Necrotizing fasciitis: manifestations, microbiology and connection with black tar heroin

A 10-year review of records of the King County Medical Examiner's Office found 87 deaths due to necrotizing fasciitis and related necrotizing soft tissue infections. In 64 of these cases there were sufficient details to provide an analysis of the manifestations, microbiology, and source of infection. One half (32) of the cases were due to injection of black tar heroin, the nearly exclusive form of heroin in the Northwest United States. Of those due to black tar injection, 24 were clostridial infections with various species represented, eight of which were Clostridium sordellii. Of the 32 cases not associated with drug injection, streptococcal species predominated, with Streptococcus pyogenes isolated in 14 cases. Only three of 32 cases not associated with injection drug use were clostridial infections. These differences were statistically significant. Staphylococcus aureus was isolated from 14 cases; two were methicillin-resistant strains. Overall, 28 of the 64 cases were polymicrobial infections, 15 due to black tar injection and 13 not associated with drug injection. This study supports the conclusion that necrotizing fasciitis due to black tar heroin injection is predominantly a clostridial disease, and in this way differs significantly from necrotizing fasciitis due to other causes.     

Producing race disparities: A study of drug arrests across place and race*

In studies of race disparities in policing, scholars generally employ quantitative methodologies with the goal of determining whether race disparities exist or, in fewer instances, of ruling out correlates. Yet, lacking from theoretical and empirical efforts is an elucidation of how and why on‐the‐ground policing produces race disparities that are justified in legal, race‐neutral terms. To address this knowledge gap, I analyze officers’ self‐reported accounts of their enforcement activities, justifications, and decision‐making in a representative sample of 300 official reports of drug arrests made in St. Louis from 2009 to 2013. These accounts are analyzed across neighborhood racial contexts and arrestee race, revealing important differences that help illuminate the race disparity problem. Unlike drug arrests in White neighborhoods or of White citizens that primarily stem from reactive policing, drug arrests in Black and racially mixed neighborhoods and of Black citizens result from officers’ greater use of discretionary stops based on neighborhood conditions, suspicion of ambiguous demeanor, or minor infractions. During such stops, officers’ discovery of drug possession often results from discretionary Terry frisks or searches incident to arrests for outstanding bench warrants. These findings fill important theoretical and empirical gaps and have implications for reforms toward racially just policing.     

A potentially catastrophic outcome from a false-positive urinary drug screen immunoassay

Background: Urinary drug screens are routinely administered for patients returning from leave from forensic psychiatric wards, and are required to be negative for patients to continue to use their allocated leave. Case: A 35-year-old woman took leave from her low-secure psychiatric unit. On return, her urine screened positively for 3,4-Methylenedioxymethamphetamine (MDMA). She strongly denied she had taken it; however, all her leave was cancelled. Her clinical state greatly deteriorated, and she attempted to hang herself the following day. After stabilisation of the patient and continued denial of taking MDMA, the urine was sent for toxicology analysis. In the weeks that followed, she started self-harming and deteriorated to the point of needing electroconvulsive therapy. The toxicological report came back as a false-positive due to recently started Mebeverine. Conclusion: Clinicians must be mindful that urinary drug screens are not diagnostic, but also that not being believed can be devastating, especially for long-stay forensic inpatients.     

How ‘Vulnerable’ young people describe their interactions with police: building positive pathways to drug diversion and treatment in Sydney and Melbourne,Australia

This article describes findings from an Australian mixed method study, and explores young people’s perceptions of police. We focus on the nature of positive experiences, and the potential for positive encounters to improve outcomes for young offenders affected by problematic alcohol and other drug use. Buber’s concept of dialogical interaction is used to articulate the components of a positive experience and how this increases police legitimacy. In doing so, we demonstrate that, despite negative experiences, young people can be sympathetic to the tensions of modern policing, and can envisage police as positive role models. As such, police can enhance outcomes for ‘vulnerable’ young people through more respectful interactions.     

Fatal Myocarditis Following Treatment with the PD‐1 Inhibitor Nivolumab

Therapeutic antibodies targeting the programmed cell death protein 1 (PD‐1) pathway function as immune checkpoint inhibitors, allowing the immune system to recognize tumors which otherwise escape immune surveillance. However, these agents can also elicit an autoimmune response by inhibiting the ability of non‐neoplastic tissues and regulatory cells to suppress the immune system. Here we present a fatal case of active myocarditis in a 55‐year‐old man with non‐small‐cell lung cancer which occurred following monotherapy with the PD‐1 inhibitor nivolumab (Opdivo). He presented with acute right‐sided heart failure and died 1 day after admission. Postmortem examination revealed multiple gelatinous lesions in the myocardium of the interventricular septum and the bilateral atria and ventricles which had microscopic features diagnostic of myocarditis. Subsequent studies failed to identify an infectious cause. Immune checkpoint inhibitors are an increasingly common addition to anticancer regimens and they should be considered in the evaluation of acute myocarditis.     

Experimental Study on the Postmortem Redistribution of the Substituted Phenethylamine, 25B‐NBOMe

2‐(4‐Bromo‐2,5‐dimethoxyphenyl)‐N‐(2‐methoxybenzyl)ethanamine (25B‐NBOMe) is a substituted phenethylamine, which has become highly prevalent worldwide since 2014. Recently, in an autopsy case involving fatal 25B‐NBOMe intoxication, we found the postmortem increase of 25B‐NBOMe concentration in the cardiac blood approximately 2 days after death. The aim of this study was to investigate the distribution of 25B‐NBOMe and reproduce the postmortem redistribution using a rat model. Sprague‐Dawley rats were killed 30 min after intraperitoneal injection of 25B‐NBOMe (0.5 mg/kg) and left for 0, 3, 6, 9, 15, or 24 h (six rats at each time point). Postmortem 25B‐NBOMe concentrations in the cardiac blood increased by more than 10‐fold at 6‐h postmortem. 25B‐NBOMe accumulated primarily in the lung. Moreover, this postmortem redistribution occurred even in rats that had died 1 week following the 25B‐NBOMe administration. These findings indicate that attention should be paid to sample collection and data interpretation in the toxicological analysis of 25B‐NBOMe.     

环境污水毒品检测技术在禁毒情报中的应用

本文以环境污水毒品检测技术为基础,结合相关法学和统计学理论,为毒品检测技术在禁毒情报的获取中提供了新的应用方式。本文首先介绍了环境污水分析技术的起源以及污水流行病学的研究方法,并对包括样品提取与保存、固相萃取、液相色谱串联质谱法分析在内的污水样品中毒品检测技术手段进行了详细的介绍;进而,对以禁毒情报工作的需求为着力点,通过动态广泛的污水中毒品检测,以大数据的方式获得关于不同种类毒品的时间空间分布情况的方法进行说明论述,充分展现了环境污水检测技术的应用潜力及前景;最后,对此项工作目前在理论和实践中存在的问题与不足进行了简要的汇总和分析。     

Selling stolen goods on the online markets: an explorative study

Historically, criminologists studied theft from different perspectives, but only a few focused their attention on the reselling of stolen items. The advent of the Internet has boosted stolen good markets by facilitating interactions between vendors (thieves and receivers) and buyers. This study, based on 227 cases reported by news sites in 2015 and 2016, focuses on the markets and methods used to sell stolen goods online. The results suggest that the online selling methods are quite independent from existing offline methods. The findings innovate with respect to the typology provided by Sutton. The online markets for stolen goods are rather a new environment where perpetrators may choose among several methods of disposal. The results reflect a preference for resale through classified ads sites (44.24%), auction sale sites (28.11%) and social media (19.35%). In the light of this study, more research is needed to understand online stolen goods markets and their mechanisms.     

健脾化湿通络方药对3 449例风湿病患者终点事件影响的队列研究

目的 通过随访风湿病出院患者健脾化湿通络方药的应用情况,观察中医药治疗风湿病的效应。方法 采用队列研究方法,电话随访风湿病住院患者出院后服用中成药和中药汤剂的时间（＜28 d者定义为非暴露组,＞28 d、且≤90 d者为低暴露组,＞90 d、且＜180 d者为中暴露组,≥180 d者为高暴露组）。采用χ2检验、Logistic回归法分析健脾化湿通络方药治疗与终点事件发生的相关性。结果 3 449例患者完成随访,失访率16.18%（666/4 115）。出院后应用中成药、中药汤剂时间≥28 d的风湿病患者共2 877例,应用频次较高的中成药依次为新风胶囊、新癀片、黄芩清热除痹胶囊、雷公藤多苷片、杜仲壮骨丸、颈椎活血胶囊等。终点事件发生185例,其中高暴露组发生18例(9.73%),中暴露组31例(16.76%),低暴露组48例(25.95%),非暴露组88例(47.57%),终点事件发生率差异有统计学意义(P＜0.05)。Logistic回归分析结果表明,暴露强度、新风胶囊、雷公藤多苷片、黄芩清热除痹胶囊为终点事件的保护因素。结论 终点事件的发生与中医药治疗的强度相关,以新风胶囊为代表的健脾化湿通络方药能减少风湿病患者终点事件的发生。