放射诊疗管理中的问题及法律适用探讨

加强放射诊疗监督管理是落实放射诊疗安全的重要内容,对确保从事放射工作的人员、接受诊疗的患者以及在放射诊疗工作场所活动的其他人员的健康权益具有重要意义。本文根据2011年12月31日通过修改的《职业病防治法》,对基层放射诊疗许可及个人防护用品管理等问题进行探讨,就法律适用中几个问题提出粗浅见解。     

Measurement of Postmortem Pupil Size: A New Method with Excellent Reliability and Its Application to Pupil Changes in the Early Postmortem Period

Measurement of postmortem pupil width is a potential component of death time estimation. However, no standardized measurement method has been described. We analyzed a total of 71 digital images for pupil–iris ratio using the software ImageJ. Images were analyzed three times by four different examiners. In addition, serial images from 10 cases were taken between 2 and 50 h postmortem to detect spontaneous pupil changes. Intra‐ and inter‐rater reliability of the method was excellent (ICC > 0.95). The method is observer independent and yields consistent results, and images can be digitally stored and re‐evaluated. The method seems highly eligible for forensic and scientific purposes. While statistical analysis of spontaneous pupil changes revealed a significant polynomial of quartic degree for postmortem time (p = 0.001), an obvious pattern was not detected. These results do not indicate suitability of spontaneous pupil changes for forensic death time estimation, as formerly suggested.     

猪瘟病毒NASBA-ELISA检测方法的建立与应用

为建立猪瘟病毒NASBA-ELISA检测方法,以猪瘟病毒(CSFV)E2基因为研究对象,利用Prim-er 5.0和Blastn生物软件,设计并合成了特异的核酸序列依赖扩增(NASBA)引物和探针。经条件优化,确定的最佳扩增反应条件为42℃,反应1.5h。临床检测结果显示,用该方法可特异地扩增CSFV E2基因约155bp的目的片段,而对TGEV、PRRSV、PCV2、PPV、PEDV、APP和PK-15正常细胞等核酸的检测均为阴性,可最低检出1×100～1×101 copies/μL,其灵敏度比RT-PCR略高。应用该方法对采自重庆部分地区猪场的125份样品进行了检测;结果,猪瘟病毒阳性检出率为5.6%,NASBA-ELISA法与RT-PCR法的检出符合率为94.4%。结果表明,NASBA-ELISA方法可应用于CSFV的快速鉴别检测。     

钾中毒死亡家兔的尸体化学变化

目的研究家兔钾中毒死亡后的尸体化学变化特征,为钾中毒的法医学鉴定提供参考。方法采用浓度为0.3%和1%的KCl葡萄糖溶液分别以全速和100滴/min的速度输给家兔,至其死亡,测定家兔输液前后血、尿电解质浓度,比较两种不同输液方式所致钾中毒死亡后尸体化学变化特征。结果输钾前后,家兔血清K (SK)浓度升高,血清Na 、Ca2 、Cl-及HCO3-浓度均降低,全血K (TK)及血清Mg2 浓度变化无显著性差异。0.3%KCl组致死输液时间长于1%组(P=0.006),致死输钾量无显著性差异(P=0.062);TK、血清Na 、Mg2 及Cl-浓度变化值具有显著差异,SK、Ca2 、HCO3-浓度变化值无显著差异;尿量和尿液各电解质浓度指标未见显著性差异。结论尸体SK、TK及血清Mg2 浓度升高,有助于钾中毒的法医学死后诊断。     

Morphometric Investigation of Death by Asphyxia

Abstract:  The aim of this study was to investigate the possibility of distinguishing deaths by asphyxia from those due to natural causes by comparing morphometric measurements in lungs. The study population comprised 27 subjects: 14 cases of death by asphyxia (hanging or drowning) and 13 cases of sudden natural death. Eighty parenchyma sections were used for each subject. Data were collected by computerized image analysis. Measurements aimed at quantifying, as percentages, pulmonary parenchyma (mean values of positive-fraction areas [PFA] and their standard deviations). Subjects who died of natural causes and of drowning showed a relative internal homogeneity compared to those who hanged. Results show significant discrimination between drowned subjects and those dying of natural causes (mean of PFA p  = 0.01) and between hanged and drowned subjects (SD of PFA p  = 0.04). Attention must be paid to the possible role played by senile emphysema. The method is proposed as a complementary tool in forensic cases.     

早期心肌梗死死后诊断的法医病理学研究进展

心源性猝死在成人猝死的死因中占首位,心肌梗死是冠心病猝死的主要机制之一,由于早期心肌梗死发生突然,且可在短时间内死亡,肉眼和镜下都缺乏典型的形态学改变,一直都是法医实践中研究的热点,本文回顾多年来心肌梗死的研究成果在法医学中的应用及局限,展望新的临床指标在法医工作中的可行性,期望提高死后心肌梗死诊断的准确率。     

电击伤最佳病理取材部位的初步研究

目的探讨日常低电压电击后机体电流通路上极向化等病变规律和最佳病理取材部位。方法SD大鼠随机分为电击组和对照组,建立左前爪-右后爪路径220V电击大鼠模型,取电极接触处皮肤、四肢血管、神经和周边组织及腹腔大血管,常规HE染色病理组织学图像分析。结果电极接触处皮肤基底细胞(skinbasalcell,SBC)核明显极向化改变,长/短径比值与对照组比较差异高度显著,P<0.001;电流通路上腕和踝部血管及腹主动脉内皮、平滑肌细胞核的极向化与对照组比较,差异显著,P<0.05,其中腕和踝部病理改变最明显;周围骨骼肌细胞核的长/短径比值无明显规律性。结论在电击死中最常见的“手-足通路”,腕、踝部血管可能为病理取材的最佳部位。同时,由于腕和踝部距离手脚掌较远,直接接触热源和化学试剂等其他可能引起“极向化”改变的因素机会少,因此,腕和踝部血管及其周边组织的极向化改变更具有电损伤的特异性。     

3种特殊染色在急性心肌梗死死后诊断中的应用比较

目的对比观察苏木素-碱性复红-苦味酸染色(HBFP染色)、变色酸2R-亮绿染色和Heidenhain染色在急性心肌梗死死后诊断中的应用价值。方法以大鼠急性心肌梗死模型、法医检案急性心肌梗死心脏标本作为研究对象,采用HBFP染色、变色酸2R-亮绿染色和Heidenhain染色进行对比观察。结果①3种特染方法在大鼠心肌缺血15min时均可观察到阳性染色,且阳性染色面积随缺血时间的延长而扩大;②大鼠急性心肌缺血4h心脏标本在-20℃、4℃及室温条件下保存至14d,3种特染方法仍可见阳性着色,但变色酸2R-亮绿染色和HBFP染色随保存时间的延长而出现着色能力下降,阳性区域变小的趋势,Heidenhain染色效果最为稳定;③急性心肌梗死检案标本中,3种特染方法均可显示缺血心肌纤维,发病1h内死亡者Heidenhain染色优于另外两种染色。结论 3种特染均可客观的显示出急性心肌梗死早期病理改变,其中Heidenhain染色更具稳定性和可操作性。     

Attitudes towards sex offenders regarding competency,liability, voluntariness of offence,and disposal: the influence of being classified as having a learning disability

Abstract

The principal aim of this study was to investigate whether attitudes towards judicial competency, legal liability, voluntariness of offence and judicial disposal options were influenced by known classification of an offender as learning disabled compared to an offender with a suggested intellectual disability, but not formally classified. Subsidiary aims were to explore participant attitudes based upon group membership and parental status. The sample consisted of 101 participants (69 undergraduate nursing students and 32 from the general population). Participants were requested to complete a questionnaire assessing their attitudes within the aforementioned domains and towards ascribed levels of victim parental responsibility. Fifty participants completed a questionnaire designed for the purpose of the study where the offence scenario depicted made reference to the offender having a formal classification of learning disability. Fifty-one participants completed the same questionnaire where an intellectual disability was suggested but not formally stated in the form of classification. Results indicated that classification did significantly influence attitudes in most domains irrespective of group. The nursing group attributed greater levels of competency to the offenders depicted. No interactions between variables were observed. The reasons for and implications of these findings, limitations and recommendations for future research are explored.     

178例心源性猝死法医组织病理学诊断分析

目的探讨心源性猝死(SCD)的病理特点与鉴别要点。方法对四川华西法医学鉴定中心2000—2005年尸检出的178例SCD死亡案例进行回顾性分析,主要对其病因、年龄、诱因及病理改变进行分析。结果本组资料显示冠心病、心传导系统病变、心肌炎、心肌病等在SCD中占有较大比例。冠心病猝死是中老年人SCD的最主要原因,青壮年人SCD的病因以非冠心病为主。如传导系统病变、心肌炎、心肌病。在儿童的SCD中先天性心脏病、传导系统病变及心肌炎占主导地位。结论不同的病因,其病理特点不同,其病理变化是法医学鉴定的主要依据。