外伤性癫痫及其法医学评定进展

外伤性癫痫(post traumatic epilepsy,PTE)是指颅脑损伤后的癫痫性发作,影像学检查可见器质性病变,脑电图检查可见异常脑电波与颅脑损伤部位一致。外伤后癫痫发生率低,案例报道较少,患者易夸大病情,给法医学鉴定增加难度。本文就外伤性癫痫流行病学、发病机制、临床治疗、法医学鉴定等方面的现状进行综述。     

Vicarious Trauma in Child Welfare Workers: A Study of Organizational Responses

Child welfare is provided within an organizational context that both supports and thwarts the efforts of workers and administrators to meet the myriad of goals established by federal, state, and local regulation and professional bodies. As the field moves toward trauma-informed services for children and families (Ko et al., 2008 Ko, S. J., Ford, J. D., Kassam-Adams, N., Berkowitz, S. J., Wilson, C., Wong, M., Brymer, M. J., &; Layne, C. M. (2008). Creating trauma-informed systems: Child welfare, education, first responders, healthcare, juvenile justice. Professional Psychology: Research and Practice, 39(4), 396–404.[Crossref], [Web of Science ®] , [Google Scholar]), the effect of trauma on workers has received less agency attention (Middleton &; Potter, 2015 Middleton, J. S., &; Potter, C. C. (2015). Relationship between vicarious traumatization and turnover among child welfare professionals. Journal of Public Child Welfare, 9(2), 195–216.[Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]). This exploratory, qualitative study examines the level of knowledge administrators have regarding vicarious trauma and probes the organizational responses of public child welfare agencies to the vicarious trauma experienced by workers.     

当代文学女性创伤叙事的三个维度

女性创伤叙事具有独特而重要的价值。作为文化记忆的创伤、作为认同困境的创伤和作为个体体验的创伤是当代女性创伤叙事的基本图景。那些具有大事件性质的“缠绕式”的创伤是历史的骨架和关节;历史演进中各种新的创伤是具有时代症候的特质呈现;历史和时代之外的个人创伤构成历史骨架之外的血肉和脉络。当代文学的女性创伤叙事呈现出三个可能的维度,从女性创伤出发,又超脱出性别的界限,将女性创伤叙事的视野和层次提升到两性、国民甚至人类的高度,形成一种现实主义的人文情怀,显现出更为广阔的形态。     

Cardiac Ventricular Laceration Due to Child Abuse: Abusive Ventricular Laceration

Traumatic cardiac ventricular ruptures in children are rare. Only a single case of left ventricular rupture due to child abuse has been reported. We report a child who sustained a fatal left ventricular apical rupture. It appeared to have resulted from hydrostatic forces resulting from abusive blunt thoracic injury. That he was being abused was previously missed when he was presented to the emergency department with facial pyoderma. It was not noted that he also had lip and oral mucosal injury, sites not affected by staph toxins. As a result, his underlying, abusive and secondarily infected, facial flow type scald burn was not appreciated. Within a week thereafter his fatal injury occurred, accompanied by extensive and obvious associated abusive injuries. Postmortem high‐detail whole body computed tomography scanning aided the autopsy. Although rare, ventricular rupture from abusive blunt thoracic injury can occur.     

An Anthropological Examination of the Types of Skeletal Fractures Resulting from Fatal High (˃3 m) Free Falls,

Fatal falls from heights (?3 m) often result in blunt force trauma (BFT) to the skeleton. The fracture patterns that result from this BFT mechanism are well understood in forensic anthropology and forensic pathology; however, details of the specific types of fractures that result remain poorly documented. The aim of this study was to provide a detailed examination of the types of fractures that may result from fatal high falls. Fractures were recorded from 95 full‐body postmortem computed tomography scans of individuals known to have died from a high fall. Trauma was then analyzed taking into account the extrinsic and intrinsic variables known to influence a fall using multiple logistic regression. A total of 339 types of fractures were classified, of which 16 were significantly associated with this BFT mechanism. Classified fracture types will augment anthropological interpretations of the circumstances of death from BFT in cases of suspected high falls.     

Fatal acute intracranial injury, subdural hematoma, and retinal hemorrhages caused by stairway fall

We describe an infant with an acute subdural hematoma, a fatal head injury, and severe hemorrhagic retinopathy caused by a stairway fall. His cerebral and ocular findings are considered diagnostic of abusive head trauma by many authors. Our literature search of serious injuries or fatalities from stairway or low-height falls involving young children yielded 19 articles of primary data. These articles are discrepant, making the classification of a young child's death following a reported short fall problematic. This case report contradicts the prevalent belief of many physicians dealing with suspected child abuse that low-height falls by young children are without exception benign occurrences and cannot cause fatal intracranial injuries and severe retinal hemorrhages. The irreparable harm to a caregiver facing an erroneous allegation of child abuse requires physicians to thoroughly investigate and correctly classify pediatric accidental head injuries.     

重伤家兔体内Cu及代谢酶变化与MOF及死亡关系

目的探讨兔重伤后机体内铜（Cu）含量及其代谢酶铜锌超氧化物歧化酶（Cu/Zn-SOD）、细胞色素c氧化酶（CCO）活性变化与继发性多器官衰竭（MOF）及死亡的关系。方法参照国际通用的创伤程度量化评分标准（ISS）,建立致MOF的家兔重伤模型,检测伤后不同时段血清及组织Cu含量与Cu/Zn-SOD和CCO的活性,分析其变化规律与继发MOF及死亡的关系。结果①重伤组家兔（包括死亡组家兔）血清Cu含量在伤后12h显著下降,36h后逐步回复;脑、心、肺组织中Cu含量伤后下降,肝脏组织Cu含量于伤后12h显著升高,36h后回落。伤后死亡组家兔脑、心、肺、肝Cu含量均较对照组降低,其中脑、肝组织Cu含量下降显著。②重伤组家兔血清Cu/Zn-SOD活性伤后12h下降3,6h之后呈升高的趋势,肝脏组织中的Cu/Zn-SOD活性伤后持续显著升高。③重伤后家兔（包括死亡组家兔）大脑皮质、心、肝CCO活性变化不明显,但脑干组织CCO活性显著升高。伤后死亡组家兔脑、心、肺、肝等器官的大体及组织学呈MOF改变。结论严重创伤可引发兔血清和组织Cu水平及Cu/Zn-SOD、CCO活性变化,这些变化可能与继发多器官衰竭和死亡相关。     

Taphonomic changes to blunt force trauma: a preliminary study

This study examines the effects of taphonomic processes on blunt force trauma (BFT) through an experimental study involving pig heads. Of particular concern is the possibility that taphonomic changes can create pseudo-trauma and/or conceal evidence of actual trauma. BFT was inflicted on 10 pig skulls using a hammer. The skulls were subsequently exposed to the environment for 12 months. Seven taphonomic changes were evaluated: the freeze-thaw cycle; rodent gnawing; carnivore scavenging; presence/weight of soil; presence/weight of rain and snow; movement/displacement of bones; and discoloration due to sun bleaching and grass staining. Taphonomic effects varied between cancellous, compact, fresh, and degreased bone. Freezing and thawing, exposure to rain and snow, movement of the skulls, and soil erosion altered and, in some cases disguised, pre-existing trauma. Rodent and carnivore activity did not obliterate evidence of BFT. Recommendations for evaluating BFT on remains affected by taphonomic processes are presented. As each taphonomic process outlined by this study has the potential to disguise antemortem injury, the authors propose that one must carefully examine large, circular openings in the skull that may represent the remnant evidence of BFT.     

The characteristics of head wounds inflicted by "humane killer" (captive-bolt gun)--a 15-year study

The "humane killer" or captive-bolt gun, is the tool/weapon widely used in meat industry and private farmer households for slaughtering animal stock. Out of 17,250 autopsies performed at the Institute of Forensic Medicine in Novi Sad during the 15-year period (1991-2005), 29 cases of suicides and two homicides were committed by captive-bolt pistols. Wounds inflicted by captive-bolt guns have specific morphological features, distinctive from wounds made by other kinds of hand firearms. Selected features of the captive-bolt wounds (punched round entrance and a double pattern of smoke soiling) depend on distance and angle of instrument at the time of firing. Autopsy findings were compared with an experimental model consisting of 20 domestic pigs. Obtained results confirmed that the appearance of the entrance hole and soot deposits, along with differences in shape, location, extent, and density of soot blackening, could be useful in identification of weapon, direction of discharge, shooting distance, and angle of the muzzle to the frontal and sagittal planes of the head at the moment of fire.     

Cardiac Injuries Caused by Blunt Trauma: An Autopsy Based Assessment of the Injury Pattern

Abstract:  Nonpenetrating chest trauma with injury to the heart and aorta has become increasingly common, particularly as a result of rapid deceleration in high-speed vehicular accidents, over the past 2–3 decades. The high mortality rate of cardiac injuries and possible late onset complications make blunt cardiac injuries an important challenging point for legal medicine. One hundred and ninety cases with blunt cardiac injuries in a period of 3 years were analyzed retrospectively in terms of patterns of cardiac injury, survival times, and demographic profiles of the cases in this study.