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.     

大鼠死后肌动蛋白降解与死亡时间的相关性

目的观察大鼠死后不同时间心肌、肝、脾、肺、肾、脑和骨骼肌肌动蛋白（actin）的降解规律,为晚期死亡时间（postmortem interval,PMI）的推断寻找客观指标。方法28只SD大鼠随机分为7组,经机械性窒息致死后．分别置于20℃恒温箱内,于0、24、48、72、96、120和168h后剖取以上器官,应用免疫印迹技术检测各组织内actin的含量,SPSS11．5软件对所得数据进行方差分析。结果大鼠死后上述各器官actin含量均随PMI的延长而逐渐下降,与PMI相关,决定系数（R2）均在0．75以上。但actin在上述各器官内的降解速度有显著差异（P〈O．05）,在脑组织中降解速度最快,其余依次为肺、脾、肝、肾、心肌和骨骼肌。结论尽管大鼠死后心肌、肝、脾、肺、肾、脑和骨骼肌actin的降解规律具有组织差异性,但是actin在上述组织中的含量变化与PMI相关．有助于较晚期PMI的推断。     

The succession and development of insects on pig carcasses and their significances in estimating PMI in south China

The succession of insect communities on carrion varies at local and global spatial scales. As such, ecological succession data obtained from corpses at one geographic location cannot necessarily be applied to other locations. Our study describes this succession in the far southern part of China to provide such data for forensic cases in this region. A total of 18 pig carcasses were placed in the field in four seasons, and the timing of the following events were recorded: appearance of larvae, onset of larval wandering, when most larvae had wandered, onset of pupariation, when most larvae had pupariated, onset of eclosion and end of eclosion. Our results indicated that all of the evaluated events could be used as accurate indicators of postmortem interval (PMI). The carcasses decayed fairly quickly in spring, summer and autumn, taking 225+/-75 h, 183+/-44 h, and 247+/-70 h, respectively, to decay from the fresh stage to skeletonisation. In winter, carcasses needed longer (1180+/-291) to decay as much. Carcasses attracted 47 species of insect, with flies predominating. The larvae were mainly Chrysomya megacephala (Fabricius), Chrysomya rufifacies (Macquart) and Hydrotaea (Ophyra) spinigera (Stein). Most necrophagous insects were found all year around, and there were no marked differences in species among the four seasons, except that Dermestes maculatus (De Geer) was absent in winter. Blowflies produced only one generation on a carcass before it became skeletonised, which simplified the estimation of PMIs.     

Pig-mentation: postmortem iris color change in the eyes of Sus scrofa

Experienced forensic pathologists and examiners may be familiar with the phenomenon of postmortem iris color change; however, only Knight, Simpson's forensic medicine, Arnold, London, 1997; Ref. 1 and Saukko and Knight, Knight's forensic pathology, 3rd ed., Arnold, London, 2004; Ref. 2 have referred to it in the literature, and to date, there have been no published scientific research studies on this taphonomic artifact. A controlled experiment was conducted of postmortem changes to isolated Sus scrofa eyes. The eyes (n = 137) were separated into three groups and each sample was observed for 3-day postmortem at a different temperature. In addition, a Sus scrofa head was obtained to observe postmortem changes of eyes in situ. All isolated blue eyes in the experiment, at room temperature and higher, changed to brown/black within 48 h. The in situ blue eye, at room temperature, turned brown/black within 72 h. If iris color consistently changes postmortem in humans, then this taphonomic artifact must be incorporated into victim identification protocol, including disaster victim identification software, and autopsy reports to prevent inaccurate victim identification and inappropriate exclusion from the identification process.     

The Application of Flow Cytometry as a Rapid and Sensitive Screening Method to Detect Contamination of Vitreous Humor Samples and Avoid Miscalculation of the Postmortem Interval

Research into maximizing the speed, precision, and reliability of estimating the postmortem interval (PMI) has been a recurring object of investigation and methodologies based on the vitreous humor (VH) have provided good results. However, contamination from causes not readily apparent, such as blood, can occur, and thus lead not only to an erroneous estimation of PMI, but also interfere with the correct identification of other substances in the VH. We have developed a flow cytometry method which quantifies blood contamination and is able to detect erythrocytes in 1:750,000 dilution of contaminated VH which affects the results of hypoxanthine. It is an improvement on the previous more complex mass spectrometry method, being faster, more sensitive, and readily available. As such, it could be proposed for the rapid screening of appropriate samples by detecting and eliminating blood contaminated samples from PMI estimation.     

Soilwater Conductivity Analysis to Date and Locate Clandestine Graves of Homicide Victims

In homicide investigations, it is critically important that postmortem interval and postburial interval (PBI) of buried victims are determined accurately. However, clandestine graves can be difficult to locate; and the detection rates for a variety of search methods (ranging from simple ground probing through to remote imaging and near‐surface geophysics) can be very low. In this study, simulated graves of homicide victims were emplaced in three sites with contrasting soil types, bedrock, and depositional environments. The long‐term monthly in situ monitoring of grave soil water revealed rapid increases in conductivity up to 2 years after burial, with the longest study evidencing declining values to background levels after 4.25 years. Results were corrected for site temperatures and rainfall to produce generic models of fluid conductivity as a function of time. The research suggests soilwater conductivity can give reliable PBI estimates for clandestine burials and therefore be used as a grave detection method.     

The Reliability of Facial Recognition of Deceased Persons on Photographs

In humanitarian emergencies, such as the current deceased migrants in the Mediterranean, antemortem documentation needed for identification may be limited. The use of visual identification has been previously reported in cases of mass disasters such as Thai tsunami. This pilot study explores the ability of observers to match unfamiliar faces of living and dead persons and whether facial morphology can be used for identification. A questionnaire was given to 41 students and five professionals in the field of forensic identification with the task to choose whether a facial photograph corresponds to one of the five photographs in a lineup and to identify the most useful features used for recognition. Although the overall recognition score did not significantly differ between professionals and students, the median scores of 78.1% and 80.0%, respectively, were too low to consider this method as a reliable identification method and thus needs to be supported by other means.     

针刺治疗腰椎间盘突出症的临床正交设计观察

目的 对腰椎间盘突出症的针刺治疗方案进行初步优选。方法 以48例腰椎间盘突出症患者为观察对象,以视觉模拟评分法（visual analogue scale,VAS）、日本骨科协会（Japanese orthopaedic association,JOA）评分系统为评价指标,以针刺腰夹脊穴为主要治疗方法,采用四因素二水平正交设计方案,对加强局部选穴、循经远端取穴、电针频率、针刺间隔时间的组合方案进行优选。结果 加强局部取穴、循经远端取穴、电针频率3个因素两水平间的VAS及JOA评分差异具有统计学意义（P<0.05）;针刺时间间隔两水平之间VAS及JOA评分差异无统计学意义（P>0.05）;交互作用中,加强局部取穴与电针频率4 Hz、循经远端取穴与电针频率4 Hz的交互作用最为显著。结论 腰椎间盘突出症宜针刺夹脊穴,配合加强局部取穴和循经远端取穴,电针频率4 Hz,隔日治疗1次。     

曲马多在家兔体内的死后分布研究

目的研究曲马多在中毒家兔体内死后分布规律,为曲马多中毒检材采取提供实验依据。方法家兔经口给予10倍LD50曲马多,待家兔死亡后迅速解剖取样,气相色谱／质谱联用和气相色谱-FTD法测定其体液、脏器、大脑及右上肢和右下肢肌肉中曲马多的含量,比较其变化规律。结果血液和肝脏中曲马多的最低检出限分别为0．05μg/mL和0．05μg/g,提取回收率为97．60％±0．65％～103．10％±1．24％。曲马多在家兔体内的死后分布为：肾〉胃〉肝〉脾〉肺〉脑〉心〉上肢肌肉〉下肢肌肉〉〉体液（尿〉胆汁、心血〉玻璃体液）。结论大剂量曲马多中毒致死后在体内分布不均匀,组织中曲马多含量明显高于心血、胆汁等体液。     

87例大脑及脑干挫伤HSP70变化的研究

目的探讨人大脑及脑干挫伤后神经细胞HSP70变化与损伤时间的关系及大脑与脑干HSP70变化的差异。方法对87例闭合性颅脑损伤死亡脑挫伤组织进行病理学及HSP70免疫组织化学染色,结果进行图像分析。结果脑挫伤24h后.HSP70阳性神经细胞最多见,且免疫反应性最强,随后逐渐下降,14d组及30d组HSP70表达与对照组类似。脑挫伤部位可见较多HSP70阳性的淀粉样小体。图像分析显示大脑与脑干HSP70阳性细胞3个参数(A、IOD及AOD)之间呈高度显著正相关或显著正相关,由高至低排列为:A>IOD>AOD。结论神经细胞HSP70免疫组化染色结合图像分析技术作为推断脑挫伤经过时间的参考,大脑与脑干挫伤后神经细胞HSP70变化规律基本一致,但脑挫伤灶周围淀粉样小体形成的意义有待于进一步研究。