扩张性心肌病猝死的法医病理学分析

扩张性心肌病是心性猝死常见原因之一,本文通过2例尸检病理报告并结合文献,讨论了扩张性心肌病病变特点、猝死原因、病理诊断要点及法医学鉴定注意事项.不明原因的心腔扩张;心脏轻度到中度增重,但心室壁增厚不明显:心肌肥大:心内膜和间质纤维化是病理诊断要点.猝死原因除充血性心力衰竭外,不应忽视心律紊乱.全面系统尸体解剖,在排除其他死因的基础     

云南363例猝死案例的法医病理学分析

目的研究云南猝死(sudden death,SD)的流行病学及病理学特点,为猝死的防治和法医学鉴定提供科学依据。方法收集昆明医科大学司法鉴定中心2009—2017年尸体检验的363例猝死案例,回顾性分析其性别、年龄、发病到死亡时间、好发季节、死亡原因及诱因等猝死相关因素。结果猝死者男性多于女性,≥35~55岁年龄段为猝死高峰,发病后6h内死亡率较高,各季节死亡人数从高到低分别为春季、夏季、冬季、秋季。导致猝死的前十位死亡原因依次为冠心病、不明原因猝死(sudden unexplained death,SUD)、脑出血、急性出血坏死性胰腺炎、主动脉夹层破裂、心肌病、肺炎、肺动脉血栓栓塞、羊水栓塞、过敏。运动,输液、手术、药物以及轻微损伤是冠心病猝死最常见的发病诱因,意识障碍或昏迷、胸痛或胸闷以及腹痛是冠心病猝死最常见的死亡前症状。结论中年男性猝死最常见,是猝死防治的重点人群。在法医学鉴定和猝死的防治中应对不明原因猝死给予重视。     

云南猝死综合征的流行特征及其研究进展

云南猝死综合征(Yunnan sudden death syndrome,YSDS)是一种每年6~9月份发生在云南省中部和西北部海拔1815~2225m的山区、半山区,以突然发病并死亡为特征且病因不明的疾病。该病以青壮年为主,女性多于男性,傈僳族、彝族和苗族发病率较高,具有家庭聚集性,临床表现多样,病理学特点缺乏特异性,发病原因与卫生、经济条件、硒铬微量元素缺乏、柯萨奇B组病毒感染、食用蘑菇及当地特殊地质条件相关。本文综述了YSDS的流行病学特征、临床表现、病理性特点、病因研究及假说,以期对YSDS进一步研究提供线索。     

6例甲状腺功能亢进性心脏病猝死法医学分析

目的分析甲状腺功能亢进性心脏病(以下简称甲亢性心脏病)猝死案例,探讨其死亡的一般情况及法医病理学特点,为此类案件的法医病理学鉴定提供参考。方法收集中国医科大学法医学院2001—2016年6例甲亢性心脏病猝死案例,回顾性分析基本信息(性别与年龄)、临床表现、病史、解剖所见和组织病理学所见、生物化学检测指标、死亡原因。结果 6例案例多具有明确的甲状腺功能亢进病史,并表现出不同程度的心血管病症状;均具有明显的死亡诱因;甲状腺病理学检验符合弥漫性毒性甲状腺肿的表现;心脏质量均增加,心腔扩张,心肌肥大,灶状坏死;死后心包液的生物化学检测可作为甲亢性心脏病猝死的辅助手段。结论对甲亢性心脏病猝死案例进行诊断时应参考临床病史、尸体检验、组织病理学检验、死后毒(药)物检验等结果综合判定,必要时进行死后甲状腺和心功能的生物化学检测。     

冠心病猝死的病理学研究——附128例尸检分析

本文报道128例冠心病猝死的法医病理学研究结果。其中冠脉病变4级63例,3级26例,2级29例。3级以上病变者斑块分布多较广泛。各支病变中以左前降支最常见。并发新鲜血栓形成者18例,斑块内出血17例,急性心肌梗死仅2例。36例冠脉斑块有炎性细胞浸润。56例见心肌间质纤维化或小灶疤痕形成。指出虽然我国冠心病发病率较低,但仍是猝死最常见的原因,尤以中壮年男性多见;多数病例无明显诱因而于睡眠中猝死。对冠心病猝死发生的特点、冠脉和心肌病变及病理诊断等进行了分析讨论。     

宝鸡市358例法医送检器官的组织病理学分析

目的 分析法医尸体检验后送检器官的病理学特征,总结此类案件的特点.方法 对宝鸡市法医送检358例尸体解剖器官标本进行常规检查并进行组织病理学诊断. 结果 358例中以青壮年男性为主,死亡原因主要为创伤、猝死、中毒.组织学能明确死亡原因250例,无典型组织学病变101例,组织自溶腐败7例.病理诊断以心血管疾病为主,其次为呼吸、神经、消化系统疾病. 结论 法医解剖具有专业特点,与病理解剖不尽相同.组织病理学检验进行死亡原因诊断时,应积极与法医沟通,以充分掌握案情、死亡经过及特定的法医病理学特征.     

东莞地区外来工青壮年猝死综合征的流行病学研究

目的研究东莞地区青壮年猝死综合征(SMDS)的流行病学特征。方法对东莞市公安局1990～2001年的法医学检案中遴选的284例SMDS案例资料进行回顾性研究。结果分析SMDS猝死者的籍贯、年龄、性别、死亡季节的分布及死亡经过、尸检所见的特征。结论此项研究为下一步进行SMDS的流行病学研究积累了初步资料。     

云南不明原因猝死研究进展

云南不明原因猝死(Yunnan unexplained sudden death,YUSD)具有明显的空间和时间聚集性,而且发病突然,死亡迅速,至今仍然病因未明。但YUSD的发生与病区特定海拔范围内的地质和气候条件有关,同时YUSD病区群众存在易感基因位点或多个SNP位点突变、长期劳累、膳食营养水平低、微量元素缺乏、居住环境卫生差、生活卫生习惯不良、病原微生物及病毒感染等多方面因素的影响。病区人群在上述影响因素的持续作用下,最终形成以心肌损伤为突出表现的不明原因猝死。强化卫生管理,改善居住环境,提高村民体质,改变不良生活习惯,加强YUSD重点病区人群的心肌酶和心电图指标检测是预防YUSD的有效措施。及时开展死亡原因鉴定和深入遗传学研究是探索YUSD发病原因、提高诊疗效果及降低死亡率的重要途径。     

成人心脏性猝死的心脏大体病理学测量数据报告

目的 分析不同原因心脏性猝死(sudden cardiac death,SCD)的大体病理学数据,为不明原因的猝死鉴定提供证据支持。方法 收集南京医科大学司法鉴定所2010—2020年行法医病理鉴定的167例成人SCD案件,汇总SCD案例的大体病理学检验数据,统计分析不同死因的特征。结果 男、女性SCD案例比例3.4∶1。冠状动脉粥样硬化性心脏病是引起SCD的首要原因,主要分布于40岁以上的人群。心肌炎导致的猝死主要分布于年轻群体,平均死亡年龄为(34.00±9.55)岁。分析不同原因SCD的心脏病理学参数差异发现,主动脉瘤或动脉夹层猝死者的主动脉瓣瓣环周径多呈明显扩张(P<0.05)。男性主动脉瘤或动脉夹层和合并死因组的心脏质量增大,合并死因组的肺动脉瓣和三尖瓣瓣环均扩张(P<0.05)。结论 不同原因SCD存在多个大体病理学测量指标差异,在心脏性猝死的原因推断中具有参考价值。     

广东地区622例猝死案例的流行病学调查

目的研究广东地区622例猝死案例的流行病学特征,为探讨猝死的发病机制、鉴定指标提供基础依据。方法收集中山大学法医鉴定中心2009至2012年622例确诊猝死的案例,运用统计学方法对一般情况、临床病历、法医学尸体解剖所见及病理学诊断等资料进行回顾性分析。结果 622例中心源性猝死为主要类型,占59.49%,以中青年男性多见(30~50岁男性占43.78%),冠心病为主要病因,发病呈年轻化(≤35岁者占17.89%);心源性猝死、其它系统疾病猝死、不明原因猝死3组之间心脏重量存在明显差异(P0.05);青壮年猝死综合征与心源性猝死组中胸腺肥大或出血阳性率存在差异(P0.05)。结论心源性猝死为猝死主要类型,发病呈年轻化,中青年男性为甚,冠心病为主要病因;胸腺肥大或出血引起个体应激系统障碍可能是致猝死机制之一。     

Bhartṛhari and Maṇḍana on Avidyā

The concept of avidyā is one of the central categories in the Advaita of Śaṇkara and Maṇḍana. Shifting the focus from māyā, interpreted either as illusion or as the divine power, this concept brings ignorance to the forefront in describing duality and bondage. Although all Advaitins accept avidyā as a category, its scope and nature is interpreted in multiple ways. Key elements in Maṇḍana’s philosophy include the plurality of avidyā, individual selves as its substrate and the Brahman as its field (viṣaya), and the distinction in avidyā between non-apprehension and misapprehension. A closer investigation shows that Maṇḍana is directly influenced by Bhartṛhari’s linguistic non-dualism in developing the concept of avidyā. This study also compares other key constituents such as vivartta and pariṇāma that are relevant to the analysis of avidyā. As the concept of counter-image (pratibimba) emerges as a distinct stream of Advaita subsequent to Maṇḍana, this study also compares the application of pratibimba in the writings of Bhartṛhari and Maṇḍana.     

Unraveling the <Emphasis Type="Italic">Kāvyaprakāśa</Emphasis>: Jayadeva Pīyūṣavarṣa’s idiosyncratic sequence of topics in the <Emphasis Type="Italic">Candrāloka</Emphasis>

In his twelfth century alaṃkāraśāstra, the Candrāloka, Jayadeva Pīyūṣavarṣa reverses the sequence of topics found in Mammaṭa’s Kāvyapr-akāśa, an earlier and immensely popular work. With such a structural revisionism, Jayadeva asserts the autonomy of his own work and puts forth an ambitious critique of earlier approaches to literary analysis. Jayadeva investigates the technical and aesthetic components of poetry in the first part of the Candrāloka, prior to his formal semantic investigations in the latter half of the text, thus suggesting that aesthetic evaluations of poetry beneficially inform scientific investigations of language. Jayadeva’s organization of his chapters on the semantic operations, moreover, intimates that the study of suggestive and metaphoric functions of language clarifies our understanding of denotation, which is conventionally understood to be the primary and direct path of verbal designation.     

Immigration,intermarriage and the changing face of Europe in the post war period

In this article we compare the propensity to intermarry of various migrant groups and their children who settled in Germany, France, England, Belgium and the Netherlands in the post-war period, using a wide range of available statistical data. We try to explain different intermarriage patterns within the framework of Alba and Nee's assimilation theory and pay special attention to the role of religion, colour and colonial background. We therefore compare colonial with non colonial migrants and within these categories between groups with ‘European’ (Christian) and non-European (Islam, Hinduism) religions. First of all, religion appears to be an important variable. Migrants whose faith has no tradition in Western Europe intermarry at a much lower rate than those whose religious backgrounds correspond with those that are common in the country of settlement. The rate of ethnic endogamous marriages in Western Europe are highest in Hindu and Muslim communities, often regardless if they came as guest workers or colonial migrants. Whereas differences in religion diminish the propensity to intermarry, colour or ‘racial’ differences on the other hand seem to be less important. This is largely explained by the pre-migration socialisation. Furthermore, the paper argues that the attention to institutions, as rightly advocated by Richard Alba and Victor Nee, needs a more refined and layered elaboration. Institutions, often as barriers to intermarriage, do not only emanate from the receiving society, but also—be it less formalized—within migrant communities. Especially religions and family systems, but also organized nationalist feelings, can have a profound influence on how migrants think about endogamy. Finally, strong pressures to assimilate, often through institutionalized forms of discrimination and stigmatization, not only produce isolation and frustrate assimilation (with resulting low intermarriage rates), but can also stimulate assimilation by 'passing' mechanisms. These factors, together with a more comparative perspective, are not completely ignored in the new assimilation theory, but—as this study of Western European intermarriage patterns stresses—deserve to be included more systematically in historical and social scientist analyses.     

The Supreme Array Scripture: A New Interpretation of the Title “Gaṇḍavyūha-sūtra”

This article argues for a new interpretation of the Sanskrit compound gaṇḍa-vyūha as it is used in the common title of the Mahāyāna text the Gaṇḍavyūha-Sūtra.The author begins by providing a brief history of the sūtra’s appellations in Chinese and Tibetan sources. Next, the meanings of gaṇḍa (the problematic member of the compound) are explored. The author proposes that contemporary scholars have overlooked a meaning of gaṇḍa occurring in some compounds, wherein gaṇḍa can mean simply “great,” “big” or “massive.” This general sense is particularly common in the compound gaṇda-śaila (a “massive rock” or “boulder”) and is found in such texts as the Bhāgavata Purāṇa, the Harivaṃśa and the Harṣacarita. Following the discussion of Gaṇḍa, the author examines the term vyūha (“array”) as it is used in the Gaṇḍavyūha-sūtra. The article concludes with the suggestion that a more appropriate translation of the Gaṇḍavyūha-sūtra would be “The Supreme array Scripture.”     

Evaluation of six presumptive tests for blood, their specificity, sensitivity, and effect on high molecular-weight DNA

Luminol, leuchomalachite green, phenolphthalein, Hemastix, Hemident, and Bluestar are all used as presumptive tests for blood. In this study, the tests were subjected to dilute blood (from 1:10,000 to 1:10,000,000), many common household substance, and chemicals. Samples were tested for DNA to determine whether the presumptive tests damaged or destroyed DNA. The DNA loci tested were D2S1338 and D19S433. Leuchomalachite green had a sensitivity of 1:10,000, while the remaining tests were able to detect blood to a dilution of 1:100,000. Substances tested include saliva, semen, potato, tomato, tomato sauce, tomato sauce with meat, red onion, red kidney bean, horseradish, 0.1 M ascorbic acid, 5% bleach, 10% cupric sulfate, 10% ferric sulfate, and 10% nickel chloride. Of all the substances tested, not one of the household items reacted with every test; however, the chemicals did. DNA was recovered and amplified from luminol, phenolphthalein, Hemastix, and Bluestar, but not from leuchomalachite green or Hemident.     

Illumination,Imagination, Creativity: Rājaśekhara,Kuntaka, and Jagannātha on <Emphasis Type="Italic">Pratibhā</Emphasis>

Sanskrit poeticians make the visionary faculty of pratibhā a necessary part of the professional poet’s make-up. The term has a pre-history in Bhartṛhari’s linguistic metaphysics, where it is used to explain the unitary perception of meaning. This essay examines the relation between pratibhā and possible theories of the imagination, with a focus on three unusual theoreticians—Rājaśekhara, Kuntaka, and Jagannātha Paṇḍita. Rājaśekhara offers an analysis of pratibhā that is heavily interactive, requiring the discerning presence of the bhāvaka listener or critic; he also positions pratibhā in relation to Bildung (vyutpatti) and practice. For Kuntaka, pratibhā, never an ex nihilo creation by a poet, serves as the basis for the peculiar forms of intensified insight and experience that constitute poetry; these may also involve the creative scrambling and re-articulation of the object in terms of its systemic composition. At times, Kuntaka’s pratibhā comes close to a strong notion of imaginative process. But the full-fledged thematization of the imagination, and of pratibhā as its support and mechanism, is best seen in the seventeenth-century debates preserved for us by Jagannātha. A link is suggested between the discourse of poetic imagination in Jagannātha and similar themes that turn up in Indo-Persian poets such as Bedil.     

Preventing Homelessness for System‐Involved Youth

Too many youth and young adults find themselves on the streets, couch‐surfing with friends, in emergency shelters or worse, after exiting the child welfare and juvenile justice systems. In some circumstances, youth have had court hearings until their exit from the legal system, but those hearings have not focused on long‐range plans of youth and emergencies youth may encounter. In other circumstances, there has been little or no planning prior to discharge, especially for young people who leave the juvenile justice system. Courts can and should prevent, alleviate or end youth homelessness for youth who appear before them through strategies that are enumerated in the recently‐passed NCJFCJ resolution. This article expounds on three of these strategies – coordinating transition and re‐entry plans, insisting on effective legal representation of youth, and utilizing sound judicial leadership. It also describes the concurrent efforts of the Coalition for Juvenile Justice and the American Bar Association's Homeless Youth Legal Network to remove legal barriers and improve outcomes for youth and young adults experiencing homelessness.     

Best practices for structuring a family court parenting plan evaluation under the 2022 AFCC Guidelines

Evaluation appointment orders provide enforceable scaffolding for conduct of family court parenting plan evaluations, and use of the evaluator's reports, feedback, file, and testimony. Unlike a contract, a stipulated or adjudicated appointment order is directly enforceable by the family court. It unambiguously positions the evaluator as the family court's appointee – answerable directly to the court and, in some jurisdictions, protected by quasi-judicial immunity from damages claims. A well-crafted appointment order governs the roles and expectations of the court, the evaluator, the parties, the lawyers, and the collateral witnesses. An appointment order mandates the legal duties, rights, powers, and responsibilities of the professionals, the parties, and the collateral witnesses. At minimum, an appointment order articulates the legal basis for the appointment, the purpose and scope of the evaluation, compensation of evaluator, and the duty of the parties to participate in the process. A written evaluation protocol or procedures statement discloses in advance the methods of investigation and assessment that the evaluator intends to use. Together, the appointment order and written protocol help the evaluator, lawyers, parents, and judge manage the complexity of the evaluation process.     

Monks Who Have Sex: Pārājika Penance in Indian Buddhist Monasticisms

In the study of Buddhism it is commonly accepted that a monk or nun who commits a pārājika offence is permanently and irrevocably expelled from the Buddhist monastic order. This view is based primarily on readings of the Pāli Vinaya. With the exception of the Pāli Vinaya, however, all other extant Buddhist monastic law codes (Dharmaguptaka, Mahāsāṅghika, Mahīśāsaka, Sarvāstivāda and Mūlasarvāstivāda) contain detailed provisions for monks and nuns who commit pārājikas but nevertheless wish to remain within the saṅgha. These monastics are not expelled. Rather, they are granted a special status known as the śikṣādattaka. In this paper I explore the rules. concerning pārājika penance and the śikṣādattaka with specific regard to monastic celibacy. Given that five out of six extant law codes recognise this remarkable accommodation to the rule of celibacy, I argue that we must look to Vinayas other than the Pāli Vinaya if we are to arrive at a nuanced and representative view of Indian Buddhist monasticism.

Grant me chastity and continence, but not yet. Augustine of Hippo (354–430 C.E.)

     

What similes in Sāṃkhya do: a comparison of the similes in the Sāṃkhya texts in the Mahābhārata, the Sāṃkhyakārikā and the Sāṃkhyasūtra

In Sāṃkhya similes are an important means to communicate basic philosophical teachings. In the texts similes are frequently used, especially in the Sāṃkhya passages in the Mahābhārata, in the Sāṃkhyakārikā and in the Sāṃkhyasūtra. This paper compares the similes in these three texts and analyses changes in the philosophy as revealed in the similes. A comparison of the similes of Sāṃkhya texts produced over more than one thousand years reveals changes in the emphasis in this philosophical system. The purpose of the similes in the Sāṃkhya passages of the Mahābhārata is to produce an intuitive understanding of the separateness of puruṣa and prakṛti. The similes are designed to lead the listener to understand this basic dualism. In the Sāṃkhyakārikā the most difficult issues are the relationship between prakṛti and puruṣa and the idea of prakṛti working for the salvation of puruṣa. One whole chapter of the Sāṃkhyasūtra is devoted to similes.