肢体肌肉功能评定研究进展

肢体肌肉功能的评定一直是法医临床学领域的一大难题.近年来,法医临床学鉴定实践中需要进行肢体肌肉功能评定的案件呈增多趋势,肢体肌肉功能评定方法的研究也日益受到重视.本文介绍了肌肉功能的分类和肌肉收缩的类型,对徒手肌力评定、简单器械肌力测试、等速肌力测试、神经电生理检测等肢体肌肉功能的评定方法及其应用价值进行了综述,并提出...     

正常人不同姿势膝关节等速肌力测试

目的：研究应用CON-TREX Biomechanical Test and Training系统测试膝关节肌力时,分析不同姿势对测试结果的影响,从而选择最适用于法医学鉴定的肌力检测条件。方法对52例正常人分别在未固定姿势和固定姿势两种条件下进行60°/s和30°/s速度的等速肌力测试,对这两种条件下双侧膝关节屈、伸肌的峰力矩（peak torque,PT）、峰力矩角度（peak torque angle,PTA）进行统计学分析。结果在未固定姿势,两种测试速度下受试者膝关节屈、伸肌的PT双侧比较差异均存在统计学意义（P〈0.05）;在固定姿势,两种测试速度下受试者膝关节屈、伸肌的PT双侧比较差异均无统计学意义（P〉0.05）。不论受试者身体姿势是否加以固定,其膝关节屈、伸过程的PTA双侧比较差异均无统计学意义（P〉0.05）。结论受试者姿势的规范对测试结果,对PT有影响,因此,在进行膝关节等速肌力测试时应规范受试者的姿势。     

等速肌力检测在辨别伪肢体瘫中的应用

目的：探讨等速肌力检测在法医学鉴定中辨别伪肢体瘫的应用价值,为建立规范、统一的法医学肌力评价方法提供科学依据。方法选取骨折或神经损伤者57例（损伤组）和伪装者128例（伪装组）,应用等速肌力测试系统对损伤组两侧膝关节与伪装组膝关节进行检测,对双侧膝关节屈、伸肌的峰力矩（peak torque,PT）、峰力矩角度（peak torque angle,PTA）进行比较,归纳两组膝关节的力矩-时间图特征。结果损伤组膝关节屈、伸肌的双侧PT的比较差异有统计学意义（P＜0.05）,PTA的比较差异无统计学意义（P＞0.05）;伪装组膝关节屈、伸肌的双侧PT、PTA的比较差异均有统计学意义（P＜0.05）。损伤组两侧膝关节力矩-时间图主要为单峰前置型,伪装组膝关节力矩-时间图主要为多峰型。结论在法医学鉴定中,等速肌力检测在辨别伪肢体瘫方面可以通过力矩-时间图的相关特点进行评价。     

关节活动受限的测量、记录和失能的法医学评价

关节是骨连结的最高级形式。骨关节内外、控制关节运动的神经及肌肉的损伤约会造成关节运动功能障碍，关节活动受限是关节功能障碍重要形式。《人身重伤鉴定标准》简称《重伤标准》中肢体残废部分规定，四肢大关节活动度丧失达50％属重伤。《道路交通事故受伤人员伤残评定》（简称《伤残评定》）中四肢大关节功能丧失划分成25％、50％、75％、100％四个等级。然而《重伤标准》附则说明和《伤残评定》附录B均缺乏有关异常关节活动规范统一测量、记录和功能评价原则，造成检案实践中缺乏可操作性，关节功能状况评价主观随意性较大。作者就上…     

卷积神经网络在识别等速运动配合程度中的应用

目的开发识别不同配合程度下等速膝关节运动力矩-时间图的卷积神经网络(convolutional neu⁃ral network,CNN)模型。方法200名健康青年志愿者分别在30°/s和60°/s角速度下各进行两次、间隔45min的等速向心右侧膝关节全力和半力屈伸往复运动,收集力矩-时间图。200名受试者随机分为训练集(140名)与测试集(60名),用训练集受试者的力矩-时间图训练CNN模型,再用训练好的模型预测测试集内图形的类别。共进行3次随机取样与模型开发。结果在等速膝关节全力及半力运动条件下各收集2400张力矩-时间图。3次训练的CNN模型分类准确率分别为91.11%、90.49%和92.08%,平均准确率为91.23%。结论本研究开发的CNN模型对全力及半力等速力矩-时间图具有较好的区分效果,有助于识别受试者在等速膝关节运动过程中的配合程度。     

膝关节损伤的伤残等级评定与分析

正膝关节是人体关节中最大、构造最复杂的承重关节,功能较多,因此在法医临床学检案实践中相关损伤鉴定的案例也较多。膝关节损伤可导致膝关节的半月板、韧带、骨、关节腔及肌肉等发生损伤~([1])。有关膝关节损伤伤残等级评定的检查方法及伤病关系在法医学实践中较难把握。本文就膝关节损伤的原因、类型、损伤特点、检查方法、伤病关系及注意事项进行分析,为膝关节损伤的伤残等级评定提供参考。1膝关节损伤的原因及类型     

法医参与医疗事故鉴定的现状与对策研究

正《医疗事故处理条例》第二十五条规定,在涉及死因、伤残等级评定两种情况下,法医需参与医疗事故鉴定。法医如何在医疗事故鉴定中发挥作用,本文结合多年参与医疗鉴定工作的实际予以分析。1目前法医参与医疗事故鉴定的现状1.1专业领域特殊,与临床医学交叉面较小法医专业工作是应用医学、生物学等多学科的理论与技术解决法律实践中有关医学的问题,它偏重于     

经颅磁刺激运动诱发电位检测应用进展及法医学意义

经颅磁刺激运动诱发电位（transcranial magnetic stimulation-motor evoked potential,TMS-MEP）检查是评价中枢神经系统功能的一种神经电生理检查方法,其法医学应用价值已逐步得到一些法医学者的关注。本文综述了TMS-MEP的发展概况、原理、优势以及目前在评价中枢神经系统功能和临床治疗方面的研究和应用进展,探讨了TMS-MEP在法医学中的应用价值,尤其是对中枢神经系统损伤者客观肌力评定的意义。     

交通伤致手功能丧失的伤残评定

在交通事故伤残评定中,手功能评定是目前法医界关注的焦点问题之一.现行《道路交通事故受伤人员伤残评定》标准规定的手功能分配比例是由国外手外科专家的理念与我国手外科的实际情况相结合而产生的.在进行手功能评定时,需考虑缺失、运动、感觉等三方面的功能丧失程度,测算相应的功能丧失比例,然后在标准中寻找对应的适用条款.然而,目前我国的手功能评定中也存在一定的问题,包括手指(拇指除外)远侧关节比例大于近侧关节比例,缺乏对于拇指内收、外展、对掌、对指等功能的评价等.手功能评定方法在司法鉴定的实践中尚需不断完善,在吸取国外成功经验的同时,不应一味追求简便而断章取义,忽视了一些重要的问题.     

肢体关节功能计算方法的比较

目的分析比较两种不同的关节功能计算方法．探讨关节功能评定方法的合理性。方法收集福建闽中司法鉴定所2007--2010年道路交通事故致四肢大关节损伤伴有或不伴有周围神经损伤案件806例．分别应用关节运动活动度和《法医临床司法鉴定实务》中的方法（查表法）计算关节功能丧失程度,并根据损伤关节和损伤性质对两种不同方法的评残结果列表比较分析。结果单纯性骨关节损伤642例．两种方法评残结果完全一致。骨关节损伤伴有用圉神经损伤118例,若按直接查表法评定均达到伤残程度,且有33例（28．00％）伤残等级比用关节活动度法评残有不同程度的提高,而且按关节运动活动度法有21例（17．80％）未达到伤残程度。结论应用直接查表法计算关节功能丧失程度比单纯应用关节运动活动度替代关节功能作评残依据更简便、更科学、更合理。     

Fatal poisoning in drug addicts in the Nordic countries in 2007

The frequency of medico-legally examined fatal poisonings in 2007 among drug addicts was investigated in five Nordic countries; Denmark, Finland, Iceland, Norway, and Sweden. The number of deaths, age, sex, place of death, main intoxicant, and other drugs present in blood samples were recorded to obtain national and comparable Nordic data, as well as data to compare with earlier studies in 2002, 1997, and 1991. Norway had the highest incidence of drug addict deaths by poisoning followed by Denmark, with 8.24 and 6.92 per 100,000 inhabitants, respectively. The death rates in Finland (4.02), Iceland (4.56), and Sweden (3.53) were about half that of Norway and Denmark. Compared with earlier studies, the death rates were unchanged in Denmark and Norway, but increased in Finland, Iceland, and Sweden. In all countries, fewer deaths (29-35%) were recorded in the capital area compared with earlier studies. Females accounted for 11-19% of the fatal poisonings. Iceland deviates with a more equal distribution between men and women (40%). Deaths from methadone overdoses increased in all Nordic countries, and methadone was the main intoxicant in Denmark in 2007, accounting for 51% of the poisonings. In Norway and Sweden, heroin/morphine was still the main intoxicant with a frequency of 68% and 48%, respectively. In Iceland, 3 deaths each were due to heroin/morphine and methadone, respectively. Finland differs from other Nordic countries in having a high number of poisonings caused by buprenorphine and very few caused by heroin/morphine. The total number of buprenorphine deaths in Finland doubled from 16 in 2002 to 32 in 2007, where it constituted 25% of deaths. The general toxicological screening program showed widespread multi-drug use in all countries. The median number of drugs per case varied from 3 to 5. The most frequently detected substances were heroin/morphine, methadone, buprenorphine, tramadol, amphetamine, cocaine, tetrahydrocannabinol, benzodiazepines and ethanol.     

2008年中国法治亮点巡礼

2008年，是中国法治进程稳步推进和稳健发展的一年，也是法治亮点频频闪现的一年。2008年的立法景观依然多姿多彩，科学立法、民主立法继续推进，公民对立法工作的有序参与进一步扩大，已出台的十一届全国人大常委会立法规划值得人们期待。此外，实施不久的《政府信息公开条例》、全面开展的监狱体制改革，以及此起彼伏的问责风暴等都是值得我们关注的法治亮点。     

Trends in Non-Muslim Divorces in Singapore

This article examines the trends and patterns in the way thesecular divorce law has been utilized by couples in Singaporeseeking to end their marriage. Social and demographic featuresof the divorcing couples, as well as the ‘fact’relied on in support of their divorce petitions, are studiedand compared to earlier analyses. It is found that while somepatterns observed by earlier researchers have remained intact,others have changed. This article suggests explanations forthese observed patterns and contributes to the discussion onwhether and how the divorce law can be improved in Singaporeand elsewhere.     

Drugs in injured drivers in Denmark

As part of the project Impaired Motorists, Methods of Roadside Testing and Assessment for Licensing (IMMORTAL) under the European Commission's Transport RTD Programme of the 5th Framework Programme [I.M. Bernhoft, Drugs in accidents involved drivers in Denmark, D-R4.3 of the project Impaired Motorists, Methods Of Roadside Testing and Assessment for Licensing (IMMORTAL), www.immortal.or.at, 2005], a study regarding drugs in accident-involved drivers was carried out in Denmark. The main objectives of this study were: (1) to collect and analyse samples from injured drivers for the presence of drugs; (2) to give an indication whether drugs may have contributed to traffic accidents; and (3) to get information on the drug-positive drivers and their drug use. This paper focuses on objective 1. Injured drivers who were treated in hospital were asked to give a saliva sample, a blood sample or both. The samples were screened for the following substances: opiates, amphetamines, methamphetamines, incl. MDMA (ecstasy), cannabinoids and metabolites, cocaine and metabolites and benzodiazepines. Screenings were carried out by means of Cozart Microplate EIA kit. Positive screenings were confirmation analysed by gas chromatography–mass spectrometry (GC–MS) or liquid chromatography/tandem mass spectrometry (LC/MS/MS). In total, 26 out of 330 patients were confirmed positive for one or more of the six drug groups. However, three patients were excluded from the survey for various reasons. Of the remaining 23 drug-positive patients 15 were found positive for one drug group, and in five of these cases alcohol was present in a concentration over the legal limit in Denmark (0.05%). The other eight patients were found positive for two drug groups, and in four of these cases, alcohol was also present in a concentration over the legal limit. Alcohol was found both in combinations with medicinal drugs, with illegal drugs and with both. Based on the saliva or blood concentrations, we estimate that there is a strong suspicion of impairment in 9 out of 23 cases, and in another six cases it was likely that the drivers were impaired.     

Competence in caring in legal practice

This article is concerned with the stories of female solicitors working in Queensland, Australia, and their account of ethics in practice. These narratives were sought and made in the context of our project investigating complaints received against practitioners in this jurisdiction. Our interviews with female lawyers were intended to provide more insight into complaints matters. Yet this discussion revealed broader insights into ethical questions about the nature of lawyer–client relationships and legal professionalism. This article considers these accounts by reflecting on the concept of ‘care’ and its fit with legal practice requirements today. In doing so, we consider the difficult gendered question of the relationship between caring and ‘women's’ practice. We do not assert a true woman's working style; we seek to contextualise our empirical research by tracing the complex effect of gender on lawyering roles. Finally, we suggest that the adoption of caring practice is a valid approach to lawyering and call for a caring approach to be re-valued in the legal professional context as an ethical proposition.     

Differences in female and male involvement in lethal violence in Russia

Relatively little is known of the distributions of homicide event characteristics in non-Western nations in which women relative to men are involved. This article utilizes unique homicide narratives drawn from Russian court and police records to compare homicide victim, offender, and event characteristics by sex of victim and separately by sex of offender. Results from logistic regression show that homicides in which a female was the victim or offender were more likely to occur between intimates and to occur in the home, whereas homicides involving males were more likely to occur in a public place, to be alcohol-related, to involve a firearm, and to involve a victim and offender who did not know each other well. These results not only present an important first glimpse at women as homicide victims and offenders in Russia specifically, but also provide a point of comparison with findings from similar analyses undertaken in the West, and present further initial observations upon which to construct a cohesive theory about female involvement in serious violent events.     

Trustees in Cyprus regulated in 2007

Trust and company service providers in Cyprus are followingin the footsteps of their European counterparts and will toobe regulated at the beginning of 2007.