2型糖尿病合并原发性高血压证型分析

目的 观察2型糖尿病合并原发性高血压患者的中医证候分布和演变规律。方法 共收集318例2型糖尿病合并原发性高血压患者的病历资料,对患者的证型进行分析,并按病程分层对证候演变规律进行分析。结果 318例患者中,单纯虚证68例,占21.4%;单纯实证27例,占8.5%;虚实夹杂证223例,占70.1%。病程0～2年者可见以痰(湿)热互结为主的实证,病程2年以上者气阴两虚证最为多见,病程10年以上者多见脾肾阳虚证、阴阳两虚证。随着病程延长,血瘀证逐渐增多。结论 随着病程进展,2型糖尿病合并高血压的证型由热盛津伤、痰热互结逐渐向肝肾阴虚、气阴两虚、脾肾阳虚、阴阳两虚证转化,血瘀证、痰浊证是贯穿于整个病程的常见兼夹证。     

Fatal capnocytophaga infection associated with splenectomy

A case of fatal sepsis due to Capnocytophaga species is described. Capnatophaga canimorsus and C. cynodegmi can cause localized wound infections and/or systemic infections in people who have been bitten, licked, scratched, or merely exposed to cats or dogs, especially splenectomized individuals. A thorough social, medical, and surgical history, the clinical presentation, and cultures are important in making the diagnosis of Capnocytophaga infections. It is important that the forensic pathologist be aware of this zoonotic disease.     

故意传播严重性病行为定性之探究——兼论现行《刑法》第360条第1款的立法完善

从实然的角度来看,现行<刑法>第360条第1款的"严重性病"的范围应包括艾滋病;对于不具有卖淫、嫖娼性质以外的性行为或其他方式传播性病的行为应在现行法律框架下适用相关条款予以定罪量刑.从应然的角度出发,有必要对现行<刑法>第360条第1款予以完善,以为惩治司法实践中发生的形形色色的故意传播严重性病行为提供法律依据,进而促进司法的统一和公正.     

Mothers on Trial: Discourses of Cot Death and Munchausen’s Syndrome by Proxy

This article explores some of the issues raised by Munchausens Syndrome by Proxy (MSbP) and the relationship between medicine and law, specifically the discourses which feature in the courtroom portraying motherhood and expectations of parenting. These discourses are often hidden yet play a determining role in prosecutions for alleged maltreatment of children involving medically unexplained infant death syndrome. We offer a critique of MSbP and seek to unveil the assumptions about mothers, the parent predominantly affected by the diagnosis, and mothering that underlie the association of women accused of deliberating harming their children. We suggest such insights are valuable because although the syndrome has never acquired a clear medical or legal definition, it has had repeated appearances in the literature and courtroom over the last 25 years and has more recently attracted attention from government, health care practitioners, academics and the media. We explore these issues through an examination of two recent Court of Appeal decisions in England: those of Sally Clark and Angela Cannings.     

美国刑法中受虐妇女与自身防卫问题之研究

自身防卫就是自然人在遇到不法侵害时,有权运用适度的暴力加以防范,但在司法实践的具体操作中仍然很复杂。受虐妇女与自身防卫是美国刑法中颇受重视的一个问题。鉴于受虐妇女的特殊性,美国法庭对“合理性的标准”与“紧迫性的要求”做出了适当的调整。     

新冠肺炎尸检:法医工作者面临的挑战与对策

新型冠状病毒肺炎(简称"新冠肺炎")病例于2019年12月出现,疫情在短时间内蔓延,已导致数千名患者死亡。目前我们对新冠肺炎的致病、转归、致死的病理学机制了解甚少,尽早开展新冠肺炎死亡病例的尸体检验尤为重要,这给法医工作者带来了挑战。新冠肺炎尸检应在可以维持负压的独立解剖室进行,检验人员应严格按照三级防护标准穿戴防护用具,注重环境、器械、耗材的消毒以及废液废弃物处理。解剖及检验过程应规范、谨慎,尽量减少切割操作,并避免体液流出或组织飞溅导致病毒传播。本文将就法医工作者面临新冠肺炎尸检的挑战与对策做一述评。     

缺失信号肽和跨膜区的PRRSV GP5融合蛋白基因的表达

通过分析猪繁殖与呼吸综合征病毒(PRRSV)HH08株GP5基因序列,设计了2对引物,经PCR扩增,获得不含信号肽和跨膜功能区的GP5基因片段,长度分别为121 bp和248 bp。应用酶切位点相连构建融合基因技术,将2段基因亚克隆到原核表达载体pET-30a(+)中,获得重组表达质粒pET-GP5。将重组质粒转入大肠杆菌,经IPTG诱导后获得高效表达。免疫印迹试验证实,表达的融合蛋白能与特异性血清抗体反应,表明表达的PRRSV GP5蛋白具有良好的生物学活性。     

断奶仔猪多系统衰竭综合征淋巴结与脾损伤的病理学观察

对通过临床特征与PCR确诊为断奶仔猪多系统衰竭综合征的8例自然病例进行剖检取材,常规石蜡切片与超薄切片,HE染色及醋酸铀一柠檬酸铅染色,观察了淋巴结与脾的病理学变化.肉眼观察可见淋巴结肿大,特别是腹股沟淋巴结、肠系膜淋巴结与肺门淋巴结明显肿大;脾萎缩或中度肿大.组织学观察显示,淋巴结与脾淋巴细胞坏死,数量明显减少,网状内皮细胞增生与巨噬细胞浸润,在一些网状内皮细胞与巨噬细胞的胞浆内见嗜碱性包涵体.超微结构观察显示,淋巴结与脾淋巴细胞线粒体肿胀,内质网扩张,核浓缩,边集,甚至形成凋亡小体;在巨噬细胞与网状内皮细胞核和胞浆内均可见包涵体,包涵体为大小不等,圆形、椭圆形或不规则形的均质或颗粒状2种类型,胞浆包涵体常见于肿胀的线粒体与扩张的内质网附近.表明断奶仔猪患多系统衰竭综合征可致淋巴结与脾淋巴细胞坏死、凋亡,淋巴细胞数量减少.     

原发性高血压早期肾损害中医证候学观察

目的:观察原发性高血压早期肾损害的中医证候学特点和规律。方法:对120例原发性高血压早期肾损害患者进行中医证候学分析,并以60例无肾损害的原发性高血压患者作为对照,统计分析不同中医证候积分。结果:原发性高血压早期肾损害患者以肝、肾证候及阴虚、气虚、血瘀证候积分最高,明显高于无肾损害的原发性高血压患者(P<0.01)。结论:原发性高血压早期肾损害的主要病机为肝肾阴虚兼气虚血瘀。     

Intravenous Drug Use and HIV in Estonia: Socio-Economic Integration and Development of Indicators Regarding the Right to Health for its Russian-Speaking Population

This article seeks to highlight some potential indicators and benchmarks for the right to health under the International Covenant on Economic, Social and Cultural Rights, ratified by Estonia. These potential key indicators, as part of a human rights based approach to health indicators being developed by the UN Special Rapporteur, are argued to be particularly important in the context of the exceptionally high HIV rates among the Russian speaking population in Estonia. The historical emergence of the HIV epidemic in Estonia is traced, comparing its development with the situations in Latvia and Lithuania. This article describes the current extent of the HIV epidemic in Estonia which is the country with the highest reported number of HIV infections per capita in Europe, a number impacting in an extremely disproportionate fashion on its Russian-speaking population, particularly in North-Eastern Estonia. Understanding of the HIV epidemic in Estonia cannot exclude the social contextual factors of the social marginalization of many among the Russian-speaking population, the ‹alien’ status of those without citizenship of Estonia or any other State, and other failures of Estonian State policy with regard to intravenous drug use and HIV in the recent past. HIV among the prison population is also examined as disproportionately impacting upon Russian-speaking prisoners. It is argued that the language and logic of the Estonian State Integration Programme, as well as Estonia’s Second Report on the implementation of the Council of Europe Framework Convention for the Protection of National Minorities (2004) which refer to its Russian-speaking citizens as ‹non-Estonians’ is discrimination based on ethnic origin. In order to develop a system of State accountability in relation to the right to health, candidate indicators and benchmarks are proposed as structural, process and outcome indicators relevant to Estonia regarding the right to health and HIV, intravenous drug use, socio-economic integration and its Russian-speaking population. Dr. Paul Downes is Director of the Educational Disadvantage Centre, St. Patrick’s College, Drumcondra, Dublin, Ireland.