Discussion on Standardization of Forensic Assessment of Olfactory Dysfunction / 法医学杂志

With the development of society, the improvement of living standards and the advancement of research methods, olfactory function has been paid more and more attention. Therefore, higher requirements for the forensic identification of olfactory function have also been put forward. Standardization construction of forensic medical examination and identification of olfactory dysfunction is urgently needed. Based on a comprehensive review of olfactory function and forensic assessment of olfactory dysfunction, this paper elaborates on problems related to the principles and timing of forensic assessment of olfactory dysfunction, the requirements of identification of traumatic olfactory dysfunction, the subjective and objective methods of examination of olfactory function. Strict control of the above issues is an important mean of standardization of forensic assessment of olfactory dysfunction.

Clinical Observation of Addition and Subtraction Therapy of Taohong Siwutang Combined with Chaihu Shugansan to Unstable Angina Pectoris with Type A Behavior Pattern / 中国实验方剂学杂志

Objective: To observe the clinical efficacy of addition and subtraction therapy of Taohong Siwutang combined with Chaihu Shugansan to unstable angina pectoris with type A behavior pattern (Qi stagnation and blood stasis syndrome), and investigate its effects on proinflammatory factors and serotonin (5-HT). Method: One hundred twenty-four patients were randomly divided into control group (60 cases) and observation group(64 cases) by random number table. Patients in control group got Aspirin enteric-coated tablets, 100 mg/time, 1 time/day. Tigrillo tablets, 90 mg/time, 2 times/days. Metoprolol tartrate tablets, 50 mg/time, 2 times/days. Simvastatin tablets, 10 mg/time, 1 time/day. Nitroglycerin tablets, 0.5 mg/time. Based on the treatment in control group, patients in observation group also received addition and subtraction therapy of Taohong Siwutang combined with Chaihu Shugansan, 1 dose/day. The treatment course was 8 weeks in both groups. Number of attacks, duration, degree of pain and usage of nitroglycerin were recorded for every week. Before and after treatment, electrocardiogram was also recorded. And levels of triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α), hypersensitive C-reactive protein and 5-HT were detected. In addition, scores of Seattle Angina Scale (SAQ) and Qi stagnation and blood stasis syndrome were graded. Result: In the rank sum test, the curative effect in electrocardiogram of observation group was better than that of control group (Z=1.965, PPPPα and 5-HT in observation group were lower than those in control group (PPConclusion: On the basis of conventional western medicine, addition and subtraction therapy of Taohong Siwutang combined with Chaihu Shugansan can further control angina attack, relieve clinical symptoms, improve quality of life, regulate lipid metabolism, and can inhibit expression of proinflammatory factors and 5-HT, so it can play a role in stabilizing the disease.

Retrospective Analysis of 24 Cases of Forensic Medical Identification on Traumatic Tympanic Membrane Perforations / 法医学杂志

OBJECTIVES@#To study the case characteristics of forensic medical identification of traumatic tympanic membrane perforations, and to discuss the key points of forensic medical identification and evaluations methods for tympanic membrane perforations.@*METHODS@#Twenty-four cases of traumatic tympanic membrane perforations accepted by the Academy of Forensic Science during 2017 were retrospectively analysed. The data of perforation size, form, predilection site, healing time and healing mode were evaluated.@*RESULTS@#For the traumatic tympanic membrane perforations, the study showed that the small size of perforation （<1/2 quadrant） with irregular shape was common. The location of perforations was almost on the anterior and inferior quadrant, and centripetal migration healing was common. The healing rate within 6 weeks was up to 90%.@*CONCLUSIONS@#In the identification cases of traumatic tympanic membrane perforations, the key is to determine whether it is traumatic and whether it will heal spontaneously within 6 weeks. It is suggested to check the tympanic membrane weekly by an otic endoscope combined with acoustic impedance measurement at the sixth week, which can improve the accuracy, objectivity and scientificity of the identification.

Research Progress on Function Evaluation Standard and Method of Lower Ex-tremity Impairment / 法医学杂志

The lower extremity impairment can be caused by illness, accident, work-related injury, traf-fic accident and fighting, etc. The injuries of lower extremity joint, nerve, muscle and tendon may lead to lower extremity dysfunction. So far, there is no unified standard for international and domestic function evaluation of lower extremity impairment, the evaluation standards in the same field are also different, and function evaluation of lower extremity impairment has no complete research system. However, the degree of lower extremity impairment has great influence on personal damage compensation. Therefore, the function evaluation of lower extremity impairment often becomes a dispute issue in forensic medicine identification. This article summarizes the function evaluation standards, methods and status quo of lower extremity impairment, so as to provide a new insight into the research on standardization of lower extremity impairment.

Analysis of Relationship between Injury and Disease in 17 Cases of Cervical Trauma with Cervical Vertebra Degeneration / 法医学杂志

OBJECTIVES@#To study the characteristics of the relationship between injury and disease in forensic identification cases of cervical trauma with cervical vertebra degeneration, and to explore the problems about how to identify the participation rates of injury and disease using the clinical information, forensic examination and imaging examination.@*METHODS@#Seventeen forensic identification cases of cervical trauma with cervical vertebra degeneration were collected. The age distributions, injury formations, injury severities and imaging findings of these cases were analyzed and the relationship between injury and disease was evaluated comprehensively.@*RESULTS@#Middle-aged and elderly were common in 17 cases and every case was involved with intervertebral disc herniation. The main reasons of injuries were hyperextension. The degree of injury severity and vertebra degeneration were graded according to the imaging findings. The participation rates of injury and disease were also calculated comprehensively.@*CONCLUSIONS@#The forensic identification cases of cervical trauma with cervical vertebra degeneration should be evaluated with clinical information, forensic examination and imaging finding.

Cognitive Training in Older Adults with Mild Cognitive Impairment / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>We investigated the feasibility and efficacy of cognitive training for older adults in rural settings and with low education levels, who have mild cognitive impairment (MCI).</p><p><b>METHODS</b>Forty-five older adults (ages >65 years) with MCI were assigned to treatment or control groups, at a 2:1 ratio. Cognitive training occurred in the treatment group for 2 months. The cognitive abilities of the participants were assessed at pre-training, metaphase, and post-training time points, using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), and Hamilton Depression Scale (HAM-D).</p><p><b>RESULTS</b>Following training, cognitive abilities improved in the treatment group, based on the total scores of all 4 measures, as well as specifically on the MoCA and LOTCA. There were differences in the main effects of group and time point on some subscales, but these differences had little, if any, effect on the overall analyses.</p><p><b>CONCLUSION</b>The present study demonstrated that cognitive training has beneficial effects on attention, language, orientation, visual perception, organization of visual movement, and logical questioning in patients with MCI. Furthermore, the observed effects are long-term changes.</p>

Dynamic Posturography of Injured Lower Limb in Postural Evoked Response / 法医学杂志

OBJECTIVE@#To analyze the balance function of injured lower limb by dynamic posturography.@*METHODS@#Using the dynamic posturography instrument, the postural evoked responses of sixty-two normal people and two hundred and fifty-eight people with injured lower limb bones and joints were detected. The test was included sensory organization test (SOT) and adaption test (ADT). The results of two groups were compared by t test.@*RESULTS@#Compared with the normal people, the impaired people had significant statistical differences in balance scores of SOT3-SOT6 and proportion score of dynamic proprioception (P < 0.05). There was no obvious decrease in ADT.@*CONCLUSION@#The balance function of injured lower limb significantly decreases.

Isokinetic muscle test of normal people's knees in different postures / 法医学杂志

OBJECTIVE@#To study the influence of different positions in the isokinetic muscle test of knees by CON-TREX Biomechanical Test and Training System, so as to select the suitable conditions for forensic identification of muscle strength test.@*METHODS@#Fifty-two healthy volunteers joined the isokinetic muscle strength test in unfixed and fixed position, respectively and in two kinds of angular speed (60 degrees/s and 30 degrees/s). The differences of peak torque (PT) and peak torque angle (PTA) between bilateral knee flexor and extensor were statistically analyzed.@*RESULTS@#In the unfixed position, under the two speed, there was statistically significant difference in PT between bilateral knee flexor and extensor (P < 0.05); while in the fixed position, under the two speed, there was no statistically significant difference (P > 0.05). In any kind of conditions, the PTA of bilateral knee flexor and extensor did not have statistically significant difference (P > 0.05).@*CONCLUSION@#The position of the subject influences the results of PT. So the position of subject in knees isokinetic muscle test should be regulated.

Posture evoked response detecting in normal lower limb muscle and its influencing factors / 法医学杂志

OBJECTIVE@#To analyze the latency of posture evoked response of normal lower limb muscle in different stimulations and explore its influencing factors.@*METHODS@#The normal lower limb was induced to produce postural evoked response by the dynamic posturography through two kinds of perturbations, the supporting surface rotation stimulation (Toes-up and Toes-down) and the horizontal perturbation stimulation (Forward and Backward). The latencies of tibialis anterior muscle and gastrocnemius muscle were recorded by surface electromyography acquisition system. The differences of the left and right limb, gender and height on the latency of postural evoked response were analyzed.@*RESULTS@#(1) Under the Toes-up and Backward perturbation, the latency of tibialis anterior muscle was longer than gastrocnemius muscle; under the Toes-down and Forward perturbation, the latency of gastrocnemius muscle was longer than tibialis anterior muscle. (2) The latencies of left limb and right limb had no significant difference. (3) The latency in male was longer than that in female. (4) The latency gradually increased with the increase of height.@*CONCLUSION@#In the postural evoked response, different perturbations, gender and height have significant impacts on the latency of posture evoked response of lower limb muscle. However, the effect of height and gender should be not considered referring to the same individual.

Resources and application of She's nationality wild medicinal plants / 中国中药杂志

To make a thorough investigation of the common She's nationality wild medicinal plants resources in our country, including the species, the distribution, the folk application and the endemic medicinal plant species, Field surveyed was conducted with 25 She people mainly lived area (county, district or city) throughout the country, the folk prescription and treatment cases provided by She's medical personnel, the drug usage and dosage, the commonly used traditional She's medicine and drug samples were collected. And the distribution, growing environment of these plants were investigated, their characteristics, photographs, GPS data and track were record , and the fresh wax leaf or plants specimens were collected. In total 1 600 varieties of folk medicine of She's nationality, 450 disease names and 1 016 prescriptions were collected. 520 kinds of these medicinal plants were commonly used, growing mainly distributed in the southeastern China, about 200 meters above sea level to 1 500 meters. There are 5 First-Grade State protection wild plants (medicinal), 15 second-Grade State protection wild plants (medicinal), and 11 She characteristic medicinal plants in our study, they belong to 144 families, 312 genera 494 species, 2 subspecies, 17 varieties, 3 forms and 1 cultivated varieties of She's nationality. Folk medicine usage is different from the traditional Chinese medicine and ethnic medicine. This survey finds out the common She's nationality wild medicinal plants resources in China, including the species, the distribution, the folk application and commonly used drugs, and found the rare and endangered medicinal plants and the She's nationality endemic medicinal plants, which provides a basis for further development and use the traditional She's medicine resources.

Reliability study on quantitative detection of extensor digitorum brevis strength with needle electromyography and nerve conduction / 法医学杂志

OBJECTIVE@#To study the objectivity and reliability of needle electromyography and nerve conduction for detection of musculus extensor digitorum brevis strength, which may provide a basis for establishing 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 cooperation and disguise condition.@*RESULTS@#Under the cooperation condition, regardless of the same operator 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 recruitment reaction type and the repeatability of the same operator was slightly better than the repeatability between different operators. Under the disguise condition, test-retest reliabilities of MUP amplitude, CMAP amplitude, CMAP latent period and MNCV were relatively high, while test-retest reliabilities of MUP count and recruitment reaction type were relatively low.@*CONCLUSION@#There are good test-retest reliabilities in MUP amplitude, CMAP amplitude, CMAP latent period and MNCV, which can be conducive to comparison between different operators and results at various times; MUP count and recruitment reaction type, which can be easily affected by subjectivity of operators and examinees, can be used to differentiate whether an examinee disguises or not. The indexes used to objectively judge muscle strength remain to be further investigated.

Characteristics of computed dynamic posturography of patients with peripheral vertigo / 法医学杂志

OBJECTIVE@#To quantify the posture control ability of patients with peripheral vertigo by computed dynamic posturography (CDP).@*METHODS@#Ninety-one subjects diagnosed with peripheral vertigo by caloric test were divided into unilateral vestibular dysfunction group (unilateral group) and bilateral vestibular disorder dysfunction group (bilateral group). CDP tests including sensory organization test (SOT) and motor control test (MCT) were performed on all subjects. The CDP results were compared with the normal data by t-test.@*RESULTS@#In unilateral group, there was no statistically significant difference in SOT compared with normal data (P > 0.05). In bilateral group, the composite equilibrium score was lower than the normal data, especially during the moving of the platform and the changes of visual stimulation (P < 0.05). In MCT test, the latencies of both groups showed no statistically significant difference compared with normal data (P > 0.05).@*CONCLUSION@#During the non-acute period of peripheral vertigo, patients could maintain static equilibrium. Compared with normal people, dynamic equilibrium function is normal in patients with unilateral vestibular dysfunction, but declined in patients with bilateral vestibular dysfunction.

Progress in isokinetic technology in testing and training for assessment of muscle function / 法医学杂志

Isokinetic technology in testing and training is the most advanced practical technique in the evaluation of muscle function. This method is a continuous dynamic test in the full range of the joint motion which has strong pertinence at the aspect of assessing muscle strength, and is an objective and quantitative method for reflecting each point's muscle strength in the range of the joint motion. This article reviews the key concepts, brief history of development and influencing factors of isokinetic technology in testing and training, introduces the progress in the field of rehabilitation medicine and sport science, etc., and discusses the future exploration in forensic science.

Forensic medical identification of 355 cases with hearing impairment / 法医学杂志

OBJECTIVE@#To analyze the difference of subjective hearing threshold and objective hearing threshold, and to discuss the importance of standard for hearing evaluation in forensic medicine.@*METHODS@#Three hundred and fifty-five cases (387 ears) of forensic medical identification with hearing impairment were retrospectively analyzed including the items entrusted and hearing test results. All cases were collected from 2004 to 2012 in the forensic science center.@*RESULTS@#In the 387 ears, 218 ears (56.3%) were evaluated the degree of disability and 106 ears (27.4%) were identified the degree of damage. In the disability degree evaluation, the subjective hearing threshold and the objective hearing threshold were significant different in 120 ears (55.0%), while in damage degree evaluation, the subjective hearing threshold and the objective hearing threshold were significant different in 69 ears (65.1%).@*CONCLUSION@#Because of camouflaging or exaggerating the hearing impairment by the wounded, the subjective hearing threshold can't accurately assess the existence and the degree of hearing impairment. In the forensic identification, auditory brainstem response, 40 Hz auditory event related potential and auditory steady-state response should be combined in the application to evaluate the hearing impairment for the wounded in order to ensure the reliability of the evaluation of hearing impairment.

Application of needle electromyography and nerve conduction study in forensic appraisal / 法医学杂志

OBJECTIVE@#To explore the application value of needle electromyography (EMG) and nerve conduction study (NCS) in the forensic appraisal; to provide scientific basis for establishing normative and unified assessment methods of the peripheral nerve study in forensic medicine.@*METHODS@#One hundred and sixty-four samples with injured peripheral nerve (injury group) and 138 samples with normal peripheral nerve (control group) were collected and tested with methods of EMG and NCS respectively. The relevance rate of two methods were compared and statistical analysis was performed.@*RESULTS@#In the injury group, there was no statistical difference on the relevance rate between the application of EMG and that of NCS (P > 0.05). In the control group, there was no statistical difference on the negative rate between the two methods (P > 0.05). The false negative rate of the injury group and the false positive rate of the control group were both 0% when using the two methods together.@*CONCLUSION@#When the injured peripheral nerve in forensic appraisal is in doubt, application of both EMG and NCS could disclose truth from falsehood. The accuracy and credibility of identification results could be enhanced.

Comparisons among three frequency-specific auditory evoked potentials in normal hearing adults / 法医学杂志

OBJECTIVE@#To provide supports for the application of auditory evoked potential (AEP) in the evaluation of behavioral threshold, by studying the difference and relevance between the pure tone audiometry (PTA) and three frequency-specific auditory evoked potentials, including 40 Hz auditory event related potentials (40 Hz AERP), tone burst auditory brainstem response (Tb-ABR) and auditory steady-state response (ASSR).@*METHODS@#Three frequency-specific AEP and PTA thresholds were recorded at speech frequency (0.5, 1, 2, 4 kHz) from thirty-four adults with normal hearing (68 ears). Then, the relationship between the AEP thresholds and PTA thresholds were analyzed respectively.@*RESULTS@#There were good correlations between three frequency-specific AEP thresholds and PTA thresholds at speech frequency. However, the difference of thresholds between each frequency-specific AEP and PTA was not same. The difference of thresholds were the smallest and the relevance were the best between 40 Hz AERP and PTA at 0.5 kHz, and between ASSR and PTA at 2, 4 kHz. At 1 kHz, there were not statistical difference between ASSR, 40 Hz AERP and PTA, while the relevance of 40 Hz AERP was better than ASSR.@*CONCLUSION@#Different methods should be chosen to assess the objective behavioral thresholds at different frequency.

Comparisons among different reference values of nerve conduction velocity in forensic appraisal / 法医学杂志

OBJECTIVE@#To provide the evidences for the choice of normal reference value of nerve conduction velocity (NCV) in clinical forensic appraisal.@*METHODS@#One hundred and fourteen cases with normal peripheral nerve and 155 cases with injured peripheral nerve were collected. The NCV of homonymous nerves in two limbs were detected. In the normal cases, the NCV of the left limbs were used as the normal reference values. The NCV of the right limbs were compared with that of left limbs, the commendatory normal reference values from Beijing Xiehe Hospital and Shanghai Huashan Hospital. In the injured cases, the results of NCV in injuried limbs were compared with the results of healthy limbs and the reference values from Beijing Xiehe Hospital and Shanghai Huashan Hospital.@*RESULTS@#In the normal group, there was no statistical difference between the left and right limbs in NCV results of homonymous nerve (P > 0.05). The false positive rates (FPR) were 0, 11.4% and 5.2% for three choices normal reference respectively. The false negative rates (FNR) were 0, 9.7% and 12.3% for three choices normal reference in injuried group. Thee false negative cases were all slight nerve injury.@*CONCLUSION@#The reference value of self-control method could decrease the FPR of normal cases and FNR of injured cases. In clinical forensic appraisal of peripheral nerve, the nerve condition study results from healthy homonymous nerve should be regarded as the reference value at first, supplemented by reference values from clinical labs.

Study on the prevalence and risk factors of depressive symptoms among ‘empty-nest' and non-empty-nest' elderly in four provinces and cities in China / 中华流行病学杂志

Objective To investigate the prevalence and determinants of depressive symptoms among ‘empty-nest' and ‘non-empty-nest' elderly in four cities/provinces.Methods 4265 elderly aged 60 and over,were recruited with cluster sampling method in Shanghai,Heilongjiang,Guangdong and Shanxi province and interviewed,using the Geriatric Mental State Schedule and self-developed related questionnaire.Results ( 1 ) The prevalence of depressive symptoms for ‘empty-nest' elderly was (8.18％),significantly higher than that for ‘non-empty-nest' eldcrly (P=0.019) ; (2) the ‘empty-nest' elderly had a significantly higher proportion of the following factors:being male,married,with higher income ( ≥ 15 000 Yuan/year),living in city,with high education background,under employment etc.than the ‘non-empty-nest' elderly (P＜0.0001) ; (3)the ‘empty-nest' elderly had significantly higher proportions on good self-rated health status and life (P=0.0001,P＜0.0001 ) as well as heavier health problems and economic difficulties (P=0.00 1,P=0.002 ) ; (4) there were significantly negative associations between depressive symptoms and the following 10 factors:being female,single,having bad self-rated health and life status,having somatic disease ≥3,with big health problems in the last two years and loss of dearest persons,community engagement and involvement of religious activities.Conclusion The ‘empty-nest' elderly showed higher prevalence of having depressive symptoms than the ‘non-empty-nest' elderly.The ‘empty-nest' elderly had characteristics as being single,female,having adverse event etc.and should be under greater attention for care.

Characterization of patients and its relationship with medical complaints / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Patient characteristics may be an internal factor influencing patient complaints, but in China patient characterization is restricted to patient satisfaction surveys, and few studies have considered the relationship between patient characteristics and patient complaints. The aim of this research was to determine the reasons for complaints.</p><p><b>METHODS</b>In this study, we analyzed the characteristics of hospitalized patients and explored their relationship with medical complaints.</p><p><b>RESULTS</b>The significant factors were age (P = 0.045), hospital cost (P = 0.003), household nature (P < 0.001), and education (P < 0.001). The complaint rate decreased when the patients' age increased (regression coefficient, -0.606; OR, 0.545, and 95%CI, 0.301 - 0.987). The complaint rate increased with an increase in hospital cost (regression coefficient, 0.818; OR, 2.266; and 95%CI, 1.320 - 3.889). Patients from non-agricultural households had a higher complaint rate (regression coefficient, 1.051; OR, 2.861; and 95%CI, 1.611 - 5.082). Patients with higher education levels had lower complaint rates (regression coefficient, -0.944; OR, 0.389; and 95%CI, 0.234 - 0.647).</p><p><b>CONCLUSION</b>The survey confirms that older patients and patients with higher education levels had lower complaint rates, while non-agricultural population and patients with higher hospital expenses had higher complaint rates.</p>

Identifying malingering symptoms of balance disorders by computerized dynamic posturography / 法医学杂志

OBJECTIVE@#To develop an objective criteria with computerized dynamic posturography (CDP) for identification of non-organic or malingering symptoms of balance disorders.@*METHODS@#One hundred and four normal subjects were instructed to feign balance disturbance after naturally performing on CDP. Paired t-test was used to determine if there was significant difference of CDP equilibrium scores between normal and malingering performance. The CDP records including raw curve of 50 subjects were critically evaluated by previously published seven criteria in indicating malingering performance. If the sensitivity of a criterion was greater than 90%, it would be accepted as our laboratory's identifying criterion. The CDP records of remaining 54 subjects were used to test the sensitivity and specificity of the accepted criteria.@*RESULTS@#There were statistically significant differences of CDP equilibrium scores between normal and malingering performance (P < 0.01). The mean equilibrium scores of malingering performance were lower than that of normal performance. The sensitivity and specificity of our criteria for identifying malingerers were 92.5% and 98.2%, respectively.@*CONCLUSION@#It is necessary to identify malingering performance before analyzing the CDP equilibrium scores. Our identifying criteria of malingerers seems to be quite useful and accurate.