Particularities Regarding the Etiology of Sepsis in Forensic Services

If in clinical practice definitive diagnostic criteria had been established, after death sepsis is often difficult to diagnose, especially if a site of origin is not found or if no clinical data are available. This article will analyze the etiology of sepsis in a medical‐legal service with emphasis on the differences in diagnosing it in clinical and forensic environments. A total of 78 cases of sepsis cases diagnosed or confirmed at the autopsy were selected. The etiological agent was determined either during the hospitalization or by postmortem bacteriology. A high prevalence of Gram‐negative sepsis was found, especially multidrug‐resistant micro‐organisms. Most frequent etiological agents were Acinetobacter baumannii, Escherichia coli, Enterobacter, Enterococcus, Pseudomonas, and Klebsiella. Polymicrobial sepsis is much more frequent than in nonforensic cases. In legal medicine, the prevalence of Gram‐negative sepsis is much higher than in nonforensic autopsies, and the point of origin is shifted toward the skin and the gastrointestinal system.     

多焦视诱发电位在法医学客观视野检查中的应用价值

视野是视功能评定的重要指标,其客观评定是法医学鉴定的难点问题。传统视诱发电位(VEP)虽能反映视觉通路整体功能状态,但不能定位、对局灶病变不敏感,应用于客观评定视野受到一定限制。多焦VEP(mfVEP)采用多焦刺激技术,同时间分别刺激视网膜各个不同区域,并将对应部位的局部VEP提取,使客观地定量、定位检测视野成为可能。大量文献显示:mfVEP因与视野检查存在良好相关性、客观性及可重复性,成为了一项在客观视野检查方面极具应用前景的新技术。本文对mfVEP在客观视野检查中的相关研究及其法医学应用、影响因素等方面进行综述,以期为法医学的客观视野评定提供参考。     

Reliability Study on Quantitative Detection of Extensor Digitorum Brevis Strength with Needle Electromyography and Nerve Conduction

Objective To study the objectivity and reliability of needle electromyography and nerve con- duction for detection of musculus extensor digitorum brevis strength, which may provide a basis for es- tablishing a quantitative detection of muscle strength in forensic clinical study. Methods Forty-four healthy people were enrolled as the subjects, and during toe dorsiflexion, the following items including needle electromyography indexes, motor unit potential （MUP） amplitude, MUP count, recruitment reaction type, and nerve conduction detection indexes, compound muscle action potential （CMAP） amplitude, CMAP latent period and motor nerve conduction velocity （MNCV）, were simultaneously detected under the co- operation and disguise condition. Results Under the cooperation condition, regardless of the same opera- tor or different operators, there were good test-retest reliabilities in MUP amplitude, CMAP amplitude, CMAP latent period and MNCV, while there were normal test-retest reliabilities in MUP count and re- cruitment reaction type and the repeatability of the same operator was slightly better than the repeatabili- ty between different operators. Under the disguise condition, test-retest reliabilities of MUP amplitude, CMAP amplitude, CMAP latent period and M-NCV were relatively high, while test-retest reliabilities of MUP count and recruitment reaction type were relatively low. Conclusion There are good test-retest reli- abilities in MUP amplitude, CMAP amplitude, CMAP latent period and M-NCV, which can be conducive to comparison between different operators and results at various times; MUP count and recruitment reac- tion type, which can be easily affected by subjectivity of operators and examinees, can be used to dif- ferentiate whether an examinee disguises or not. The indexes used to objectively judge muscle strength remain to be further investigated.     

网络环境下的法医学循证

法医学是当前司法鉴定中的重要组成部分,其研究内容广泛,具有高度的专业性。随着网络技术的发展、信息资源的增加以及人们法律意识的增强,法医学必然会面临许多新问题,对诉讼证据的要求标准也越来越高。鉴于此,在法医学领域应建立起循证的理念,通过循证的方式在法医学以及相关领域内寻求最合适的解决法医学实务中具体问题的证据,循证不但能够及时解决法医学领域的现行问题,其对于法医学的进步与发展也将具有重大的推动作用。本文综述了循证的基本理论及其在法医学领域的作用,以及循证的途径、方法、证据的评价,并探讨网络环境下法医学循证的应用价值。     

SCIENCE,MEDICINE, AND CONFUCIANISM IN THE MAKING OF CHINA AND SOUTHEAST ASIA — LIM BOON KENG AND THE OVERSEAS CHINESE, 1897–1937

Abstract

Historians have argued for the importance of Japan and the United States in shaping the trajectory of science and medicine in Republican China, especially in the regions of North China. This article argues that another understated group of individuals—Overseas Chinese—were influential in leading institutions of Western medicine in China, as well as sharing the latest science knowledge they acquired in the West to audiences in China and Southeast Asia. An example was Lim Boon Keng, a doctor born in Singapore and educated at Edinburgh, who came to lead the first department of health in the Republican government as well as Xiamen University in pre-war China. Chinese reformers as Sun Yat-sen, Tan Kah Kee, Liang Qichao, and Kang Youwei were attracted by Lim’s medical expertise as well as his active participation in the reform movement in Southeast Asia, and invited Lim to participate in the development of medicine and politics in China proper. In addition, Lim’s unique blending of a historical view of Chinese Science and reformist notions of Confucianism help legitimate his participation as a credible Chinese intellectual. Together with other Overseas Chinese such as Wu Lien-teh and Robert Lim, they were influential in leading institutions of medicine across the country in Manchuria, Beijing, Kunming, and Xiamen in the first half of the twentieth century. Lim Boon Keng, in particular, promoted programs in science and medicine as well as the study of Confucianism during his tenure as the President of Xiamen University from 1924 to 1936. However, May Fourth intellectuals such as Lu Xun criticized Lim Boon Keng’s programs as conservative, authoritarian, and anti-humanities. Even though Lu Xun and other intellectuals soon eventually left Xiamen because of their disagreements with Lim, the university became a leader in the instruction of science and engineering. In sum, this article argues that the medical history of twentieth-century China should include the narrative on the Overseas Chinese bringing scientific knowledge and individuals to China, supplementing the Western ideas, people, and resources that came to China via Japan.     

1 003例中医体质类型流行病学调查分析

目的:初步了解安徽省自然人群的中医体质类型分布状况。方法:采用标准化的9种中医体质量表对1 003例自然人群实施横断面现状调查。结果:平和质561例,单纯偏颇体质247例,兼夹偏颇体质195例。8种偏颇体质总的分布状况是,气虚质最多(235例,单纯气虚质与兼夹体质中气虚质例数之和,下同),其次为湿热质(128例)、气郁质(122例)、痰湿质(80例);阳虚质(71例)、阴虚质(52例)和瘀血质(42例)最少,阴虚质与瘀血质主要出现在兼夹体质中。结论:9种体质在人群中的分布存在一定的差异性,兼夹体质在人群中占有一定的比例。     

视神经损伤的电视野检查及其与LED-VEP相关性

目的研究视神经损伤的电视野检查特点及其与LED-VEP相关性分析,探讨法医学鉴定相关问题。方法 以健眼为正常对照,行双眼电视野检查及LED-VEP检查。结果 64例视神经损伤眼均表现为不同程度的视野改变,其中31例为视神经完全损伤,其视野表现为完全缺损(即黑朦),LED-VEP均无波型诱出;余33例为不完全视神经损伤,视野表现为不规则型缺损,LED-VEP表现为切迹波或P1波潜伏期延长、波幅减低;64例健眼,视野正常,LED-VEP均正常。分析视野与LED-VEP结果两者的相关性,r=0.933(P<0.01,n=64)。结论视神经损伤时应重视视野检查,电视野检查本身有一定的客观性提示,视野缺损程度与LED-VEP异常程度有较为良好的相关性。     

试论中医师的告知义务及违反告知义务的责任

由于具有独特治疗方法,中医在医疗过程中对患者知情权的保护也颇具特色,因此,中医师对患者负有的告知义务具有特殊性。中医师不履行告知义务,则应当承担侵权民事责任。由于中医师治疗行为的特点,其承担的侵权责任形态为替代责任,应当按照医疗事故损害赔偿的一般规则确定其赔偿责任。     

127例蛛网膜下腔出血案例的法医学研究

目的探讨蛛网膜下腔出血(SAH)对保险公司的直接请求权,从而缓解了患者在请求赔偿方面的特点及法医学鉴定要点。方法通过对华西医科大学法医鉴定中心1983-2001年尸检检出的127例各种原因所致的SAH案例进行回顾性分析。结果各类SAH案例,男性明显多于女性,男女性别比为3:1,高峰年龄为21~40岁。按SAH常见特征可分为外伤性、脑血管畸形、动脉瘤、脑血管粥样硬化、中毒、伴发于心脏疾患、其他等八类。其中,外伤性与脑血管畸形最为多见。外伤性SAH与脑血管畸形出血可见于任何年龄,多见于11~50岁,脑血管粥样硬化出血仅见于50岁以上者,动脉瘤破裂出血者并不多见,见于11~50岁。以SAH为死亡原因者,32例,占25%,多见于脑血管畸形与动脉瘤破裂,出血部位多见于脑底及小脑天幕以下。大多数SAH,出血部位多见于大脑表面,较为局限,出血量较少,非死亡的主要原因。结论多数SAH并非导致死亡的主要原因,SAH死亡者,其死亡性质多属自然死亡。     

医疗事故的责任程度--法医鉴定30例分析

目的研究医疗事故鉴定中责任程度的判定.方法通过对30例医疗纠纷案件鉴定资料的回顾性研究和统计分析,分析医疗过失、疾病对不良后果的参与度,确定责任程度大小.结论在医疗事故鉴定过程中,需要特别注意疾病因素对不良后果的影响,这对判定责任程度很重要.