精神病患者性受害的司法精神医学鉴定分析

目的探讨精神病患者性受害的特点和性自我防卫能力。方法回顾性分析185例不同精神疾病患者性受害司法精神医学鉴定资料,探讨不同精神疾病性受害特点和性自我防卫能力的判定原则。结果性受害被害人鉴足占司法精神医学鉴定总数11．71％;所鉴定精神病患者性受害中以精神发育迟滞居首位（54．59％）,其余依次为精神分裂症（34．05％）,情感性精神障碍（6．49％）和其他精神障碍（4．86％）。其性受害的特点和性自我防卫能力因病种不同而各有差异。结论判定性受害者是否有性自我防卫能力最关键的问题是判定被害女性对两性行为的意义、性质及后果是否缺乏辨认能力或丧失控制能力。     

SonoNT半自动测量软件测量胎儿颈项透明层的初步研究

目的评价SonoNT半自动测量与手动测量两种方法测量胎儿颈项透明层（NT）的一致性及不同超声工作者的组内、组间差异。方法2011年2月至4月期间在本院行早孕期超声筛查的正常胎儿58例为研究对象,经腹超声显示每例胎儿的NT测量标准切面后储存图像,由一位高年资医生分别使用Sono NT半自动测量与手动测量所有胎儿的NT各1次,分析两种测量方法的一致性。按随机数字表法抽取30例胎儿超声图像,由不同年资的两位医生分别使用两种方法测量胎儿NT各2次,分析其组内和组间差异。结果高年资医生手动测量58例胎儿NT均值为（1．40_＋0．39）mm,SonoNT~lJ量NT均值为（1．44=t：0．42）mm,两种测量方法的组间相关系数（Icc）为0．928（P=0．000）,两种测量方法测量值的差值为（0．042＋0．160）mm,95％一致性范围为一0．278～0．362mm。随机抽取30例胎儿超声图像,高年资医生的使用SonoNT测量、手动测量NT各2次,其ICC分别为0．997（P=0．000）、0．965（P=0．000）;而低年资医生的ICC分别为0．993（P=0．000）、0．889（P=0．000）。两位医生使用SonoNT软件测量NT的ICC为0．963（P=0．000）,手动测量的ICC为0．970（P=0．000）。结论SonoNT的NT测量值较手动测量值偏大,但两者的相关性良好。SonoNT可有效改善检查者,尤其是低年资医生的NT测量值的组间和组内差异。     

183 例司法精神病学重复鉴定分析

１８３例司法精神病学重复鉴定分析北京医科大学第六医院孙玉国李从培方明昭唐宏宇林弛＊马长锁胡纪念在国内外司法精神病学鉴定实践中重复多次鉴定案例并非少见，据国内、外报道约占鉴定案例总数的１０－３０％［３，４］。重复鉴定是一个对历次鉴定的诊断和法律能力判定...     

综合医院神经症再诊断

本文通过对综合医院诊断为神经症的病例，按ＣＣＭＤ－Ⅱ－Ｒ再诊断发现，从２００例神经症筛选出３１例（１５．５％）抑郁症，１４例（７％）单纯性失眠，误诊率为２２．５％；非精神科医生对神经症的认识与精神科医生基本一致，但对神经症的分类诊断则缺乏相互之间及与相关疾病之间的鉴别诊断知识，提示急需加强非精神医生的神经症知识的更新。     

食道癌患者心脏图谱指导下心脏勾画的一致性研究

目的：评价采用心脏勾画图谱对研究者进行统一学习前后,研究者之间全心勾画的变异度、一致性和稳定性。方法：在全盲模式下,由5名具有5年以上临床经验的放疗科医生对,10名拟行放疗的食道癌患者的心脏在增强定位CT横断面上进行勾画,比较学习前后医生勾画心脏的体积大小及稳定性。结果：学习前全组研究者的协方差（COY）、一致性指数（CI）、公共部分体积百分比分别为4．52％±1．73％、72．9％±4．62％和86．6％±3．35％;学习后分别为2．60％＋0．92％、79．6％±3．66％和90．3％±3．48％。学习前全组研究者的体积变异百分度及最大体积与最小体积比（Vmax/Vmin）分别为10．3％±3．3％和1．11±0．04;学习后分别为6．3％±2．3％和1．07％＋0．02％。所有各项指标与学习前相比,均有显著性差异（P〈0．01）。结论：这种由Michigan大学提出的心脏图谱是一种临床非常有用的指南,能够明显降低临床放疗科医生食道癌患者勾画心脏的差异。     

经颅三维多普勒技术评估脑震荡诊断与治愈标准

目的 探讨脑震荡经颅三维多普勒（3D－TCD）不同时期特点、参数，为诊断和判定治愈标准的评估提供一种无创的检查方法；方法 135例脑震荡患分别于24小时内、3－7天、治疗终结采用3D－TCD检测大脑中动脉（MCA）、基底动脉（BA）、脑血流平均峰流速度（vm)参数、频谱形态、特点，并与临床诊断和治愈标准进行比较分析；结果 符合诊断101例，基本符合（临界值）12例，不符合22例（占16．2％）；临床判定治愈96例（71．1％），好转39例（28．9％），而3D－TCD判定符合治愈118例（87．4％）；结论 3D－TCD技术作为脑震荡诊断依据和治愈标准之一是可行的，也是评估判定预后客观的检测新技术。     

婴儿和学前幼儿诊断性评估中文版注意缺陷多动障碍模块的效度和信度

目的:引进婴儿和学前幼儿诊断性评估(DIPA),评价其中注意缺陷多动障碍(ADHD)诊断模块的效度和信度。方法:经原作者同意后,将DIPA翻译为中文版。根据以注意力不集中或多动为主诉的244例疑似ADHD学龄前儿童及医院周边社区幼儿园招募的90例正常学龄前儿童,以精神科临床医生根据精神障碍诊断与统计手册的ADHD诊断标准进行的临床诊断为金标准,评价DIPA诊断学龄前ADHD的效度。4名评定者分别独立对被试进行DIPA诊断,考察评定者间一致性。其中39例被试在DIPA访谈后14d,再次接受DIPA访谈,考察重测信度。结果:以临床诊断为金标准,对DIPA进行效度检验显示,诊断一致性的kappa值为0.81,诊断学龄前注意缺陷多动障碍的灵敏度为89%,特异度为96%。DI-PA的评定者间一致性kappa值为0.79,重测信度为0.89。结论:婴儿和学前幼儿诊断性评估中文版的ADHD诊断模块具有较高的效度和信度,可用于临床学龄前ADHD的诊断。     

三维盆底超声在妊娠、阴道分娩盆底功能评估中的应用价值研究

目的:探究三维盆底超声在妊娠、阴道分娩盆底功能评估中的应用价值.方法:选取2021年1月至2021年6月在我院行三维盆底超声检查60例妊娠晚期孕妇和60例阴道分娩后42天产妇进行前瞻性研究.由甲、乙两名超声医生随机进行三维盆底超声检查,记录膀胱颈移动度(BND)、尿道旋转角度(?α)、Valsalva状态下尿道倾斜角(UTA)以及Valsalva动作状态下肛提肌最小裂孔的面积(LA)以及静息和Valsalva状态下差值(?LA).采用组内相关系数(ICC)评估不同超声医生之间测量结果的一致性,采用Kappa一致性检验分析经会阴超声成像与综合诊断结果的一致性.结果:妊娠、阴道分娩女性中BND、?α、UTA、LA、?LA的测量值,甲、乙超声医生相比,差异无统计学意义(P>0.05),一致性较好(ICC均>0.800,P=0.000).三维盆底超声检测,甲超声医生盆底功能障碍性疾病检出率为38.33％(46/120),乙超声医生检出率为40.83％(49/120),其检测结果较为一致(Kappa=0.913;P=0.000).经综合诊断,女性盆底功能障碍性疾病检出率31.67％(38/120),其结果分别与甲、乙超声医生三维盆底超声检测结果较为一致(Kappa=0.818,0.803;P=0.000).三维盆底超声联合综合诊断的结果分析,妊娠晚期孕妇盆底功能障碍性疾病检出率5(8.33％)明显低于阴道分娩产妇31(51.67％)(χ2=26.83,P<0.05).结论:采用三维盆底超声对妊娠、阴道分娩女性进行盆底功能评估,具有较高的诊断准确性和重复性,值得临床应用.     

泌尿生殖道支原体液体显色培养法与固体培养法的比较

目的以固体培养法为标准，探讨液体显色培养法培养支原体的敏感性、特异性和一致性。方法采用培养鉴定药敏一体化液体显色培养基和固体A7琼脂培养基平行检测155例泌尿生殖道标本的支原体。结果液体显色培养法培养的敏感性为96．5％，特异性为79．7％，一致性Kappa=0．7737，U=11．4767，P〈0．001，两种方法具有好的一致性。男性标本与女性标本比较，敏感性差异无统计学意义（Х^2=0．1298，P〉0．05），特异性差异有统计学意义（Х^2=5．4197，P〈0．025）。结论液体显色培养法可用于支原体培养初筛，结合固体培养法可以提高支原体培养的准确性。     

4074例儿童尸体解剖资料分析

对广州市儿童医院１９５８年５月～１９９２年１２月间的４０７４例儿童尸体解剖（简称尸检）资料进行分析，其结果表明：总的尸检率为２３．９％。尸检率以１９６５年以前为高，１９６６～１９７６年间低。１９７７年以后尸检率逐步回升，１９９２年达到４８．１％。总的临床误诊率为２２％。１９６９年以前的误诊率低于１９７０年以后，８０年代误诊率又高于７０年代。三个不同时期的误诊率分别为１５．３％、２５％及２５．８％。影响误诊率的因素为：（１）法定传染病发病率降低；（２）疾病的种类增多。因此，那种依靠近代先进仪器和设备进行诊断就能使诊断率提高至废弃尸检的观点是错误的。尸检仍是检验临床诊断的关键手段。     

Empirically Supported Forensic Assessment

The field of Forensic Psychology has greatly expanded over the past several decades, including the use of psychological assessment in addressing forensic issues. A number of surveys have been conducted regarding the tests used commonly by forensic psychologists. These surveys show that while tests specifically designed to address forensic issues have proliferated, traditional clinical assessment tests continue to play a crucial role in many forensic evaluations. The current article identifies some of the most salient characteristics of empirically supported forensic tests and provides examples of tests felt to meet each of these five criteria. These criteria include adequate standardization, acceptable reliability and validity, general acceptance within the community of forensic evaluators, availability of test data from cross‐cultural and cross‐ethnic samples, and comparison data relevant to specific forensic populations. Although the guidelines provided in this article provide a helpful framework for evaluating the usefulness of forensic tests, the establishment of a national review panel or workgroup to address this issue would be highly useful, particularly in the potential controversial task of identifying those tests that meet reasonable guidelines to be identified as empirically supported forensic assessment instruments.     

Coronary artery disease,sudden death and implications for forensic pathology practice

Coronary atherosclerosis is the leading cause of sudden death in developed nations. Triggers for sudden death include physical and emotional stress. At autopsy coronary artery atheroma is a common finding and may or may not be related to the cause of death. The forensic pathologist must consider the relative significant of disease, trauma and toxicological findings when determining the cause of death. This requires a consideration of evidence beyond the autopsy including the history, scene and ancillary investigations. Certain drugs including cocaine and methamphetamine are known to be atherogenic and acute and chronic use may be a factor in sudden death with underlying coronary artery atherosclerosis. Sudden death may also be associated with criminal conduct, when the scenario of “homicide by heart attack” needs to be considered. This review analyses forensic aspects of coronary artery disease.     

Research issues in forensic pathology: a survey of academic institutions employing forensic pathologists

In an effort to characterize research efforts in forensic pathology, a questionnaire was sent to a representative of each of the 14 academic medical centers that employ full-time faculty forensic pathologists. Responses were received from all 14 (100%) of the institutions queried, representing a total of 39 forensic pathology faculty positions; 21 positions were tenure track and 18 positions were clinical or other tracks. Of the 39 positions, 25 positions (64%) at 10 institutions required some degree of research or scholarly output. Of the 25 forensic pathologists with a research imperative, only 3 (12%) were principal investigators or co-investigators on funded forensic pathology-based projects. The major limitation cited by respondents on the performance of forensic pathology research was the lack of protected time from service responsibilities. Fellowship training in forensic pathology was available at 6 of the 14 respondent institutions. Of these institutions, 4 (67%) had a research requirement for trainees, and 4 (67%) provided research training. In conclusion, very few US medical schools currently employ full-time faculty forensic pathologists. Of these, only a small number of institutions prioritize research by these faculty members. Scant federal funds are available to support research in forensic pathology. Few forensic pathology fellowship programs provide research training. To achieve a robust research agenda in forensic pathology that is sufficient to support the needs of the criminal justice and public health systems will require a paradigm shift in the medicolegal death investigative system and investment by federal agencies.     

The medicolegal autopsy: when to refer to a forensic pathologist

The system of death investigation in England and Wales is complex, resulting in a distinction between ‘non-forensic’ and ‘forensic’ medicolegal autopsies. This article reviews the medicolegal investigation of sudden death and the actions of the police at the scene, and features in the history, external examination and internal examination that ‘non-forensic’ pathologists should be attune to in their everyday practice.     

BION,BECKETT AND BOB

We worked with Bob Hinshelwood for many years and begin our paper with an account of what we experienced as the essence of his approach in applying psychoanalytic understanding, especially an awareness of the ubiquitous effects of projective identification, to individual, group and organizational dynamics in mental health settings. This takes the form of a juxtaposition of some ideas and responses triggered by contact with patients expressed by Bion, Samuel Beckett and Bob himself. They all conveyed what it feels like when ‘bits of identity’ are passed around through unconscious interpersonal interactions. We then introduce the forensic psychotherapy context in which we work and try to apply what Bob helped us to see. Contact with severely mentally ill patients, who have committed catastrophic assaults, is work on the countertransference edge where patients' deficit in the capacity for symbolic communication and subsequent resort to action – sustained streams of projective identifications – evoke the maximum emotional impact in staff. We conclude with an example of a reflective practice group for beleaguered, often frightened, staff who desperately need but also attack – much as their patients do – what Bob called the attempt to build a reflective space which is so vital to survival and effective work.     

Hypothermia fatalities in a temperate climate: Sydney, Australia

AIMS: Fatal hypothermia is well known to occur in cold climates, with previous case series reflecting this. However, hypothermia can also occur in temperate climates. This case series describes the features and circumstances surrounding hypothermia-related deaths in Sydney, Australia. METHODS: The files of hypothermia-related deaths were reviewed at the Department of Forensic Medicine, Glebe between 1 January 2001 and 31 December 2005 via a search of electronic autopsy records. RESULTS: Twenty-four cases of fatal hypothermia were found. Many of the deaths occurred in winter (46%). The mean age was 76 years (range 56-92), with a female predominance (63%). Risk factors for hypothermia were identified in 58%. The mean body mass index (BMI) was 22 (range 15-33). Nineteen cases (79%) were found indoors. Four decedents were found naked, four were dressed in minimal amounts of clothing, and paradoxical undressing was found in seven cases. Pathological findings included gastric erosions (79%), and patchy reddish brown discoloration over large joints (75%). The majority of cases had significant pre-existing natural disease processes. Out of 18 cases where toxicology was performed, alcohol was detected in four cases, while other psychotropic agents were present in four deaths. No illicit drugs were detected. CONCLUSION: This study shows that fatal hypothermia, a significant public health problem, is not limited to cold climates. Forensic pathologists in Australia need to be aware of this condition, and not dismiss death as due to natural disease processes.     

重复犯罪罪犯人格特征分析

目的：了解重复犯罪罪犯的人格特征和相关因素，为提高教育改造罪犯的质量提供帮助。方法：采用中国罪犯个性分测验(COPA-PI)分别对重复犯罪罪犯和第一次入狱的罪犯进行测量。结果：重复犯罪罪犯在攻击性、报复性、同情心和犯罪思维模式四个维度上得分和人格异常比例高于第一次入狱的罪犯．且有统计学显著意义。结论：重复犯罪罪犯人格异常现象较为突出；罪犯出狱后再犯罪的影响因素有社会因素，也有人格因素；上述四个维度上所表现出来的人格异常在一定程度上可以预测罪犯出狱后再次犯罪的可能性．对罪犯实施针对性的人格矫正可提高教育改造质量。     

Anatomical variability of the frontal sinuses and their application in forensic identification

The uniqueness of anatomical structures and their variations provides the basis for forensic identification of unknown deceased persons. Similar to fingerprints, each frontal sinus is so distinctive and unique that the chances of two individuals having the same morphology of the frontal sinuses is extremely remote. Radiographs, especially the occipitomental view commonly used in the assessment of paranasal pathology, provide excellent records of these sinuses. The case illustrated here is an application of the frontal sinus identification of a victim in a mass disaster. Clin. Anat. 12:16–19, 1999. © 1999 Wiley‐Liss, Inc.     

Clinical Aspects and Issues in Assessing Premorbid IQ and Cognitive Function

Clinical approaches to estimation of preinjury IQ are and will continue to be important to neuropsychologists, especially those involved in the forensic arena. Forensic approaches require not only defensible and demonstrable theoretical and empirical bases; they also require face validity for procedures used for establishing putative preinjury mental functional status. Procedures found to be of value for such purposes include postinjury residual skill levels; predictions based on residual functional levels on abilities resistant to injury; and mental requisites of preinjury academic, vocational, and avocational activities. Ideally and fairly typically, it is possible to demonstrate good congruence among those procedures in fashion conductive to informed decision making by the courts.     

Anaphylactic deaths in Auckland, New Zealand: a review of coronial autopsies from 1985 to 2005

AIMS: To determine the frequency of anaphylactic deaths amongst coronial autopsy cases performed in the greater Auckland region from 1985 to 2005, and review the circumstances of death and autopsy findings. METHODS: A computerised search for anaphylactic deaths was performed using the Forensic Pathology Department database at Auckland City Hospital. Postmortem reports and police reports were reviewed to determine the circumstances of death. Details recorded included basic demographic data, medical history, agent responsible for the allergic reaction, and pathologic findings at autopsy. RESULTS: A total of 18 cases of anaphylactic deaths were identified for the study period, including nine males and nine females, age range 33-76 years, mean 51.9 years. There were 10 reactions to drugs or contrast media (4 anaesthetic agents, 3 antibiotic, 2 IV contrast media, 1 streptokinase), four to bee/wasp venom, two to seafood, and two undetermined. Death occurred within 1 hour of onset of anaphylaxis in 12 cases. Findings at autopsy included non-specific pulmonary oedema and congestion (n = 13), laryngeal oedema (n = 5), cerebral hypoxia (n = 4) and cutaneous oedema (n = 1). Serum tryptase levels were measured in 15 cases, and were significantly elevated (>20 microg/L) in eight cases. CONCLUSION: Anaphylactic reaction is an uncommon cause of sudden death. In many cases, no specific macroscopic or microscopic findings were detected at autopsy. In the presence of a typical clinical history, postmortem measurement of serum tryptase levels can be a useful diagnostic aid.