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Deaths in traffic accidents associated with THC abuse. 与四氢大麻酚滥用有关的交通事故死亡。
Q4 Medicine Pub Date : 2020-01-01
Másilková Monika, Kolčava Radek, Bosák Miroslav, Otásková Tamáš Jitka

From the National Registry of autopsies and toxicology examinations, we selected the deceased for 2015, 2016, 2017 and January 2018 active road accident participants, i.e. pedestrians, cyclists and motor vehicle drivers. From these, we further selected those who were tested for THC presence. Of the 836 deceased active road accident participants, only 251 (i.e. 30%) were tested for cannabinoids, most often passenger car drivers, 46 percent. Of the 251 people tested, THC was demonstrated in 12 (4.8%), most commonly motorcycle drivers (7.8%) and passenger car drivers (3.4%). Of the 12 positive people, 7 were found to have a possible effect of THC ingestion on the road accident, but only one participant was found to have overdosed on THC, and 2 were reported by the dissecting physician to have had no effect on the accident. In the Czech Republic, when driving under the influence of addictive substances, there is no uniform procedure for qualification, whether it is an offence or an offence, and thus in the award of punishment. While somewhere there is an effort to divide this wrongdoing into offences and crimes, elsewhere it practically always only constitutes an offense. This situation seeks to resolve the instruction of the Attorney-at-chief 1 SL 732/2018 of 29 December 4.2019, which, however, arose without any discussion with the professional public, which is heavily criticized especially for the absurly high limits, which in particular in morphine and cocaine are practically unachievable. At the time of this writing, the impact of this guideline on practice is not clear.

从国家尸检和毒理学检查登记处中,我们选择了2015年、2016年、2017年和2018年1月活跃的道路交通事故参与者中的死者,即行人、骑自行车的人和机动车驾驶员。从这些人中,我们进一步选择了那些被检测出四氢大麻酚存在的人。在836名死亡的活跃道路交通事故参与者中,只有251人(即30%)接受了大麻素检测,最常见的是乘用车司机,46%。在251人的测试中,12人(4.8%)被证明是四氢大麻酚,最常见的是摩托车司机(7.8%)和乘用车司机(3.4%)。在12名阳性的人中,有7人被发现可能对交通事故有THC摄入的影响,但只有一名参与者被发现过量使用THC, 2名被解剖医生报告对事故没有影响。在捷克共和国,当在成瘾物质的影响下驾驶时,没有统一的资格程序,无论这是犯罪还是犯罪,因此在处罚方面没有统一的程序。虽然有些地方努力将这种不法行为划分为罪行和犯罪,但在其他地方,它实际上总是只构成犯罪。这种情况寻求解决首席检察官2019年12月4日29日1 SL 732/2018的指示,然而,该指示没有与专业公众进行任何讨论,特别是因荒谬的高限制而受到严厉批评,特别是吗啡和可卡因实际上是无法实现的。在撰写本文时,该指南对实践的影响尚不清楚。
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引用次数: 0
Fatal suicidal perforating crossbow bolt injury of the chest. 胸口致命的自杀式十字弓穿孔伤。
Q4 Medicine Pub Date : 2020-01-01
Očko Peter, Mikuláš Ubomír, Šikuta Ján, Kuruc Roman, Šidlo Jozef

Traumatic injury due to crossbows is a rare occurrence these days. The aim of this study is to present a case of perforating chest injury caused by a bolt shot from a crossbow in suicidal intent which occurred “live“ during a telephone conversation. The autopsy revealed perforation of the heart and left lungs with massive bleeding to the left pleural cavity which caused haemorrhagic shock. The motive of the mans suicide was the breakup with his girlfriend.

如今,由弓弩造成的创伤性伤害已经很少发生了。本研究的目的是提出一例自杀意图的十字弓弹射造成胸部穿孔伤的病例,发生了“在电话交谈中。尸检发现心脏和左肺穿孔,左胸膜腔大量出血,导致出血性休克。这名男子自杀的动机是与女友分手。
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引用次数: 0
Analysis of fatal industrial accidents in forensic postmortem investigations in South Osaka. 大阪南部致命工业事故法医验尸调查分析。
Q4 Medicine Pub Date : 2020-01-01
Tani Naoto, Ikeda Tomoya, Oritani Shigeki, Morioka Fumiya, Ikeda Kei, Shida Alissa, Aoki Yayoi, Ishikawa Takaki

Předkládaná studie zkoumala aktuální stav a příčiny smrtelných pracovních úrazů ze zdravotně-sociálního hlediska. Retrospektivně jsme hodnotili případy smrtelných pracovních úrazů mezi lety 2007 a 2016 v Ósace, která je druhým nejlidnatějším městem v Japonsku, z forenzních posmrtných dat 1689 zemřelých. Z těchto případů jsme analyzovali celkem 57 smrtelných průmyslových nehod. Oběťmi byli typicky muži v relativně pokročilém věku pracující generace, téměř polovina případů (přesněji 28) byli muži mezi 50 a 70 lety života. Nejčastějším typem nehody byl pád z výše (24 případů) a nejčastějším místem, kde k nehodám docházelo, bylo staveniště (28 případů). Většina nehod (29 případů) se odehrála na pracovišti s malým pracovním týmem. V 60 % případů oběť na sobě neměla ochranou helmu a ve 34 případech (60 %) byla nehoda připisována vlastní nedbalosti. Nehody se nejčastěji stávaly v úterý. Nejběžnější doba, kdy k nehodám docházelo, byla kolem 10. a 11. hodiny dopolední a kolem 1. a 2. hodiny odpolední. V přibližně 60 % případů žaludeční obsah zahrnoval i zbytky potravy, což naznačuje, že k nehodám typicky docházelo po jídle. V předkládané studii jsme zjistili, že pracovní nehody, z nichž nejčastější byl pád z výše, vykazují tendenci se vyskytovat na pracovišti s malým pracovním týmem. Pouze pár obětí mělo na sobě ochranou helmu. Tato zjištění naznačují, že na pracovištích by měly být důkladně zaváděny systémy monitorování a řízení bezpečnosti a že pracovníci by měli před i po jídle dbát zvýšené opatrnosti.

第345页所提出的研究考察了目前的情况;íč工伤死亡;来自医疗保健-社会方面。艺术家作品回顾展我们评为př工作中的致命事故;2007年至2016年在人口第二多的大阪;jš我是日本的声音,来自法医尸检数据1689国家ř;elých。从těchto第345页案例ů我们总共分析了57岁的人;精神事故。是否ěť;我是典型的他即使是相对而言进步%283多少钱给工作一代,主题345?半př案例ů(正好28)以及在50年代和70年代之间;生活不是č;astějš从外面掉下来是什么事故?e(24 př案例ů;)和最新astějš事故发生地已建成tě(28 p#345案件)。Větš工作中发生了一起事故(29起案件);那些有小团队的人。V 60%př案例ůob#283ť;你自己neměla头盔保护和34 př在病例中(60%)是意外př;被认为是他自己的疏忽。事故顶多算是意外astě她过去每周二都来。最伟大的382;nějš事故发生的时间大约是10点。上午11点和1点左右。下午两点。VPřibliž;n滈%přcaseůž;aludeč;其内容包括食物残渣;纳兹纳269他,ž;e事故通常发生在进食后。Vpř我们发现;e工作事故,其中最佳častějš是从外面掉下来的e、 表现出在工作中发生的倾向;那些有小团队的人。只有几份工作tímě我穿着它头盔保护。这个吃tě她的名字?oují,ž;e在工作我应该是dů积极乐观的被误导的监控系统和ř;安全管理以及ž;e工人应李345ed即使在饭后也会处理邀请小心
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引用次数: 0
Sudden and unexpected death due to unilateral tonsillitis. 因单侧扁桃体炎而突然意外死亡。
Q4 Medicine Pub Date : 2020-01-01
Šidlová Henrieta, Šikuta Ján, Kuruc Roman, Šidlo Jozef

Tonsillitis is a relatively well treatable disease. Complications of untreated tonsillitis can even today result in life-threatening complications. The aim of this study is to present a case of a 47-year-old man without previous history of health problems, who suffocated after a brief episode of breathing difficulties. At the forensic autopsy, left-side necrotising tonsillitis with adjacent soft tissue, uvula, and epiglottis swelling and inflammation and significant airway narrowing were found.

扁桃体炎是一种相对容易治疗的疾病。即使在今天,未经治疗的扁桃体炎并发症也可能导致危及生命的并发症。本研究的目的是提出一个病例47岁的男子没有健康问题的历史,谁在短暂的呼吸困难发作后窒息。法医尸检发现左侧坏死性扁桃体炎伴邻近软组织、小舌、会厌肿胀、炎症及明显气道狭窄。
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引用次数: 0
Petroleum Intoxication: Literature Review and Case Report on Poisoning by Gasoline. 石油中毒:文献综述及汽油中毒病例报告。
Q4 Medicine Pub Date : 2020-01-01
Karakasi Maria-Valeria, Tologkos Stylianos, Papadatou Vasiliki, Anestakis Doxakis, Raikos Nikolaos, Lambropoulou Maria, Pavli Pavlos

A literature review of cases of acute poisoning by petroleum and its distillates was conducted, while a new fatal case of suicide by gasoline intake is reported. Specifically, a number of studies were reviewed in order to update and summarize the relevant literature on the incidence, sociodemographic variables, method of poisoning, diagnostic - toxicological procedures, variables associated with survival and fatality on acute petroleum/gasoline intoxication. Results show that acute poisoning by petroleum and its distillates is relatively rare. Male prevalence was observed among patients, while most incidents were classified as suicide attempts. Oral ingestion was the most frequent method of intake, while a case of intravenous injection was also reported. The survival rates were low, as among all literature cases, two thirds of them managed to reach the hospital alive, and only the one fourth of them had a medically successful outcome.

本文对石油及其馏分物急性中毒病例进行了文献综述,同时报道了一起新的汽油中毒自杀致死病例。具体地说,对一些研究进行了审查,以便更新和总结有关发病率、社会人口变量、中毒方法、诊断-毒理学程序、与急性石油/汽油中毒的生存和死亡率相关的变量的相关文献。结果表明,石油及其馏分物急性中毒较为罕见。在患者中观察到男性患病率,而大多数事件被归类为自杀未遂。口服是最常见的摄入方式,静脉注射也有报道。存活率很低,因为在所有文献病例中,三分之二的患者设法活着到达医院,只有四分之一的患者获得了医疗成功。
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引用次数: 0
Molecular autopsy and sudden cardiac death in the young. 分子解剖与年轻人心源性猝死
Q4 Medicine Pub Date : 2020-01-01
Rücklová Kristina, Kulvajtová Markéta, Krebsová Alice, Dobiáš Martin, Petřková Jana

Sudden cardiac death is defined as sudden death due to a confirmed cardiovascular disease or when there is no explanation after medico-legal autopsy and arrhythmogenic, possibly hereditary etiology is presumed. Molecular autopsy should be indicated in all cases of sudden cardiac death due to suspected cardiomyopathy and hereditary arrhythmic syndrome. It should also be considered in thoracic aortic dissection. These hereditary cardiovascular diseases account for the majority of sudden cardiac death cases in the young up to 40 years of age. They are mostly inherited in an autosomal dominant manner carrying a 50% risk of passing the diasease-causing mutation to the offspring. In fact, all first-degree relatives have a high risk of developing the disease associated with sudden cardiac death. Hence, knowledge of the exact cause of death derived from molecular autopsy combined with a cardiologic and targeted genetic examination of first-degree relatives may help us detect other at risk family members and provides us with an opportunity to prevent further sudden deaths in the family by means of timely preventive measures. Forensic pathologists play a key role in this process of primary prevention of sudden death. They should retain tissue samples for DNA analysis whenever a hereditary cardiovascular disease is suspected. They should also recommend to the relatives a thorough cardiogenetic examination at one of the specialized centres. A multipdisciplinary team including cardiologists, geneticists, psychologists, forensic pathologists and coroners should be involved in the investigation of sudden cardiac death in the young.

心源性猝死的定义是由于确诊的心血管疾病或在法医尸检后无法解释并推测可能是遗传原因的心律失常而导致的猝死。所有疑似心肌病和遗传性心律失常综合征引起的心源性猝死病例均应进行分子解剖。胸主动脉夹层也应考虑到这一点。在40岁以下的年轻人中,这些遗传性心血管疾病占心脏性猝死病例的大多数。它们大多以常染色体显性方式遗传,有50%的风险将致病突变遗传给后代。事实上,所有的一级亲属都有患与心源性猝死相关的疾病的高风险。因此,从分子解剖中获得的确切死亡原因的知识,结合对一级亲属的心脏病学和有针对性的基因检查,可以帮助我们发现其他有风险的家庭成员,并为我们提供一个机会,通过及时的预防措施,防止家庭中进一步的突然死亡。法医病理学家在猝死的初级预防过程中发挥着关键作用。当怀疑有遗传性心血管疾病时,他们应该保留组织样本进行DNA分析。他们还应建议亲属在一个专门中心进行彻底的心脏遗传学检查。一个包括心脏病专家、遗传学家、心理学家、法医病理学家和验尸官在内的多学科团队应该参与对年轻人心源性猝死的调查。
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引用次数: 0
Recodification of expert law in the Czech Republic since 2021 and its impact on expertise in health care with special regard to forensic medicine. 自2021年以来,捷克共和国对专家法进行了重新编纂,及其对医疗保健专业知识,特别是法医专业知识的影响。
Q4 Medicine Pub Date : 2020-01-01
Vojtíšek Tomáš

A new law on experts will be in force in the Czech Republic from 1st January 2021. It is an entirely new law that repeals the old law of 1967, which has already been criticized. The new regulations, of course, bring changes to which experts must respond. The main change is the legal right to appoint an expert after meeting the pre-set conditions. It is essential, it is now possible that of the two equally qualified doctors from the two counties, only one has been appointed. Furthermore, it is the appointment of the only administrative body of the managing expert, which will be the Ministry of Justice. It will be mandatory for a medical examiner to pass an attestation exam and have eight years of experience. The certificate will have to be given by the Czech Medical Chamber. The expert opinion will also be able to be in electronic form. Expert institutes, such as universities, will also have to have natural persons as appointed experts. Experts will have to pass an entrance examination, which will have a general part and a special part. The special part will be professional for each field. Current experts will not have to compose a special part, only a general one. The general exam will be based on knowledge of legal regulations in expertise. The structure of the report will be given precisely and in detail. Expert opinions for private entities will need to be detailed. Liability insurance will be mandatory. Although there were other proposals, the rule for forensic autopsy, which still has to be performed by two experts, remains valid. The law provides for severe sanctions for breaches of various duties of an expert. It may be advantageous to apply for the appointment of an expert by the end of 2020.

一项关于专家的新法律将于2021年1月1日在捷克共和国生效。这是一部全新的法律,废除了已经受到批评的1967年旧法律。当然,新法规带来了变化,专家们必须对此做出回应。主要的变化是在满足预设条件后任命专家的法律权利。至关重要的是,现在可能两个县的两名同样合格的医生中,只有一名被任命。此外,还将任命管理专家的唯一行政机构,即司法部。法医必须通过鉴定考试,并有八年的工作经验。证明必须由捷克医疗商会出具。专家意见也将能够以电子形式呈现。此外,大学等专门研究所的任命专家也必须由自然人担任。专家必须通过入学考试,考试将分为一般部分和特殊部分。特殊的部分将是专业的每个领域。现在的专家不需要编写一个特殊的部分,只需要编写一个一般的部分。综合考试将以法律法规知识为基础。报告的结构将精确而详细地给出。私人实体的专家意见将需要详细说明。责任保险将是强制性的。虽然有其他建议,但仍然必须由两名专家进行法医解剖的规则仍然有效。法律规定对违反专家各项职责的行为予以严厉制裁。建议在2020年底前申请聘任专家。
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引用次数: 0
The reasons for reoperations after surgery for acute subdural hematoma and the implications of suspected injury mechanisms. 急性硬膜下血肿术后再手术的原因及可能的损伤机制。
Q4 Medicine Pub Date : 2020-01-01
Krajsa Jan, Šilar Čeněk, Zeman Tomáš, Hrabovský Dušan, Chrastina Jan

Study aim: The primary aim is to analyze the relationship between the reasons for reoperation after surgery for acute subdural hematoma and the injury mechanism and secondarily the relationship between the acute subdural hematoma primarily operated on and the area of reoperation.

Methods: Among adult patients operated on for acute subdural hematoma between 2013 and 2017, patients reoperated within 14 days were identified. Injury mechanisms, reasons for reoperation, and reoperated lesion location were studied.

Results: Of 86 patients operated on for acute subdural hematoma, 24 patients were reoperated (27.9%). The main indications for reoperation after uncomplicated falls as injury cause (12 patients) were recurrent/significant residual subdural hematoma (7 patients) and contralateral subdural hematoma (3 cases). In complicated falls (long staircase, 3 patients), the reasons for reoperation were expansive intraparenchymal hematoma or brain contusion. In traffic accidents (4 patients, 3 pedestrians hit by cars), the reason for reoperations was brain contusion (two cases), contralateral intracerebral and subdural hematoma and postoperative epidural hematoma. Injury mechanism was unknown in 5 patients. In 20.8% of reoperations, the reoperated lesion (mainly subdural hematoma) was contralateral to the primary subdural hematoma. Prognosis was worse in reoperated patients.

Conclusions: Recurrent/significant residual subdural hematomas are the most frequent reasons for reoperation after acute subdural hematoma surgery. The reasons for reoperations are related to the mechanism of injury. Simple falls are associated mainly with recurrent/significant residual or contralateral subdural hematomas. In complicated falls or traffic accidents (vigorous injuring force) hemorrhagic injuries of the brain parenchyma prevail.

研究目的:首先分析急性硬膜下血肿术后再手术的原因与损伤机制的关系,其次分析初次手术的急性硬膜下血肿与再手术面积的关系。方法:选取2013 ~ 2017年接受急性硬膜下血肿手术的成人患者,选取14天内再次手术的患者。研究损伤机制、再手术原因及再手术病变部位。结果:86例急性硬膜下血肿手术中,24例再次手术,占27.9%。单纯外伤跌倒后再手术(12例)主要指征为复发性/显著性残余硬膜下血肿(7例)和对侧硬膜下血肿(3例)。复杂跌伤(长楼梯,3例),再手术原因为扩张性脑实质内血肿或脑挫伤。交通事故(4例,行人撞车3例)中,再手术原因为脑挫伤(2例)、对侧脑内及硬膜下血肿及术后硬膜外血肿。5例患者损伤机制不明。在20.8%的再手术中,再手术病变(主要是硬膜下血肿)在原发硬膜下血肿的对侧。再手术患者预后较差。结论:急性硬膜下血肿术后复发或明显残留的硬膜下血肿是再手术最常见的原因。再手术的原因与损伤机制有关。单纯性跌倒主要与复发/显著残余或对侧硬膜下血肿有关。在复杂的跌倒或交通事故(剧烈的伤害力)中,出血性脑实质损伤是常见的。
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引用次数: 0
Fatal consequences of uterine rupture in late pregnancy. 妊娠后期子宫破裂的致命后果。
Q4 Medicine Pub Date : 2020-01-01
Šidlová Henrieta, Očko Peter, Mikuláš Ubomír, Šikuta Ján, Šidlo Jozef

Uterine rupture in pregnancy belongs to acute conditions in gynaecology and obstetrics. It is a life-threatening complication for both mother and foetus. The occurrence of fatal consequences in developed countries is very rare. The causes of rupture include scarring after the caesarean section, fibroid enucleation, rough curettage, muscular insufficiency in uterine developmental defects, uterine wall damage due to inflammation, uterine hypoplasia, elevated intrauterine pressure during contraction, cephalopelvic disproportion, previous fibroid, prostaglandin or oxytocin administration, etc. This paper aims at the presentation of a 32-year-old woman who died in the 35th week of gestation due to uterine rupture at home despite having been transferred to a medical facility at the terminal stage of life. At the autopsy, a complete rupture of the posterior uterine wall with bleeding into the abdominal cavity and an amniotic sac with a male foetus in the abdominal cavity was found. There were no signs of the effects of violence detected. Histopathological examination revealed no pathological changes in the uterine muscle. The immediate cause of maternal death was a haemorrhagic shock. The autopsy of the foetus revealed signs of asphyxia. The immediate cause of foetal death was intrauterine asphyxia. In this case, forensic expertise ruled out the violent causes of uterine rupture and deaths in terms of mechanical and chemical factors and supported to make a diagnosis of spontaneous rupture.

妊娠期子宫破裂属于妇产科急症。对母亲和胎儿来说,这是一种危及生命的并发症。在发达国家,致命后果的发生非常罕见。子宫破裂的原因包括剖宫产后结疤、肌瘤去核、粗糙刮除、子宫发育缺陷所致肌肉功能不全、炎症所致子宫壁损伤、子宫发育不全、宫缩时宫内压力升高、头盆腔比例失调、既往肌瘤、前列腺素或催产素使用等。这篇论文的目的是介绍一个32岁的妇女谁死于妊娠35周由于子宫破裂在家中,尽管已转移到医疗机构在生命的最后阶段。在尸检中,发现子宫后壁完全破裂,腹腔出血,腹腔内有一个男性胎儿的羊膜囊。没有发现暴力影响的迹象。组织病理检查未见子宫肌肉病变。产妇死亡的直接原因是出血性休克。胎儿的尸检显示有窒息的迹象。胎儿死亡的直接原因是宫内窒息。在这个案例中,法医专家排除了子宫破裂和死亡的机械和化学因素方面的暴力原因,并支持作出自发破裂的诊断。
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引用次数: 0
Unusual mechanism of injury in a case of suicide by the jump from height. 跳楼自杀案件中不寻常的伤害机制。
Q4 Medicine Pub Date : 2019-01-01
Šidlo Jozef, Kováč Peter, Očko Peter, Mikuláš Ľubomír, Šikuta Ján

Investigation of fatal cases of falls from height as well as jumps from height in suicidal ideation makes up an integral part of forensic practice. In Slovakia, a method of suicide by jumping from height is after hanging the second most chosen method of ending life. In about one third of the cases, the influence of addictive substances is determined. The basic mechanism of injury is a sudden deceleration of body movement when hitting a solid surface. Several factors influence the nature, localization, severity, and frequency of injuries. In most cases, there occur multiple injuries to the skeleton and internal organs caused by blunt objects. The authors demonstrate the case of an unusual mechanism of injury in a 55-year-old man who committed suicide by jumping from the seventh floor of a block of flats. A stepped fall from height resulted in the through knee amputation of both legs by hitting posterior thigh area and knee joints on the railing of the terrace of the block of flats on the ground floor level. The body was found in the basement. In contact with the railing, the mans trousers and pants were pulled off. The autopsy determined the immediate cause of death as polytrauma. Additional toxicological-chemical examination of blood and urine samples collected at autopsy revealed ethanol at the concentration within the extent of laboratory error, caffeine, and nicotine in toxicologically insignificant concentrations and traces of acetone. Motivation of mans suicide remains unknown.

调查高空坠楼和跳楼自杀致死案件是法医工作的重要组成部分。在斯洛伐克,跳楼自杀是继上吊之后第二大选择的结束生命的方式。在大约三分之一的案例中,成瘾物质的影响是确定的。受伤的基本机制是身体运动在撞击固体表面时突然减速。有几个因素影响损伤的性质、部位、严重程度和频率。在大多数情况下,骨骼和内脏会受到钝器造成的多重伤害。作者展示了一个不寻常的受伤机制,一个55岁的男人从一栋公寓楼的七楼跳下自杀。一名男子从高处阶梯式坠落,大腿后部及膝部关节被击中,双腿全膝截肢。尸体是在地下室发现的。在与栏杆接触时,男子的裤子和裤子被扯掉了。尸检确定直接死因是多重创伤。对尸检时收集的血液和尿液样本进行了进一步的毒理学-化学检查,发现乙醇的浓度在实验室误差范围内,咖啡因和尼古丁的毒理学浓度微不足道,还有微量的丙酮。该男子自杀的动机尚不清楚。
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引用次数: 0
期刊
Soudni Lekarstvi
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