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Detection and quantification of selected cannabinoids in hair samples by liquid-liquid extraction and LC-MS/MS 液液萃取- LC-MS/MS法测定头发样品中大麻素含量
IF 2.5 3区 医学 Q1 MEDICINE, LEGAL Pub Date : 2026-02-01 Epub Date: 2025-10-06 DOI: 10.1016/j.forsciint.2025.112685
Mónica Antunes , Susana Simões , Suzana Fonseca , João M. Franco , Mário Barroso , Eugenia Gallardo
Cannabis remains the most used illicit drug worldwide, with rising use linked to medical and recreational decriminalization. This has driven the development of analytical techniques to detect cannabinoids in biological matrices. Hair offers key advantages due to its non-invasive collection, extended detection window, stability, and easy storage. This study presents the development and validation of a robust method for extracting natural cannabinoids from hair, following ANSI/ASB 2019, FDA, and Society of Hair Testing guidelines. Hair samples were washed with methanol and cut into small pieces. Approximately 20 mg of hair was incubated with 1 M NaOH and methanol (30 min, 50 °C). The mixture was acidified with acetic acid and underwent liquid-liquid extraction using hexane/ethyl acetate (90/10, v/v). The organic phase was evaporated and reconstituted in 1-pentanol/methanol (50/50, v/v). Analysis was conducted by LC-MS/MS using multiple reaction monitoring (MRM) and triple-stage mass spectrometry (MS³). The method was selective, specific, precise, and linear, with working ranges of 5–2000 pg/mg for THC, CBN, and CBD; 50–2000 pg/mg for THC-OH; and 0.2–20 pg/mg for THC-COOH. Ion suppression was observed but did not affect sensitivity, with LLOQs and LODs from 0.2 to 50 pg/mg. Over 25 hair samples from university students tested positive for cannabis. THC ranged from 5.9 to 2430.7 pg/mg; one sample had THC-OH above LLOQ (61.4 pg/mg); THC-COOH ranged from 0.3 and 36.4 pg/mg; CBN from 5.7 to 461.0 pg/mg; and CBD from 5.7 to 850.2 pg/mg. Results aligned with self-reported use, confirming the method's forensic suitability.
大麻仍然是世界上使用最多的非法药物,其使用与医疗和娱乐非刑事化有关。这推动了分析技术的发展,以检测生物基质中的大麻素。由于其非侵入性收集,延长检测窗口,稳定性和易于存储,头发提供了关键优势。本研究提出了一种从头发中提取天然大麻素的可靠方法的开发和验证,遵循ANSI/ASB 2019、FDA和头发测试协会的指导方针。头发样本用甲醇清洗并切成小块。约20 mg头发与1 M NaOH和甲醇(30 min, 50°C)孵育。混合物用乙酸酸化,用正己烷/乙酸乙酯(90/10,v/v)液-液萃取。蒸发有机相,在1-戊醇/甲醇(50/50,v/v)中重构。采用多反应监测(MRM)和三级质谱法(MS³)的LC-MS/MS进行分析。四氢大麻酚、CBN、CBD的检测范围为5 ~ 2000 pg/mg,具有选择性、专属性、精密度、线性好等特点;THC-OH 50-2000 pg/mg;THC-COOH为0.2-20 pg/mg。观察到离子抑制,但不影响灵敏度,lloq和lod在0.2至50 pg/mg之间。超过25名大学生的头发样本被检测出大麻阳性。THC范围为5.9 ~ 2430.7 pg/mg;1份样品THC-OH高于限定限(61.4 pg/mg);THC-COOH范围为0.3 ~ 36.4 pg/mg;CBN从5.7 ~ 461.0 pg/mg;CBD从5.7到850.2 pg/mg。结果与自我报告的使用情况一致,证实了该方法的法医适用性。
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引用次数: 0
Drug use pattern of suspected drug-influenced drivers in Hungary (2019–2023) 2019-2023年匈牙利疑似吸毒司机用药情况
IF 2.5 3区 医学 Q1 MEDICINE, LEGAL Pub Date : 2026-02-01 Epub Date: 2025-10-07 DOI: 10.1016/j.forsciint.2025.112681
László Institóris , Előd Hidvégi , Ferenc Rárosi , Éva Sija , Katalin Kovács , Gábor Süvegh , Róbert Berkecz , Éva M. Kereszty
Between 2019 and 2023, blood and urine samples of 6229 suspected impaired drivers were analysed, with a positivity rate of 91.5 %. Classical illicit drugs were detected in 4693 drivers, medicines in 850 drivers, stimulant new psychoactive substances (sNPS) in 928 drivers and synthetic cannabinoid receptor agonists (SCRAs) in 657 drivers. The consumption of cannabis, N-ethyl-norpentedron, and N-ethyl-hexedrone increased significantly over time, while the consumption of five SCRAs declined. These changes were concordant with the seizure data for the entire country.
74.2 % of drug-positive drivers were deemed impaired. Impairment was determined by fixed concentration limits in 3538 cases, multi-drug use in 507 cases, and clinical symptoms (when only one active substance with no impairment limit was present in the blood) in 217 cases.
To evaluate clinical tests, the prevalence of positive and negative clinical findings was compared for amphetamine/methamphetamine, THC, MDMA, alprazolam, and clonazepam above and below their fixed concentration limits. Only alprazolam showed a significantly higher frequency of positive clinical signs above the limit. This finding suggests that the current protocol of medical examination in Hungary is inadequate for diagnosing impairment when only one active substance without a defined threshold is detected in the blood. Given that sNPS was detected in 24.1 % of drivers, the medical investigation system requires a major revision.
The aim of this study was to investigate the illicit and licit drug consumption of suspected impaired drivers in Hungary and to present the disadvantages of the system currently used for diagnosing and proving impairment.
2019年至2023年,对6229名疑似受损司机的血液和尿液样本进行了分析,阳性率为91.5 %。检出经典违禁药物4693例,药物850例,兴奋剂新型精神活性物质928例,合成大麻素受体激动剂657例。大麻、n -乙基去戊体和n -乙基己烯酮的消费量随着时间的推移显著增加,而五种scra的消费量下降。这些变化与全国的缉获数据一致,74.2 %的药物阳性司机被认为是受损的。3538例采用固定的浓度限值,507例采用多种药物使用,217例采用临床症状(血液中只有一种活性物质无损害限值)。为了评价临床试验,比较了安非他明/甲基苯丙胺、四氢大麻酚、MDMA、阿普唑仑和氯硝西泮高于和低于其固定浓度限值的阳性和阴性临床结果的流行率。只有阿普唑仑出现阳性临床症状的频率明显高于极限。这一发现表明,如果在血液中只检测到一种活性物质而没有确定阈值,匈牙利目前的医疗检查方案不足以诊断损伤。考虑到24.1% %的司机被检测出sNPS,医疗调查系统需要进行重大修改。本研究的目的是调查匈牙利疑似残疾司机的非法和合法药物消费,并提出目前用于诊断和证明残疾的系统的缺点。
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引用次数: 0
Microscopic characterisation of dental fractures caused by firearm projectiles 枪械弹丸引起的牙骨折的显微特征
IF 2.5 3区 医学 Q1 MEDICINE, LEGAL Pub Date : 2026-02-01 Epub Date: 2026-01-09 DOI: 10.1016/j.forsciint.2026.112819
Ángel Rubio Salvador , Lydia P. Sánchez-Barba Muñoz , Fernando Navarro Merino , Jesús M. Úbeda-Portugués , Aristeidis Strimenopoulos , Paula Yanke , Elena Vera-Cruz , Marina Lozano
The analysis of bone injuries resulting from high-velocity firearm projectile trauma is a complex process, due to the influence of numerous variables on the resultant injury patterns. This complexity is particularly evident in specific skeletal regions, such as the oral cavity and teeth, which have received minimal attention in forensic research. In this study, four fractured teeth from an individual interred in a mass grave dating to the Spanish Civil War (1936–1939) in Seville, Spain, were analysed to assess gunshot-related trauma.The teeth were examined using digital 3D microscopy and scanning electron microscopy (SEM). This analysis enabled the identification of features in the dental tissue indicative of perimortem trauma, including characteristics related to the fracture response of living or hydrated dental tissue. Additionally, variations in damage —such as edges, surfaces, and fracture lines— were observed, depending on the proximity of the teeth to the projectile’s impact point in the oral cavity. Notably, surface damage presenting as pits was identified, with morphologies and patterns potentially linked to the forces generated by the projectile. These findings suggest that such microscopic features may serve as indicators of ballistic trauma, even in the absence of prior microscopic analyses of dental tissues.
高速弹丸伤致骨损伤的分析是一个复杂的过程,其损伤模式受多种因素的影响。这种复杂性在特定的骨骼区域尤其明显,例如口腔和牙齿,在法医研究中很少受到关注。在这项研究中,研究人员分析了在西班牙塞维利亚的一个万人坑中埋葬的一个人的四颗断裂牙齿,以评估与枪击有关的创伤。该万人坑可追溯到西班牙内战(1936-1939)。采用数字三维显微镜和扫描电子显微镜(SEM)对牙齿进行检查。这一分析能够识别出表明死前创伤的牙组织特征,包括与活的或水合的牙组织骨折反应相关的特征。此外,观察到损伤的变化,如边缘、表面和断裂线,这取决于牙齿与弹丸在口腔中的撞击点的接近程度。值得注意的是,表面损伤表现为凹坑,其形态和模式可能与弹丸产生的力有关。这些发现表明,即使在没有事先对牙齿组织进行显微镜分析的情况下,这些显微镜特征也可以作为弹道创伤的指标。
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引用次数: 0
Qualitative assessment of DNA isolation from fresh, frozen, and ancient human bone using a homogenizer-assisted workflow 使用均质机辅助工作流程对从新鲜、冷冻和古代人骨中分离的DNA进行定性评估
IF 2.5 3区 医学 Q1 MEDICINE, LEGAL Pub Date : 2026-02-01 Epub Date: 2025-12-31 DOI: 10.1016/j.forsciint.2025.112807
Volkan Karaman , Fatih Tepgeç , Pulat Akın Sabancı , Ayça Dilruba Aslanger , Mehmet Görgülü , Duygu Dölen , Zehra Oya Uyguner
Effective DNA recovery from bone material is essential for applications in biomedical research, clinical diagnostics, and forensic and archaeogenetic investigations. In this study, DNA isolation performance was evaluated in an exploratory manner in human bone samples representing three preservation states: fresh, cryopreserved, and ancient. All samples were processed using a unified bead mill homogenization and magnetic bead–based extraction workflow in order to maintain procedural consistency. DNA quantity and purity were evaluated by spectrophotometry, and amplifiability was assessed using nuclear and mitochondrial PCR assays as well as representative STR profiling. Fresh and cryopreserved samples yielded higher DNA concentrations and more consistent amplification than ancient specimens, in which recovery was primarily constrained by postmortem degradation. PCR success demonstrated a clear dependence on amplicon length, with shorter mitochondrial and nuclear targets amplifying more reliably across all sample types. Due to the limited sample size and the use of a single individual per preservation group, the results are presented as qualitative observations rather than as statistically generalizable conclusions. Within these constraints, the study demonstrates the feasibility of using a standardized mechanical disruption and extraction workflow across bone samples of differing preservation status and provides a methodological reference for future larger-scale studies involving both modern and degraded skeletal material.
有效地从骨材料中恢复DNA对于生物医学研究、临床诊断、法医和考古调查的应用至关重要。在这项研究中,以探索性的方式评估了代表三种保存状态的人骨样品的DNA分离性能:新鲜,冷冻保存和古代。所有样品均使用统一的球磨均质和基于磁珠的提取工作流程进行处理,以保持程序的一致性。用分光光度法评估DNA的数量和纯度,用核和线粒体PCR分析以及代表性STR分析评估扩增性。新鲜和冷冻保存的样品比古代标本产生更高的DNA浓度和更一致的扩增,古代标本的恢复主要受到死后降解的限制。PCR的成功证明了扩增子长度的明显依赖性,在所有样品类型中,较短的线粒体和核靶标扩增更可靠。由于样本量有限,并且每个保存组使用单个个体,因此结果是定性观察结果,而不是统计上可推广的结论。在这些限制条件下,该研究证明了在不同保存状态的骨样本中使用标准化机械破坏和提取工作流程的可行性,并为未来涉及现代和降解骨骼材料的更大规模研究提供了方法参考。
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引用次数: 0
Identification of the brands of the inkjet printers used in the altered document identification proficiency test: Combination of chemical analysis with conventional morphological examination 涂改文件鉴定能力测试用喷墨打印机的品牌鉴定:化学分析与常规形态检查相结合
IF 2.5 3区 医学 Q1 MEDICINE, LEGAL Pub Date : 2026-02-01 Epub Date: 2026-01-09 DOI: 10.1016/j.forsciint.2026.112818
Xu Hu , Xiao-guang Jia , Ling-yun Zhang , Xiao-xia Zhang , Hui Zhang
The altered document identification proficiency test of the China National Accreditation Service for Conformity Assessment (CNAS), initiated by the China Academy of Forensic Science in 2022, provided a specially prepared questioned document sample. This challenging case sample rendered conventional morphological examination methods virtually ineffective. As a result, only a low percentage of judicial appraisal institutions received the “satisfactory” rating. This work examined the characteristics of the inkjet printers used in the proficiency test from two independent perspectives, by combining volatile solvent composition analysis of printing inks using GC–MS creatively with conventional morphological examination. This work not only efficiently determined whether there was appended content via a secondary printing pass in the case sample, but also further identified the brands of the inkjet printers used to prepare the sample of the proficiency test. Finally, precautions for identifying the brands of inkjet printers were summarized. We hope this work will underscore the importance of incorporating physical and chemical analytical methods in questioned document examination and draw forensic examiners’ attention to its necessity.
由中国法医学研究院于2022年发起的中国合格评定国家认可委员会(CNAS)变更文件识别能力测试,提供了专门准备的质疑文件样本。这种具有挑战性的病例样本使得传统的形态学检查方法几乎无效。因此,只有很低比例的司法鉴定机构获得“满意”评级。本研究创造性地将气相色谱-质谱联用分析印刷油墨挥发性溶剂成分与传统形态学检查相结合,从两个独立的角度考察了用于能力测试的喷墨打印机的特性。这项工作不仅有效地确定了案例样品中是否有附加内容,而且还进一步确定了用于准备能力测试样品的喷墨打印机的品牌。最后总结了识别喷墨打印机品牌的注意事项。我们希望这项工作将强调将物理和化学分析方法纳入可疑文件检查的重要性,并提请法医检查人员注意其必要性。
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引用次数: 0
Detecting fentanyl analogs in counterfeit pharmaceuticals by surface-enhanced Raman spectroscopy using handheld Raman spectrometers 手持拉曼光谱仪表面增强拉曼光谱检测假药中芬太尼类似物。
IF 2.5 3区 医学 Q1 MEDICINE, LEGAL Pub Date : 2026-02-01 Epub Date: 2025-10-03 DOI: 10.1016/j.forsciint.2025.112679
Sevde Dogruer Erkok , Martin M. Kimani , Adam Lanzarotta , Bruce McCord
According to the CDC, approximately 87,000 drug overdose deaths occurred in the United States from October 2023 to September 2024, and the estimated number of overdose deaths in the US attributed to fentanyl and fentanyl analogs was around 54,000 in 2024. While fentanyl and its analogs are abused via numerous administration routes, the number of seized counterfeit tablets containing these drugs is significantly high. The DEA seized over 60 million fentanyl-laced counterfeit pills in 2024, equivalent to more than 380 million lethal doses of fentanyl. Portable techniques can be especially useful for law enforcement. Raman spectroscopy, especially surface-enhanced Raman spectroscopy (SERS), is one such technique which can be useful in both field and laboratory applications due to its sensitivity and selectivity. This study demonstrates SERS for presumptive detection of fentanyl and fentanyl analogs in counterfeit tablets using two portable Raman instruments equipped with 785 nm and 1064 nm lasers, combined with commercial Ag nanoparticles and synthesized Au/Ag nanostars. The analysis of 14 counterfeit tablets revealed that SERS correctly identified fentanyl or a fentanyl analog in all samples, achieving 100 % sensitivity. However, the 1064 nm laser configuration demonstrated slightly superior performance, yielding clearer and more consistent spectral features compared to the 785 nm laser. These findings suggest that SERS, particularly with a 1064 nm laser, is a promising tool for presumptive field detection of fentanyl and its analogs in counterfeit tablets.
根据美国疾病控制与预防中心的数据,从2023年10月到2024年9月,美国约有8.7万例药物过量死亡,而2024年芬太尼和芬太尼类似物在美国的过量死亡人数估计约为5.4万人。虽然芬太尼及其类似物通过多种给药途径被滥用,但查获的含有这些药物的假冒片剂数量相当高。美国缉毒局在2024年查获了6000多万颗含有芬太尼的假药,相当于3.8亿多剂致命的芬太尼。便携式技术对执法尤其有用。拉曼光谱,特别是表面增强拉曼光谱(SERS),是一种可用于现场和实验室应用的技术,由于其灵敏度和选择性。本研究利用配备785 nm和1064 nm激光器的两种便携式拉曼仪器,结合商用银纳米粒子和合成金/银纳米星,验证了SERS对假药中芬太尼和芬太尼类似物的假定检测。对14片假药的分析显示,SERS正确地识别了所有样品中的芬太尼或芬太尼类似物,灵敏度达到100% %。然而,与785 nm激光器相比,1064 nm激光器的配置表现出稍微优越的性能,产生更清晰和更一致的光谱特征。这些发现表明,SERS,特别是1064 nm激光,是一种很有前途的工具,可以用于假药片剂中芬太尼及其类似物的假定现场检测。
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引用次数: 0
The mechanisms of forensic vacuum metal deposition (fVMD): A literature review 法医真空金属沉积(fVMD)机制的文献综述。
IF 2.5 3区 医学 Q1 MEDICINE, LEGAL Pub Date : 2026-02-01 Epub Date: 2025-11-18 DOI: 10.1016/j.forsciint.2025.112733
Aaron Dove , Benoit Daoust , Andreas Ruëdiger
Since the early 1970s, forensic vacuum metal deposition (fVMD) has been used in operational casework. It is renowned for its sensitivity and ability to work on aged impressions and difficult substrates. However, the precise mechanism by which this development occurs remains unclear. This article examines the current literature on fVMD to see what is known about the technique, what is unclear, and what are the next steps that should be taken. This review shows that, while the operational utility of the technique is not in question, none of the currently posited theories can explain all the observed phenomena. They are therefore, at best, incomplete, and further research is required.
自20世纪70年代初以来,法医真空金属沉积(fVMD)已用于实际案件工作。它以其敏感性和能力而闻名,可以在老化的印痕和困难的基材上工作。然而,这种发展发生的确切机制尚不清楚。本文研究了当前关于fVMD的文献,以了解关于该技术的已知内容,不清楚的内容以及应该采取的下一步措施。这篇综述表明,虽然该技术的操作效用没有问题,但目前假设的理论都不能解释所有观察到的现象。因此,它们充其量是不完整的,需要进一步的研究。
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引用次数: 0
Distribution of gunshot residue particles of a submachine gun fired at cotton fabric from the nearest vicinity – A study by means of SEM-EDX technique 冲锋枪从最近距离射击棉织物时射击残留颗粒的分布——SEM-EDX技术的研究。
IF 2.5 3区 医学 Q1 MEDICINE, LEGAL Pub Date : 2026-02-01 Epub Date: 2025-11-10 DOI: 10.1016/j.forsciint.2025.112715
Zuzanna Brożek-Mucha , Iga Klag , Katarzyna Ankus
Studies into shooting patterns and distribution of gunshot residue originating from a submachine gun were carried out. Multiple shootings at targets covered with cotton woven fabric using a 9 mm PM-06 submachine gun in the range of shooting distance 0 – 150 cm were performed. Optical examinations of the patterns revealed a cross-like tear of the fabric for the contact shot and for distances 1 cm and 2 cm, whereas for semi-automatic pistols of the same calibre cross-like openings were observed only for contact and 1 cm shots. Samples of inorganic residue collected from shooting patterns were examined with scanning electron microscopy and energy dispersive X-ray spectrometry (SEM-EDX) in the automatic manner. Results of the measurements provided information on the abundance, chemical composition and distribution of sizes of the populations of the revealed particles in relation to the shooting distance. The data reflected a greater dynamics of the spread and deposition of particles comparing to results of studies for particles obtained using a semiautomatic pistol of the same or similar calibres. The average values of the total numbers of GSR particles in relation to the shooting distance were detected in the range of distances between 5 cm and 50 cm, whereas, in the case of data obtained using a semiautomatic pistols rather narrow peak of numbers of particles was observed in the range of distances about 10 – 20 cm. The information on the distribution of particles originating from the use of a submachine pistol can be supportive in forensic casework.
对冲锋枪的射击模式和射击残留物的分布进行了研究。使用9 毫米PM-06冲锋枪在射击距离0 - 150 厘米范围内对棉织物覆盖的目标进行了多次射击。对图案的光学检查显示,在接触射击和距离1 cm和2 cm时,织物上有十字状撕裂,而对于相同口径的半自动手枪,只在接触射击和距离1 cm时观察到十字状开口。采用扫描电子显微镜和能量色散x射线能谱仪(SEM-EDX)对射击模式中采集的无机残留物进行了自动检测。测量结果提供了与射击距离有关的暴露粒子种群的丰度、化学成分和大小分布的信息。与使用相同或类似口径的半自动手枪获得的颗粒研究结果相比,这些数据反映了颗粒扩散和沉积的更大动态。在5 ~ 50 cm的距离范围内检测到GSR粒子总数与射击距离的平均值,而在使用半自动手枪获得的数据中,在10 ~ 20 cm的距离范围内观察到相当窄的粒子数峰值。关于使用冲锋枪产生的颗粒分布的资料可对法医案件工作提供支助。
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引用次数: 0
Prevalence of psychoactive drugs in injured drivers over 10 years in Victoria, Australia 澳大利亚维多利亚州10年来受伤司机服用精神药物的情况
IF 2.5 3区 医学 Q1 MEDICINE, LEGAL Pub Date : 2026-02-01 Epub Date: 2025-12-20 DOI: 10.1016/j.forsciint.2025.112790
Matthew Di Rago , Dimitri Gerostamoulos , Carla Morris , Gemma Wynd , Noel W. Woodford , Olaf H. Drummer AO
One thousand of the mandatory blood specimens taken from injured drivers attending a hospital over a decade were analyzed for a full range of legal and illegal drugs in an accredited forensic toxicology laboratory with confirmation by a validated LC-MS/MS procedure. Ethanol ( ≥0.05 g/100 mL), methamphetamine (≥0.01 mg/L), THC (≥1 ng/mL) were present in 13.6 %, 12.7 % and 11.5 %, respectively with only minor variations over the decade. In contrast, the prevalence of ketamine, cocaine, fentanyl and new psychoactive substances (NPS) increased substantially over this period reaching 7.0 %, 1.8 %, 2.0 % and 3.0 % in the last 5 years of the study. A substantial proportion of drivers were also positive for opioids, antidepressants, and benzodiazepines, although some of these may have been given post-crash as part of their medical treatment. Overall, about 38 % of drivers had a potentially impairing drug detected in their blood on presentation to hospital and at least one common illicit drug with or without ethanol were present in almost 23 % of drivers. The presence of more than one common illicit drug (THC, methamphetamine, MDMA, cocaine, heroin), with or without ethanol, increased from 4.3 % in the first 5 years to 5.8 % in the last five years, which may reflect a higher crash risk for those drivers.
在一个认可的法医毒理学实验室中,从十多年来在医院就诊的受伤司机身上采集的一千份强制性血液样本进行了全面的合法和非法药物分析,并通过有效的LC-MS/MS程序进行了确认。乙醇(≥0.05 g/100 mL)、甲基苯丙胺(≥0.01 mg/L)和四氢大麻酚(≥1 ng/mL)分别占13.6 %、12.7 %和11.5 %,10年间变化不大。相比之下,氯胺酮、可卡因、芬太尼和新型精神活性物质(NPS)的患病率在此期间大幅增加,在研究的最后5年达到7.0 %、1.8 %、2.0 %和3.0 %。相当一部分司机的阿片类药物、抗抑郁药和苯二氮卓类药物检测也呈阳性,尽管其中一些可能是在车祸后作为治疗的一部分服用的。总体而言,约38% %的司机在被送往医院时血液中检测到一种潜在的有害药物,至少有一种常见的非法药物(含或不含乙醇)存在于近23% %的司机身上。含有或不含乙醇的一种以上常见非法药物(四氢大麻酚、甲基苯丙胺、摇头丸、可卡因、海洛因)的存在,从前5年的4.3 %增加到最近5年的5.8 %,这可能反映了这些司机更高的撞车风险。
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引用次数: 0
Metformin-related fatalities − The importance of combining forensic toxicology and postmortem biochemistry analyses in death involving antidiabetics 与二甲双胍相关的死亡-结合法医毒理学和死后生物化学分析在涉及抗糖尿病的死亡中的重要性
IF 2.5 3区 医学 Q1 MEDICINE, LEGAL Pub Date : 2026-02-01 Epub Date: 2025-10-03 DOI: 10.1016/j.forsciint.2025.112680
Guillaume Drevin , Laurent Leuger , Laura Renard , Nathalie Jousset , Stéphane Malbranque , Xavier Dieu , Séverine Férec , Antoine Baudriller , Marie Briet , Chadi Abbara
Metformin is the most commonly used drug in the treatment of type 2 diabetes mellitus and appears as a promising drug for several other conditions. While generally well-tolerated and relatively safe, metformin can cause serious side effects, and intoxication cases have been reported. Classically, the severity of metformin intoxications is better assessed by measuring lactate blood concentration and/or blood pH than by directly determining blood drug concentration. However, such an approach is more complicated in postmortem investigation. Indeed, biochemistry changes occur after death, affecting both lactate concentration and pH. In this context, the authors report a case of a metformin-related fatality for which toxicological and biochemical analyses have been integrated in order to better understand pathophysiological mechanisms and/or circumstances surrounding such fatalities. Metformin was quantified in femoral blood (FB) (45 mg/L), heart blood (HB) (39 mg/L), urine (464 mg/L), vitreous (18 mg/L) and gastric content (202 mg/L) using liquid chromatography-tandem mass spectrometry (LC-MS/MS). β-hydroxybutyrate (BHB) was also quantified in FB (491 mg/L) and vitreous (473 mg/L) using LC-MS/MS. Vitreous sodium (122 mmol/L), chloride (102 mmol/L), glucose (<0.10 mmol/L), creatinine (277 µmol/L) and lactate (13 mmol/L) concentrations were determined in vitreous on an Atellica® CH 930 analyzer. Glycated hemoglobin (HbA1C) was assessed in FB (7.7 %) using a Tosoh® G8 HPLC analyser. Overall, only few cases of metformin-related fatalities have been described. Here, the metformin FB concentration appeared particularly high, in agreement with other reported cases. Similarly, the results of the postmortem biochemistry analysis were also consistent with those reported in other metformin-related fatalities. Interestingly, BHB concentrations were notably elevated in both FB and vitreous humor. Furthermore, creatinine was determined in vitreous humor at a particularly high concentration. This case highlights the importance of combining postmortem toxicological and biochemical analyses in deaths involving antidiabetics. Indeed, such fatalities are quite complex and both drug toxicity and metabolic disorders may overlap with regard to mechanisms of death.
二甲双胍是治疗2型糖尿病最常用的药物,在治疗其他几种疾病方面也很有前景。虽然二甲双胍通常耐受性良好且相对安全,但它可能导致严重的副作用,并且有中毒病例的报道。通常,测量血乳酸浓度和/或血pH值比直接测定血药浓度更能评估二甲双胍中毒的严重程度。然而,这种方法在死后调查中更为复杂。确实,生物化学变化发生在死亡后,影响乳酸浓度和ph值。在这种情况下,作者报告了一个与二甲双胍相关的死亡病例,为了更好地了解这种死亡的病理生理机制和/或环境,对其进行了毒理学和生物化学分析。采用液相色谱-串联质谱法(LC-MS/MS)对股骨血(FB)(45 mg/L)、心脏血(HB)(39 mg/L)、尿液(464 mg/L)、玻璃体(18 mg/L)和胃内容物(202 mg/L)中的二甲双胍进行定量分析。采用LC-MS/MS定量测定FB(491 mg/L)和玻璃体(473 mg/L)中β-羟基丁酸酯(BHB)的含量。玻璃体中钠(122 mmol/L)、氯(102 mmol/L)、葡萄糖(<0.10 mmol/L)、肌酐(277µmol/L)和乳酸(13 mmol/L)浓度在Atellica®CH 930分析仪上测定。使用Tosoh®G8高效液相色谱分析仪测定FB中糖化血红蛋白(HbA1C)(7.7 %)。总的来说,只有少数与二甲双胍相关的死亡病例被描述。这里,二甲双胍FB浓度显得特别高,与其他报道的病例一致。同样,死后生物化学分析的结果也与其他二甲双胍相关死亡的报告一致。有趣的是,FB和玻璃体中的BHB浓度都显著升高。此外,测定玻璃体体液中肌酐浓度特别高。本病例强调了在涉及抗糖尿病药物的死亡病例中结合尸检毒理学和生化分析的重要性。事实上,这种死亡是相当复杂的,药物毒性和代谢紊乱在死亡机制方面可能重叠。
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Forensic science international
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