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Olds ML, Jones AW. Preanalytical factors influencing the results of ethanol analysis in postmortem specimens. J Anal Toxicol 2024; 48:9-26. [PMID: 37804205 DOI: 10.1093/jat/bkad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/22/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023] Open
Abstract
Excessive drinking and drunkenness are underlying factors in many fatal accidents, which make the quantitative determination of ethanol in postmortem (PM) specimens an essential part of all unnatural death investigations. The same analytical methods are used to determine ethanol in blood taken from living and deceased persons although the interpretation of the results is more complicated in medical examiner cases owing to various preanalytical factors. The biggest problem is that under anaerobic conditions ethanol can be produced naturally in decomposed bodies by microbial activity and fermentation of blood glucose. Ways are needed to differentiate antemortem ingestion of ethanol from PM synthesis. One approach involves the determination of ethanol in alternative specimens, such as bile, cerebrospinal fluid, vitreous humor and/or urine, and comparison of results with blood alcohol concentration (BAC). Another approach involves the analysis of various alcohol biomarkers, such as ethyl glucuronide, ethyl sulfate and/or phosphatidylethanol or the urinary metabolites of serotonin 5-hydroxytryptophol/5-hydroxyindoleacetic acid (5-HTOL/5-HIAA). If ethanol had been produced in the body by microbial activity, the blood samples should also contain other low-molecular volatiles, such as acetaldehyde, n-propanol and/or n-butanol. The inclusion of 1-2% w/v sodium or potassium fluoride, as an enzyme inhibitor, in all PM specimens is essential to diminish the risk of ethanol being generated after sampling, such as during shipment and storage prior to analysis. Furthermore, much might be gained if the analytical cut-off for reporting positive BAC was raised from 0.01 to 0.02 g% when PM blood is analyzed. During putrefaction low BACs are more often produced after death than high BACs. Therefore, when the cadaver is obviously decomposed, a pragmatic approach would be to subtract 0.05 g% from the mean analytical result. Any remaining BAC is expected to give a more reliable indication of whether alcohol had been consumed before death.
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Affiliation(s)
- Maria L Olds
- Fort Worth Police Department, Crime Laboratory, East Lancaster Ave, Fort Worth, TX 3616, United States
| | - Alan W Jones
- Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology, University of Linköping, Linköping 58183, Sweden
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Brubacher JR, Chan H, Erdelyi S, Yuan Y, Daoust R, Vaillancourt C, Rowe B, Lee J, Mercier E, Atkinson P, Davis P, Clarke D, Taylor J, Macpherson A, Emond M, Al-Hakim D, Horwood C, Wishart I, Magee K, Rao J, Eppler J. High-'n'-dry? A comparison of cannabis and alcohol use in drivers presenting to hospital after a vehicular collision. Addiction 2023; 118:1507-1516. [PMID: 36898848 DOI: 10.1111/add.16186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023]
Abstract
DESIGN This was a prospective observational study. BACKGROUND AND AIMS The characteristics of cannabis-involved motor vehicle collisions are poorly understood. This study of injured drivers identifies demographic and collision characteristics associated with high tetrahydrocannabinol (THC) concentrations. SETTING The study was conducted in 15 Canadian trauma centres between January 2018 and December 2021. CASES The cases (n = 6956) comprised injured drivers who required blood testing as part of routine trauma care. MEASUREMENTS We quantified whole blood THC and blood alcohol concentration (BAC) and recorded driver sex, age and postal code, time of crash, crash type and injury severity. We defined three driver groups: high THC (THC ≥ 5 ng/ml and BAC = 0), high alcohol (BAC ≥ 0.08% and THC = 0) and THC/BAC-negative (THC = 0 = BAC). We used logistic regression techniques to identify factors associated with group membership. FINDINGS Most injured drivers (70.2%) were THC/BAC-negative; 1274 (18.3%) had THC > 0, including 186 (2.7%) in the high THC group; 1161 (16.7%) had BAC > 0, including 606 (8.7%) in the high BAC group. Males and drivers aged less than 45 years had higher adjusted odds of being in the high THC group (versus the THC/BAC-negative group). Importantly, 4.6% of drivers aged less than 19 years had THC ≥ 5 ng/ml, and drivers aged less than 19 years had higher unadjusted odds of being in the high THC group than drivers aged 45-54 years. Males, drivers aged 19-44 years, rural drivers, seriously injured drivers and drivers injured in single-vehicle, night-time or weekend collisions had higher adjusted odds ratios (aORs) for being in the high alcohol group (versus THC/BAC-negative). Drivers aged less than 35 or more than 65 years and drivers involved in multi-vehicle, daytime or weekday collisions had higher adjusted odds for being in the high THC group (versus the high BAC group). CONCLUSIONS In Canada, risk factors for cannabis-related motor vehicle collisions appear to differ from those for alcohol-related motor vehicle collisions. The collision factors associated with alcohol (single-vehicle, night-time, weekend, rural, serious injury) are not associated with cannabis-related collisions. Demographic factors (young drivers, male drivers) are associated with both alcohol and cannabis-related collisions, but are more strongly associated with cannabis-related collisions.
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Affiliation(s)
- J R Brubacher
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - H Chan
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - S Erdelyi
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - Y Yuan
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - R Daoust
- Department of Emergency Medicine, University of Montréal, Montréal, QC, Canada
| | - C Vaillancourt
- Department of Emergency Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - B Rowe
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - J Lee
- Department of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - E Mercier
- Department of Emergency Medicine, Université Laval, Québec City, QC, Canada
| | - P Atkinson
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, St John, NB, Canada
| | - P Davis
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - D Clarke
- Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada
| | - J Taylor
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - A Macpherson
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - M Emond
- Department of Emergency Medicine, Université Laval, Québec City, QC, Canada
| | - D Al-Hakim
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - C Horwood
- Department of Emergency Medicine, Memorial University, St John, NB, Canada
| | - I Wishart
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - K Magee
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - J Rao
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - J Eppler
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
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3
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Chitty KM, Buckley NA, Lim J, Ali Z, Schumann JL, Cairns R, Daniels B, Pearson SA, Preen DB, Schaffer AL. Psychotropic and other medicine use at time of death by suicide: a population-level analysis of linked dispensing and forensic toxicology data. Med J Aust 2023; 219:63-69. [PMID: 37230472 PMCID: PMC10952140 DOI: 10.5694/mja2.51985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To determine the numbers and types of medicines dispensed around the time of death to people who die by suicide; to compare the medicines recently dispensed and those recorded in post mortem toxicology reports. DESIGN, SETTING, PARTICIPANTS Analysis of linked National Coronial Information System (NCIS) and Pharmaceutical Benefits Scheme (PBS) data from the Australian Suicide Prevention using Health Linked Data (ASHLi) study, a population-based case series study of closed coronial cases for deaths of people in Australia aged ten years or more during 1 July 2013 - 10 October 2019 deemed by coroners to be the result of intentional self-harm. MAIN OUTCOME MEASURES Proportions of people to whom medicines were dispensed around the time of death, by medicine group, class, and specific medicine; comparison of medicines recently dispensed and those detected by post mortem toxicology. RESULTS Toxicology reports were available for 13 541 of 14 206 people who died by suicide (95.3%; 10 246 men, 75.7%); poisoning with medicines contributed to 1163 deaths (8.6%). At least one PBS-subsidised medicine had been dispensed around the time of death to 7998 people (59.1%). For three medicine classes, the proportions of people in whom the medicines were detected post mortem and their death was deemed medicine-related were larger for those without records of recent dispensing than for people for whom they had been dispensed around the time of death: antidepressants (17.7% v 12.0%), anxiolytics (16.3% v 14.8%), and sedatives/hypnotics (24.3% v 16.5%). At least one recently dispensed medicine not detected post mortem was identified for 6208 people (45.8%). CONCLUSIONS A considerable proportion of people who died by suicide were not taking psychotropic medicines recently dispensed to them, suggesting non-adherence to pharmacotherapy, and a smaller than expected proportion were using antidepressants. Conversely, medicines that had not recently been dispensed were detected post mortem in many people for whom poisoning with medicines was a contributing factor, suggesting medicine stockpiling.
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Affiliation(s)
- Kate M Chitty
- The University of SydneySydneyNSW
- The University of Western AustraliaPerthWA
| | - Nicholas A Buckley
- The University of SydneySydneyNSW
- Poisons Information CentreChildren's Hospital at WestmeadSydneyNSW
| | | | - Zein Ali
- The University of SydneySydneyNSW
| | - Jennifer L Schumann
- Victorian Institute of Forensic MedicineMonash UniversityMelbourneVIC
- Monash Addiction Research CentreMonash UniversityMelbourneVIC
- Monash UniversityMelbourneVIC
| | - Rose Cairns
- The University of SydneySydneyNSW
- Poisons Information CentreChildren's Hospital at WestmeadSydneyNSW
| | | | | | | | - Andrea L Schaffer
- The Bennett Institute of Applied Data ScienceUniversity of OxfordOxfordUnited Kingdom
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Fusaroli M, Pelletti G, Giunchi V, Pugliese C, Bartolucci M, Necibi EN, Raschi E, De Ponti F, Pelotti S, Poluzzi E. Deliberate Self-Poisoning: Real-Time Characterization of Suicidal Habits and Toxidromes in the Food and Drug Administration Adverse Event Reporting System. Drug Saf 2023; 46:283-295. [PMID: 36689131 PMCID: PMC9869307 DOI: 10.1007/s40264-022-01269-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Deliberate self-poisoning (DSP) using drugs is the preferred method of suicide at a global level. Its investigation is hampered by limited sample sizes and data reliability. We investigate the role of the US FDA Adverse Event Reporting System (FAERS), a consolidated pharmacovigilance database, in outlining DSP habits and toxidromes. METHODS We retrieved cases of 'intentional overdose' and 'poisoning deliberate' from the FAERS (January 2004-December 2021). Using descriptive and disproportionality analyses, we estimated temporal trends, potential risk factors, toxidromes, case-fatality rates and lethal doses (LDs) for the most frequently reported drugs. RESULTS We retrieved 42,103 DSP cases (17% fatal). Most cases were submitted in winter. Reports of DSP involved younger people, psychiatric conditions, and alcohol use, compared with non-DSP, and fatality was higher in men and older patients. Suspected drugs were mainly antidepressants, analgesics, and antipsychotics. Multiple drug intake was recorded in more than 50% of the reports, especially analgesics, psychotropics, and cardiovascular agents. The most frequently reported drugs were paracetamol, promethazine, amlodipine, quetiapine, and metformin. We estimated LD25 for paracetamol (150 g). CONCLUSION Worldwide coverage of the FAERS complements existing knowledge about DSP and may drive tailored prevention measures to timely address the DSP phenomenon and prevent intentional suicides.
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Affiliation(s)
- Michele Fusaroli
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Guido Pelletti
- Legal Medicine Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Valentina Giunchi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Chiara Pugliese
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Mattia Bartolucci
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Elena Narmine Necibi
- School of Emergency Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fabrizio De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Susi Pelotti
- Legal Medicine Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Brubacher JR, Chan H, Erdelyi S, Staples JA, Asbridge M, Mann RE. Cannabis Legalization and Detection of Tetrahydrocannabinol in Injured Drivers. N Engl J Med 2022; 386:148-156. [PMID: 35020985 DOI: 10.1056/nejmsa2109371] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The effect of cannabis legalization in Canada (in October 2018) on the prevalence of injured drivers testing positive for tetrahydrocannabinol (THC) is unclear. METHODS We studied drivers treated after a motor vehicle collision in four British Columbia trauma centers, with data from January 2013 through March 2020. We included moderately injured drivers (those whose condition warranted blood tests as part of clinical assessment) for whom excess blood remained after clinical testing was complete. Blood was analyzed at the provincial toxicology center. The primary outcomes were a THC level greater than 0, a THC level of at least 2 ng per milliliter (Canadian legal limit), and a THC level of at least 5 ng per milliliter. The secondary outcomes were a THC level of at least 2.5 ng per milliliter plus a blood alcohol level of at least 0.05%; a blood alcohol level greater than 0; and a blood alcohol level of at least 0.08%. We calculated the prevalence of all outcomes before and after legalization. We obtained adjusted prevalence ratios using log-binomial regression to model the association between substance prevalence and legalization after adjustment for relevant covariates. RESULTS During the study period, 4339 drivers (3550 before legalization and 789 after legalization) met the inclusion criteria. Before legalization, a THC level greater than 0 was detected in 9.2% of drivers, a THC level of at least 2 ng per milliliter in 3.8%, and a THC level of at least 5 ng per milliliter in 1.1%. After legalization, the values were 17.9%, 8.6%, and 3.5%, respectively. After legalization, there was an increased prevalence of drivers with a THC level greater than 0 (adjusted prevalence ratio, 1.33; 95% confidence interval [CI], 1.05 to 1.68), a THC level of at least 2 ng per milliliter (adjusted prevalence ratio, 2.29; 95% CI, 1.52 to 3.45), and a THC level of at least 5 ng per milliliter (adjusted prevalence ratio, 2.05; 95% CI, 1.00 to 4.18). The largest increases in a THC level of at least 2 ng per milliliter were among drivers 50 years of age or older (adjusted prevalence ratio, 5.18; 95% CI, 2.49 to 10.78) and among male drivers (adjusted prevalence ratio, 2.44; 95% CI, 1.60 to 3.74). There were no significant changes in the prevalence of drivers testing positive for alcohol. CONCLUSIONS After cannabis legalization, the prevalence of moderately injured drivers with a THC level of at least 2 ng per milliliter in participating British Columbia trauma centers more than doubled. The increase was largest among older drivers and male drivers. (Funded by the Canadian Institutes of Health Research.).
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Affiliation(s)
- Jeffrey R Brubacher
- From the University of British Columbia, Vancouver (J.R.B., H.C., S.E., J.A.S.), Dalhousie University, Halifax, NS (M.A.), and the Centre for Addiction and Mental Health (R.E.M.) and the University of Toronto (R.E.M.), Toronto - all in Canada
| | - Herbert Chan
- From the University of British Columbia, Vancouver (J.R.B., H.C., S.E., J.A.S.), Dalhousie University, Halifax, NS (M.A.), and the Centre for Addiction and Mental Health (R.E.M.) and the University of Toronto (R.E.M.), Toronto - all in Canada
| | - Shannon Erdelyi
- From the University of British Columbia, Vancouver (J.R.B., H.C., S.E., J.A.S.), Dalhousie University, Halifax, NS (M.A.), and the Centre for Addiction and Mental Health (R.E.M.) and the University of Toronto (R.E.M.), Toronto - all in Canada
| | - John A Staples
- From the University of British Columbia, Vancouver (J.R.B., H.C., S.E., J.A.S.), Dalhousie University, Halifax, NS (M.A.), and the Centre for Addiction and Mental Health (R.E.M.) and the University of Toronto (R.E.M.), Toronto - all in Canada
| | - Mark Asbridge
- From the University of British Columbia, Vancouver (J.R.B., H.C., S.E., J.A.S.), Dalhousie University, Halifax, NS (M.A.), and the Centre for Addiction and Mental Health (R.E.M.) and the University of Toronto (R.E.M.), Toronto - all in Canada
| | - Robert E Mann
- From the University of British Columbia, Vancouver (J.R.B., H.C., S.E., J.A.S.), Dalhousie University, Halifax, NS (M.A.), and the Centre for Addiction and Mental Health (R.E.M.) and the University of Toronto (R.E.M.), Toronto - all in Canada
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Lefrancois E, Reymond N, Thomas A, Lardi C, Fracasso T, Augsburger M. Summary statistics for drugs and alcohol concentration recovered in post-mortem femoral blood in Western Switzerland. Forensic Sci Int 2021; 325:110883. [PMID: 34229141 DOI: 10.1016/j.forsciint.2021.110883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
In post-mortem investigations of fatal intoxication, it is challenging to determine which drug(s) were responsible for the death, and which drugs did not. This study aims to provide post-mortem femoral blood drug levels in lethal intoxication and in post-mortem control cases, where the cause of death was other than intoxication. The reference values could assist in the interpretation of toxicological results in the routine casework. To this end, all post-mortem toxicological results in femoral blood from 2011 to 2017 in Western Switzerland were considered. A full autopsy with systematic toxicological analysis (STA) was conducted in all cases. Results take into account the cause of death classified into one of four categories (as published by Druid and colleagues): I) certified intoxication by one substance alone, IIa) certified intoxication by more than one substance, IIb) certified other causes of death with incapacitation due to drugs, and III) certified other causes of death without incapacitation due to drugs. This study includes 1 990 post-mortem cases where femoral blood was analysed. The material comprised 619 women (31%) and 1 371 men (69%) with a median age of 50 years. The concentrations of the 32 most frequently recorded substances as well as alcohol are discussed. These include 6 opioids and opiates, 3 antidepressants, 6 neuroleptics and hypnotics, 1 barbiturate, 11 benzodiazepines (and related drugs), 2 amphetamine-type stimulants, cocaine, paracetamol, and tetrahydrocannabinol (THC). The most common substances that caused intoxication alone were morphine, methadone, ethanol, tramadol, and cocaine. The post-mortem concentration ranges for all substance are categorized as I, IIa, IIb, or III. Statistical post-mortem reference concentrations for drugs are discussed and compared with previously published concentrations. This study shows that recording and classifying cases is time-consuming, but it is rewarding in a long-term perspective to achieve a more reliable information about fatal and non-fatal blood concentrations.
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Affiliation(s)
- Elodie Lefrancois
- School of criminal justice, Faculty of Law, Criminal Justice and Public Administration, University of Lausanne, Switzerland; University Centre of Legal Medicine (CURML), Lausanne, Geneva, Switzerland
| | - Naomi Reymond
- School of criminal justice, Faculty of Law, Criminal Justice and Public Administration, University of Lausanne, Switzerland
| | - Aurélien Thomas
- University Centre of Legal Medicine (CURML), Lausanne, Geneva, Switzerland
| | - Christelle Lardi
- University Centre of Legal Medicine (CURML), Lausanne, Geneva, Switzerland
| | - Tony Fracasso
- University Centre of Legal Medicine (CURML), Lausanne, Geneva, Switzerland
| | - Marc Augsburger
- University Centre of Legal Medicine (CURML), Lausanne, Geneva, Switzerland
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Dziadosz M, Bolte K, Rosenberger W, Klintschar M, Teske J. Interpretation of melperone intoxication: post-mortem concentration distribution and interpretation of intoxication data. Drug Metab Pers Ther 2021; 36:233-237. [PMID: 34412172 DOI: 10.1515/dmpt-2020-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/28/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Since melperone abuse with lethal intoxication is common, expert opinions based on therapeutical and lethal concentration ranges can be considered as important. Because there is a lack of information about fatalities caused by melperone mono-intoxications and data on tissue samples with concentration distribution, the aim of this work is the examination of lethal concentration ranges of melperone and drug quantification in different matrices. METHODS An LC-MS/MS method was applied for analyses performed in blood and tissue samples. Quantification based on standard addition and sample preparation on liquid-liquid extraction with 1-chlorobutane. An appropriate tissue homogenization was performed ahead of extraction with an IKA Ultra-Turrax-Tube-Drive®. A Luna 5 µm C18 (2) 100 Å, 150 × 2 mm analytical column was used for chromatographic separation and the elution was performed with two mobile phases consisted of A (H2O/methanol = 95/5, v/v) and B (H2O/methanol = 3/97, v/v) both with 10 mM ammonium acetate and 0.1% acetic acid. RESULTS A multi-drug LC-MS/MS analytical method developed was applied successfully for melperone quantification in different post-mortem matrices. No analytical problems could be identified during method development and analyses of real samples. The melperone lethal concentration calculated in femoral blood of the drug mono-intoxication investigated was 10 mg/L. Melperone concentration distribution was presented for the first time. CONCLUSIONS The lethal reference concentration of melperone in femoral blood of 17.1 mg/L pointed out in different reference lists should be used with caution. Instead, a lower lethal melperone concentration should be considered. The post-mortem concentration distribution of the drug presented could be helpful in the interpretation of cases where no blood samples are available.
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Affiliation(s)
- Marek Dziadosz
- Institute of Legal Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - Katarina Bolte
- Institute of Legal Medicine, Hannover Medical School (MHH), Hannover, Germany
| | | | - Michael Klintschar
- Institute of Legal Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - Jörg Teske
- Institute of Legal Medicine, Hannover Medical School (MHH), Hannover, Germany
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8
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Dziadosz M, Bolte K, Rosenberger W, Klintschar M, Teske J. Interpretation of melperone intoxication: post-mortem concentration distribution and interpretation of intoxication data. Drug Metab Pers Ther 2021; 0:dmdi-2020-0181. [PMID: 33770824 DOI: 10.1515/dmdi-2020-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/28/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Since melperone abuse with lethal intoxication is common, expert opinions based on therapeutical and lethal concentration ranges can be considered as important. Because there is a lack of information about fatalities caused by melperone mono-intoxications and data on tissue samples with concentration distribution, the aim of this work is the examination of lethal concentration ranges of melperone and drug quantification in different matrices. METHODS An LC-MS/MS method was applied for analyses performed in blood and tissue samples. Quantification based on standard addition and sample preparation on liquid-liquid extraction with 1-chlorobutane. An appropriate tissue homogenization was performed ahead of extraction with an IKA Ultra-Turrax-Tube-Drive®. A Luna 5 µm C18 (2) 100 Å, 150 × 2 mm analytical column was used for chromatographic separation and the elution was performed with two mobile phases consisted of A (H2O/methanol = 95/5, v/v) and B (H2O/methanol = 3/97, v/v) both with 10 mM ammonium acetate and 0.1% acetic acid. RESULTS A multi-drug LC-MS/MS analytical method developed was applied successfully for melperone quantification in different post-mortem matrices. No analytical problems could be identified during method development and analyses of real samples. The melperone lethal concentration calculated in femoral blood of the drug mono-intoxication investigated was 10 mg/L. Melperone concentration distribution was presented for the first time. CONCLUSIONS The lethal reference concentration of melperone in femoral blood of 17.1 mg/L pointed out in different reference lists should be used with caution. Instead, a lower lethal melperone concentration should be considered. The post-mortem concentration distribution of the drug presented could be helpful in the interpretation of cases where no blood samples are available.
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Affiliation(s)
- Marek Dziadosz
- Institute of Legal Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - Katarina Bolte
- Institute of Legal Medicine, Hannover Medical School (MHH), Hannover, Germany
| | | | - Michael Klintschar
- Institute of Legal Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - Jörg Teske
- Institute of Legal Medicine, Hannover Medical School (MHH), Hannover, Germany
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Lin Z, Wang H, Jones AW, Wang F, Zhang Y, Rao Y. Evaluation and review of ways to differentiate sources of ethanol in postmortem blood. Int J Legal Med 2020; 134:2081-2093. [PMID: 32940841 DOI: 10.1007/s00414-020-02415-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/27/2020] [Indexed: 11/24/2022]
Abstract
Accurate determination of a person's blood alcohol concentration (BAC) is an important task in forensic toxicology laboratories because of the existence of statutory limits for driving a motor vehicle and workplace alcohol testing regulations. However, making a correct interpretation of the BAC determined in postmortem (PM) specimens is complicated, owing to the possibility that ethanol was produced in the body after death by the action of various micro-organisms (e.g., Candida species) and fermentation processes. This article reviews various ways to establish the source of ethanol in PM blood, including collection and analysis of alternative specimens (e.g., bile, vitreous humor (VH), and bladder urine), the identification of non-oxidative metabolites of ethanol, ethyl glucuronide (EtG) and ethyl sulfate (EtS), the urinary metabolites of serotonin (5-HTOL/5-HIAA), and identification of n-propanol and n-butanol in blood, which are known putrefaction products. Practical utility of the various biomarkers including specificity and stability is discussed.
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Affiliation(s)
- Zijie Lin
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, People's Republic of China
| | - Hao Wang
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, People's Republic of China
| | - Alan Wayne Jones
- Division of Drug Research, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Fanglin Wang
- Institute of Forensic Science, Ministry of Public Security, Beijing, 100038, People's Republic of China
| | - Yunfeng Zhang
- Institute of Forensic Science, Ministry of Public Security, Beijing, 100038, People's Republic of China
| | - Yulan Rao
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, People's Republic of China.
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Pivariu D, Oros AN, Tabaran F, Gal A, Martonos C, Nagy AL. Intentional Carbofuran poisoning in 7 dogs. BMC Vet Res 2020; 16:318. [PMID: 32867767 PMCID: PMC7457768 DOI: 10.1186/s12917-020-02534-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 08/23/2020] [Indexed: 11/29/2022] Open
Abstract
Background Carbofuran is a widely used broad-spectrum pesticide that, despite strict regulation and being banned for more than a decade, is still encountered in cases of intentional poisoning in dogs and wildlife. The objective of the study was to provide a complete and detailed description of the pathological, histological and toxicological findings of 7 cases of intentional carbofuran poisoning in dogs. Results In this retrospective study, 7 cases of carbofuran intoxication recorded from July 2015 to June 2017 were analyzed. Following complete history recording, all cases were examined by complete necropsy and histopathology. Carbofuran intoxication was confirmed in all cases by gas chromatography. The postmortem examination revealed extensive hemorrhaging and congestion located mainly within the respiratory, nervous and cardiovascular systems, accompanied by degeneration and necrosis within the lungs, heart, and kidneys. Conclusions Although carbamates have been banned in the European Union, carbamate poisoning is still frequently encountered, especially in wild animals. This paper will contribute to a better understanding of the occurrence and pathogenesis of acute carbofuran exposure in dogs and contribute some peculiar pathological features of this type of poisoning to the current literature.
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Affiliation(s)
- Dalma Pivariu
- Department of Veterinary Toxicology, University of Agricultural Sciences and Veterinary Medicine, 3-5 Mănăştur Street, 400372, Cluj-Napoca, Romania
| | - Adrian-Nechita Oros
- Department of Veterinary Toxicology, University of Agricultural Sciences and Veterinary Medicine, 3-5 Mănăştur Street, 400372, Cluj-Napoca, Romania
| | - Flaviu Tabaran
- Department of Veterinary Pathology, University of Agricultural Sciences and Veterinary Medicine, 3-5 Mănăştur Street, 400372, Cluj-Napoca, Romania.
| | - Adrian Gal
- Department of Veterinary Cell Biology, Histology and Embryology, University of Agricultural Sciences and Veterinary Medicine, 3-5 Mănăştur Street, 400372, Cluj-Napoca, Romania
| | - Cristian Martonos
- Department of Veterinary Cell Biology, Histology and Embryology, University of Agricultural Sciences and Veterinary Medicine, 3-5 Mănăştur Street, 400372, Cluj-Napoca, Romania
| | - Andras-Laszlo Nagy
- Department of Veterinary Toxicology, University of Agricultural Sciences and Veterinary Medicine, 3-5 Mănăştur Street, 400372, Cluj-Napoca, Romania
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11
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Sarkar R, Ozanne-Smith J, Dipnall JF, Bassed R. Population study of orofacial injuries in adult family violence homicides in Victoria, Australia. Forensic Sci Int 2020; 316:110467. [PMID: 32891827 DOI: 10.1016/j.forsciint.2020.110467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/16/2020] [Accepted: 08/18/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study describes the prevalence and orofacial injury patterns associated with adult family violence (FV) homicides in Victoria, Australia. It follows a methods study for case selection of all FV homicides and injury measurement. Comprehensive analysis of orofacial injuries in FV homicides and their clinico-demographic context will inform future research on clinical FV indicators and sentinel injuries, and potentially lead to premorbid intervention in health services. METHODS All closed cases of FV homicides aged ≥18 years, January 2006 to December 2018, were identified by screening Victorian fatal assaults, based on victim-offender relationship. Primary data such as post-mortem computed tomography scans and photographs were assessed. Socio-demographic, clinical, interpersonal and incident parameters were descriptively analysed and statistically compared across FV homicides with and without facial injuries using cluster analysis and nonparametric tests. RESULTS Of 170 adult homicides screened for eligibility, 151 were included for final analysis. Over the 12-year period, 78.1% of all Victorian adult FV homicides had orofacial injuries. Significant cluster patterns of injury mechanism, victim-offender relationship and drug/alcohol impairment were identified in all homicides. Non-facial injuries were significantly higher in facial vs. non-facial injury homicides. Facial abrasion and incised wounds were the most common injury types. CONCLUSIONS This is the first forensic-epidemiologic study evaluating the empirical evidence concerning orofacial injuries associated with population-wide adult Victorian FV homicides. The high level of orofacial injuries in this population during the study period may inform clinical practice and policy in FV intervention in Victoria and globally.
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Affiliation(s)
- Reena Sarkar
- Department of Forensic Medicine, Monash University, Australia.
| | | | - Joanna F Dipnall
- Pre-hospital, Emergency and Trauma Research, School of Public Health and Preventive Medicine, Monash University, Australia; School of Medicine, Deakin University, Australia
| | - Richard Bassed
- Department of Forensic Medicine, Monash University, Australia; Victorian Institute of Forensic Medicine, Victoria, Australia
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12
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Le Daré B, Gicquel T, Baert A, Morel I, Bouvet R. Self-inflicted neck wounds under influence of lysergic acid diethylamide: A case report and literature review. Medicine (Baltimore) 2020; 99:e20868. [PMID: 32629675 PMCID: PMC7337592 DOI: 10.1097/md.0000000000020868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/17/2020] [Accepted: 05/21/2020] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Lysergic acid diethylamide (LSD) is a highly potent psychedelic drug derived from ergot alkaloids. The available literature data derived from controlled studies or usage in a medical setting seem reassuring; however the literature contains very rare cases of fatal self-inflicted injuries associated with LSD exposure. The behavioral disorder that created the conditions conducive to death is a maladaptive or irrational response to the psychiatric manifestations induced by the substance. PATIENT CONCERN Here, we report the case of a 26-year-old man found dead with large neck wounds in a locked house. No medical history other than recreational use of alcohol and narcotics was reported as well as any history of psychotic disease. The entirety of the other investigations carried out did not demonstrate the presence of a third party at the place of death and a dropper bottle containing LSD was found near the body. DIAGNOSIS We report the first case of fatal self-inflicted neck wounds with a cutting instrument in the context of acute exposure to LSD in a patient with no psychiatric history and without suicidal symptoms at the time of the self-aggressive act. INTERVENTION AND OUTCOMES In the present work, we used a validated method using liquid chromatography coupled with mass spectrometry for simultaneous quantification of LSD and its metabolites (O-H-LSD and Nor-LSD) in whole blood and urine samples. LSD and O-H-LSD were respectively found at 1460 and 182 pg/mL in blood. In the urine, the concentrations of LSD, nor-LSD, O-H-LSD were, respectively, 3670, 201, and 4890 ng/L. LESSONS This observation is particularly relevant in view of the resurgence of interest in the therapeutic use of LSD, notwithstanding the fact that the literature has not demonstrated a link between suicidal risk and acute or chronic exposure to LSD.
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Affiliation(s)
- Brendan Le Daré
- Institut national de la santé et de la recherche médicale, Institut national de recherche agronomique, University Hospital Rennes, Institut NuMeCan (Nutrition, Metabolism and Cancer)
- Forensic Toxicology Laboratory
| | - Thomas Gicquel
- Institut national de la santé et de la recherche médicale, Institut national de recherche agronomique, University Hospital Rennes, Institut NuMeCan (Nutrition, Metabolism and Cancer)
- Forensic Toxicology Laboratory
| | - Alain Baert
- Department of Forensic Medicine, Rennes University Hospital
| | - Isabelle Morel
- Institut national de la santé et de la recherche médicale, Institut national de recherche agronomique, University Hospital Rennes, Institut NuMeCan (Nutrition, Metabolism and Cancer)
- Forensic Toxicology Laboratory
| | - Renaud Bouvet
- Department of Forensic Medicine, Rennes University Hospital
- Institut du droit public et de la science politique - EA 4640, University Rennes, Rennes, France
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Peterson BL, Schreiber S, Fumo N, Brooke Lerner E. Opioid Deaths in Milwaukee County, Wisconsin 2013-2017: The Primacy of Heroin and Fentanyl. J Forensic Sci 2018; 64:144-148. [PMID: 29684941 DOI: 10.1111/1556-4029.13808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/24/2018] [Accepted: 04/02/2018] [Indexed: 12/30/2022]
Abstract
Heroin and fentanyl are the overwhelming and increasing cause of opioid deaths in Milwaukee County, Wisconsin. We reviewed all drug and opioid deaths from 2013 to 2017 to delineate the specific opioid drugs involved and changes in their incidence. From 2013 to 2017, 980 deaths were due to opioids, rising from 184 in 2013 to 337 in 2017. In 2017, opioid deaths exceeded combined non-natural deaths from homicide and suicide. Illicit heroin and fentanyl/analogs caused 84% of opioid deaths and 80% of drug deaths, with no increase in deaths due to oral prescription drugs such as oxycodone and hydrocodone. Any approach to decreasing this dramatic increase in opioid deaths should first focus on interdicting the supply and cheap availability of these illicit opioids. Fentanyl and its analogs represent the most deadly opioids and the greatest threat to human life in our population.
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Affiliation(s)
- Brian L Peterson
- Milwaukee County Medical Examiner's Office, 933 West Highland Avenue, Milwaukee, WI, 53233.,Department of Pathology, Medical College of Wisconsin, Froedert/Medical College Lab Building FMCLB 239, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226
| | - Sara Schreiber
- Milwaukee County Medical Examiner's Office, 933 West Highland Avenue, Milwaukee, WI, 53233
| | - Nicole Fumo
- Comprehensive Injury Center, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226
| | - E Brooke Lerner
- Department of Emergency Medicine, Medical College of Wisconsin, Froedert Hospital, Pavilion 1P, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226
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Aitken G, Murphy B, Pilgrim J, Bugeja L, Ranson D, Ibrahim JE. Frequency of forensic toxicological analysis in external cause deaths among nursing home residents: an analysis of trends. Forensic Sci Med Pathol 2017; 13:52-57. [PMID: 28091985 DOI: 10.1007/s12024-016-9830-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2016] [Indexed: 11/28/2022]
Abstract
There is a paucity of research examining the utility of forensic toxicology in the investigation of premature external cause deaths of residents in nursing homes. The aim of this study is to describe the frequency and characteristics of toxicological analysis conducted in external cause (injury-related) deaths amongst nursing home residents in Victoria, Australia. This study was a retrospective cohort study examining external cause deaths among nursing home residents during the period July 1, 2000 to December 31, 2012 in Victoria, Australia, using the National Coronial Information System (NCIS). The variables examined comprised: sex, age group, year-of-death, cause and manner of death. One-third of deaths among nursing home residents in Victoria resulted from external causes (n = 1296, 33.3%) of which just over one-quarter (361, 27.9%) underwent toxicological analysis as part of the medical death investigation. The use of toxicological analysis varied by cause of death with a relatively low proportion conducted in deaths from unintentional falls (n = 286, 24.9%) and choking (n = 36, 40.4%). The use of toxicological analysis decreased as the decedents age increased. Forensic toxicology has the potential to contribute to improving our understanding of premature deaths in nursing home residents however it remains under used and is possibly undervalued.
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Affiliation(s)
- Georgia Aitken
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia. .,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.
| | - Briony Murphy
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia. .,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.
| | - Jennifer Pilgrim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - Lyndal Bugeja
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - David Ranson
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - Joseph Elias Ibrahim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
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de Siqueira A, Rodrigues KBA, Gonçalves-Júnior V, Calefi AS, Fukushima AR, Cuevas SEC, Spinosa HDS, Maiorka PC. Exhumation of Wistar rats experimentally exposed to the carbamate pesticides aldicarb and carbofuran: A pathological and toxicological study. ACTA ACUST UNITED AC 2016; 68:307-14. [DOI: 10.1016/j.etp.2016.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 03/14/2016] [Accepted: 03/21/2016] [Indexed: 11/24/2022]
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16
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Poisoning of cats and dogs by the carbamate pesticides aldicarb and carbofuran. Res Vet Sci 2015; 102:142-9. [DOI: 10.1016/j.rvsc.2015.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 06/12/2015] [Accepted: 08/06/2015] [Indexed: 11/22/2022]
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Sedative and hypnotic drugs—Fatal and non-fatal reference blood concentrations. Forensic Sci Int 2014; 236:138-45. [DOI: 10.1016/j.forsciint.2014.01.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 12/30/2013] [Accepted: 01/05/2014] [Indexed: 11/20/2022]
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