documenting the position in which the decedent was initially found may be a significant factor in accurate reporting and in harm reduction efforts to decrease the opioid mortality rate.     

欧亚经济联盟框架下海关管控领域犯罪及其刑法规制路径研究

欧亚经济联盟作为复杂的跨国组织机构,其经济体系刑法保护机制的构建必须具备一定前提,即应当对各成员国所面临的现实经济安全威胁及其预防的基本方向进行详实分析,并在此基础上制定和实施切实可行的刑法规制路径,构建欧亚经济安全保障新理念。欧亚经济联盟框架内的动态整合过程,不仅影响各成员国内国政治、经济、社会、法律等领域的发展进程,而且使得打击海关领域犯罪成为各成员国的紧迫任务。海关管控领域的常发型犯罪对同属于"关税同盟"和"欧亚经济联盟"国家的经济安全造成严重威胁。欧亚经济联盟成员国应当在公平正义和罪刑相称原则的基础上,修订本国经济活动领域和海关管控领域犯罪的刑事立法规定,有效打击统一关税空间内的违法犯罪,以保障各成员国的内国经济安全。     

经济法规的合宪性审查标准——基于对美国联邦最高法院判例的考察

对法律文件的违宪审查是我国合宪性审查体系的重要组成部分。在美国的违宪审查实践中,针对法律所涉及的内容,分别存在着合理审查、中等审查和严格审查等不同的审查标准。对于经济领域的法律,一般采用合理审查标准,但近年来在涉及言论自由的经济领域,其审查标准往往会提高。在我国的合宪性审查制度中,如果法院在个案审判中发现法律存在违宪嫌疑时,可以建立向最高人民法院移送的机制,并通过听证程序进行充分论证以决定是否向全国人大常委会提出合宪性审查请求。在审查中,对于我国的经济法律不宜直接采用合理审查标准,而应提高审查标准。     

论行政机关协助执行行为的可诉性

行政机关协助执行行为认定为"司法协助行为+行政行为",可以在确保司法权威与提高执行效率的同时促进法治政府的建设,为当事人合法权益救济提供可能。《关于适用〈中华人民共和国行政诉讼法〉的解释》第一条第二款第七项但书前的规定,因为受司法权作用,是不具有可诉性的司法协助义务;但书后的规定,因为有行政机关独立自主的意思表示,是具有可诉性的行政行为。其中,但书中"扩大执行范围"包括执行范围内容、种类、期限的扩大,"采取违法方式"包括滥用职权、超越职权以及程序违法。"缩小执行范围""不作为""擅自撤销或变更"等协助执行违法行为需要通过类推适用的方式对条款的法律漏洞予以填补。     

Stay cool or get hot? An applied primer for using temperature in forensic entomological case work

The reliable reconstruction of the temperature conditions at a crime scene is still a great challenge in forensic-entomological case work. Despite many published standards and guidelines for reconstructing temperature, and studies analysing the influence of various factors on the accuracy on such reconstructions, there are astonishingly many cases in the literature in which the temperature at the place of discovery is not reconstructed at all, i.e. the most common method is using the data of the nearest meteorological weather station without any correlation with on-site data. This study summarizes the state of the art in temperature reconstruction from an entomological point of view and compares the application of generalized additive models (GAMs) and linear regression on the basis of hypothetical death scenarios with various post mortem intervals (PMI) and measurement periods for the correlation between crime scene and weather station. We show that GAMs i.e. analysing the potential delay effect of temperature within a day, are the tools of choice because they give better, i.e. more accurate estimations than linear regression in 95,6% of all analysed cases regardless of the PMI, body discovery site and correlation period. Nevertheless, each case and crime scene is unique and therefore each entomological expertise should discuss the possible strengths and weaknesses of its temperature reconstruction. Even if temperature is not or cannot be reconstructed for various reasons, a comparison of on-site data with those of a meteorological weather station is the minimum forensic experts should do.     

新时代中国国家安全治理模式转型研究

2013年11月,中共十八届三中全会决定设立中央国家安全委员会,完善国家安全体制和国家安全战略,确保国家安全。2014年,习近平主席在中央国家安全委员会第一次会议上正式提出总体国家安全观。总体国家安全观是中国国家安全治理活动的灵魂和纲领。根据总体国家安全观要求,特别是国家安全法治的深入发展,国家安全组织的内涵和国家安全事务的范围发生了很大变化,前者特指由国家安全职能部门转化为囊括国家安全领导机关、国家安全职能机关和国家安全责任机关的整个安全组织体系;后者由传统安全事务范围扩大到非传统安全事务范围。与此同时,中国国际秩序观也发生了根本性的变化,即由原来对国际秩序和国际体系的排斥转变到对国际秩序和国际体系的接纳和融合。这一切都意味着,国家安全治理模式也要随之发生变化,这种变化主要表现在：由单一治理主体向多元治理主体转变、强制治理向综合治理转变、行政治理向法治治理转变以及封闭治理向开放治理转变。国家安全治理模式转型的路径主要有以下三种：转变安全观念,树立总体国家安全观;加强国家安全教育,强化安全治理主体意识;梳理安全职责,为中央国家机关履职奠定基础。