Fatal Hemorrhage from an Arteriovenous Fistula

In this study, we present two cases of sudden deaths of people with end‐stage kidney with arteriovenous fistulas for long‐term hemodialysis treatment. This procedure is associated with a number of known complications. While stenosis, thrombosis, and infection are well known, lethal hemorrhage from arteriovenous fistula is much less commonly encountered. Inspection of the bodies at the scene of the death by a medical examiner suggested that the deaths were due to exsanguination. Autopsies revealed visible defects on the front wall of the arteriovenous fistulas. Microscopic examination showed wall necrosis with infiltration of various inflammatory cells. Deaths were due to exsanguination from the ulcerated arteriovenous fistulas in patients with chronic renal failure. Further investigation revealed that complications in the area around the arteriovenous fistulas were known and were being treated until a sudden rupture of the vessels and hemorrhage from the arteriovenous fistulas resulted in the deaths.     

Stranger rape: classifying Spanish sexual offences using multiple correspondence and cluster analyses

We have analysed the information in 342 police reports of stranger sexual offences recorded in 2010. We have carried out a multiple correspondence analysis and a cluster analysis using modus operandi variables to identify differential profiles in these types of sexual offences. We have come up with three profiles of stranger sexual offences, which concur in the two techniques used. By analysing the personal variables of the offenders with such profiles, we have found differences in terms of the offender’s country of origin and age. We will discuss the consequences of these results on the police investigation of stranger sexual offences.     

基于经络平衡的电导法经络测量分析方法对慢性肾病的诊断价值研究

目的 基于经络平衡理论,探究电导法经络测量值的分析方法,考察其对慢性肾病的诊断价值。方法 纳入健康人群82例和慢性肾病人群222例,采用电导法测量手足井穴和原穴的电阻值,分别计算原穴阴阳比值、井穴阴阳比值、原穴手足比值、井穴手足比值、原穴左右比值、井穴左右比值,采用接收者工作特征（receiver operating characteristic, ROC）曲线考察两组差异具有统计学意义的比值对慢性肾病的诊断价值。结果 两组人群在井穴阴阳比值、原穴手足比值方面比较,差异具有统计学意义（P<0.05）。ROC曲线显示井穴阴阳比值的曲线下面积（area under curve, AUC）为0.618,95% CI为［0.537,0.699］（P<0.05）,原穴手足比值的AUC为0.727,95% CI为［0.655,0.800］（P<0.01）。井穴阴阳比值的最优切点是1.16,灵敏度为0.64,特异度为0.52,原穴手足比值最优切点是1.04,灵敏度为0.68,特异度为0.72。结论 慢性肾病患者的经络平衡处于阴盛阳衰、上盛下衰状态,基于经络平衡的电导法经络测量分析方法具有较好的临床诊断效能。     

万花油外用结合物理疗法治疗慢性肾衰竭血液透析患者动静脉内瘘血肿48例

目的观察万花油外用结合物理疗法对慢性肾衰竭血液透析患者动静脉内瘘血肿的临床疗效。方法将96例慢性肾衰竭血液透析动静脉内瘘血肿患者随机分为对照组和治疗组,每组各48例。对照组给予冰敷、热敷及红外照射的物理治疗,治疗组在对照组疗法基础上加用万花油,两组均治疗至血肿消失。比较两组患者治疗3d后血肿消退情况、血肿局部疼痛评分情况及治疗结束后随访6个月时的并发症发生情况。结果治疗组血肿消退情况明显优于对照组(P0.05)。两组治疗后内瘘局部血肿疼痛均明显减轻(P0.05),但治疗组治疗后疼痛评分下降程度显著大于对照组(P0.05)。随访6个月后,治疗组患者内瘘血流不足、静脉炎、内瘘狭窄、血栓形成的发生率均明显低于对照组(P0.05)。结论万花油外用结合物理疗法可促进透析患者动静脉内瘘血肿的消退,减轻局部疼痛,减少并发症的发生。     

清肾颗粒合复方α 酮酸治疗慢性肾衰竭湿热证疗效观察

目的 观察清肾颗粒联合复方α-酮酸对非透析期慢性肾衰竭（chronic renal failure,CRF）湿热证患者生活质量的改善作用。方法 将102例非透析期CRF患者随机分为常规组、对照组和治疗组,分别给予基础治疗、基础治疗联合复方α-酮酸、基础治疗联合复方α-酮酸和清肾颗粒,疗程12周,观察治疗前后血清肌酐（serum creatinine,SCr）、清蛋白（albumin,Alb）、肾小球滤过率（glomerular filtration rate,GFR）及主要中医症状变化,并采用肾病生活质量简表1.3版（kidney disease quality of life short form,version 1.3,KDQOL-SF TM1.3）评价治疗前后患者的生活质量。结果 治疗组在升高Alb方面显著优于常规组（P<0.01）,在降低中医证候积分方面显著优于常规组和对照组（P<0.01）,治疗组在升高KDQOL-SF TM1.3量表各维度评分及其总分方面显著优于常规组（P<0.05,或P<0.01）,对照组仅在升高SF 36（KDQOL-SF TM1.3量表维度）评分方面显著优于常规组（P<0.05）。多元逐步回归分析发现年龄、GFR、中医证候积分和Alb对生活质量的影响较大。结论 清肾颗粒联合复方α-酮酸在延缓肾衰竭进展的同时,对CRF湿热证患者生活质量具有较好改善作用。     

慢性心衰中西医结合生存质量量表与SF-36量表的效度对比研究

目的 简明健康状况量表（以下简称SF 36量表）为标准参照,评价慢性心衰中西医结合生存质量量表的效度。方法 采用横断面调查方法,在北京市5家医院内纳入63名慢性心力衰竭住院患者,在患者知情同意基础上采用慢性心衰中西医结合生存质量量表、SF-36量表调查其生存质量,对慢性心衰中西医结合生存质量量表的效度进行评价。结果 相关系数法、逐步回归分析证实慢性心衰中西医结合生存质量量表具有较好的内容效度,因子分析显示其具有良好的结构效度,以SF-36量表作为标准参照显示其具有良好的标准效度（r=0.79,P＜0.01）。结论 慢性心衰中西医结合生存质量量表具有较好的效度,可以作为心衰中西医结合生存质量的评价工具。     

罗红霉素对过敏性哮喘慢性气道炎症的作用研究

探讨罗红霉素对哮喘慢性气道炎症的作用。用罗红霉素对哮喘慢性气道炎症进行干预,结果发现罗红霉素治疗组炎细胞浸润明显减轻（P〈0．05）。认为罗红霉素对哮喘慢性气道炎症有一定治疗作用,其机理可能与抑制气道中的炎症细胞浸润有关。     

Deliberate ingestion of foreign bodies as a form of self-harm among inpatients within forensic mental health and intellectual disability services

Deliberate foreign body ingestion is a significant issue in prison and psychiatric settings. It is associated with serious physical complications, including bowel obstruction, perforation and haemorrhage. Episodes of deliberate foreign body ingestion were identified retrospectively from 5417 incident records from two inpatient forensic services (one mental health and one intellectual disability) over a one year timeframe, using related search terms. Rates were compared according to gender, diagnosis and level of security. Incidents of deliberate foreign body ingestion were found to occur on average every 2.7 days across the study population, with 133 incidents recorded over a one year period, accounted for by 27 patients. Women and patients in lower levels of security were significantly more likely to engage in deliberate foreign body ingestion. Staff responses to this behaviour were highly variable. Deliberate foreign body ingestion occurs frequently within inpatient forensic services, and can have significantly detrimental physical implications for affected patients. Further research should investigate the psychiatric and intellectual disability profile of such individuals in further detail, as well as exploring patient narratives; both of which will help inform development of treatment strategies.