Malingering assessment after severe traumatic brain injury in forensic psychology with a potential embedded symptom validity indicator of Symptom Checklist 90.

Objective: Malingering of neuropsychological damage is common among traumatic brain injury patients pursuing disability compensation in forensic contexts. There is an urgent need to explore differences in neuropsychological assessment outcomes with different levels of cooperation. Methods: A total of 420 participants with severe traumatic brain injury were classified into malingering group, partial cooperation group, and complete cooperation group according to the Binomial forced-choice digit memory test. The Wechsler Adult Intelligence Scale, event-related potential component, and Symptom Checklist 90 were applied subsequently to assess the psychological status of participants. Results: Participants in the malingering group presented lower scores in the binomial forced-choice digit memory test and the Wechsler Adult Intelligence Scale, lower P3 amplitude, and simultaneously higher scores in the Symptom Checklist 90 than the other two groups. The actual intelligence quotient of participants with malingering tendencies ranged mostly between normal and marginal damage, and they often reported elevated whole scale scores in the Symptom Checklist 90. The Cooperation Index (defined as the ratio of positive symptom distress index to global severity index, CI) was proposed and validated to function as an embedded validity indicator of the Symptom Checklist 90, and the area under the receiver operating characteristic (ROC) curve was 0.938. When valued at 1.28, CI has the highest classification ability in differentiating malingering from non-malingering. Combined with the CI and P3 amplitude, the area under the ROC curve for malingering diagnosis further reached 0.952. Conclusion: Any non-optimal effort in a forensic context will lead to unexpected deviation in psychology evaluation results. CI is a potential candidate to act as an embedded validity indicator of the Symptom Checklist 90. The combination of CI and P3 amplitude can help to identify malingering in participants after severe traumatic brain injury.

Complicating Symmetric Peripheral Gangrene after Dopamine Therapy to Patients with Septic Shock.

Dopamine is commonly used as a first-line agent in the treatment of patients with septic shock. The use of dopamine rarely causes symmetric peripheral dry gangrene. If the symmetric peripheral dry gangrene occurs in the patient after dopamine injection, it easily leads to disagreement between doctors and patients. A 60-year-old woman who had sudden septic shock was sent to intensive care unit (ICU). She was received dopamine injection according to the routine during treatment. Over the next 3 months, her limbs developed to dry gangrene and required amputation. The result shows that the occurrence of dry gangrene could only be associated with the long-term excessive use of dopamine according to the medical records. Although dopamine is a conventional drug for the treatment of septic shock, the forensic workers and clinicians must realize that vasopressors such as dopamine have been implicated directly or as a contributory cause in dry gangrene cases.

The exact estimation of visual acuity by VEP technology: a report of 726 cases of eye injury.

This study explored the accuracy of using visual evoked potentials (VEP) technology for visual acuity estimation. The enrolled 726 patients with post-traumatic unilateral decrease in visual acuity included the injured eyes served as the experimental group, and the healthy eyes as the control group. The least signal visual angle (LSVA), and amplitude and latency of P(100) were chosen as test indexes. The results under different experimental conditions were recorded by PRVEP technology. All data collected were processed and analyzed by SPSS software. The results showed that the coincidence between subjective and VEP visual acuity was 96.7% in control group, but there was very significant difference in experimental group. It was concluded that with the regression formulation for the amplitude of P(100) and vision under LSVA, visual acuity can be estimated more accurately and impartially.

Correlations between event-related potentials with pictures recognition and WMS-RC scores in patients with memory disorder caused by severe traumatic brain injury.

This study explored the possibility of using event-related potentials (ERP) for the measurement of picture-recognition memory and examined its correlation with the Chinese Wechsler Memory Scale-revised (WMS-RC) in patients with memory disorder caused by severe traumatic brain injury (sTBI). The subjects included 20 sTBI patients with memory disorder and 22 healthy individuals. Memory function was measured by using WMS-RC. Behavioral and ERP responses were recorded on-line during performance on a battery of picture recognition and the responses were analyzed off-line for recognition memory effects. Mean memory quotient (MQ) of patients with sTBI was significantly lower than that of the control group. Mean reaction time (RT) was significantly longer and the mean correctness rate (CR) of picture recognition was significantly lower in sTBI group than that of the controls. In controls, the main components of average ERP of picture recognition includes two positive-going waves, designated as P(170) and P(500), that appear 170 ms and 500 ms after stimulation when the subject could later successfully recall and recognize the pictures. P(500) amplitude of target stimulus was significantly higher than that of non-target stimulus. Compared to controls, P(500) responses of sTBI group were significantly delayed in latency (P<0.001) and lower in amplitude (P<0.001). P(500) latency showed significant negative correlation with MQ and the scores of "addition", "visual recognition", "picture recall", "visual reproduction" and "tactile memory" in WMS-RC. ERP of picture recognition provides a neurophysiological approach to directly assess memory impairment, and P(500) may serve as a helpful index for memory disorder caused by sTBI in forensic practice.

Sudden death due to arrhythmogenic right ventricular cardiomyopathy: Two case reports.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a kind of primary myocardial disease characterized by the regional or global replacement of right ventricular myocardium by fatty and fibrolipomatous tissues. The ARVC, usually presenting with different clinical manifestations and pathological changes, were mainly seen in young men and is one of the main causes of sudden death in the young. Here two autopsied cases of Chinese men aged 30 and 23 years old who appeared healthy but died suddenly while at work are reported respectively. One of the victims had extensive and severe pathological changes in his heart involving the left ventricular wall as well as the ventricular septum and the right atrium. Not only was there a global fatty and fibrolipomatous tissue replacement of the right ventricular myocardia, but also mild sarcoplasmic coagulation in the myocardium and focal lymphocytic infiltration in the myocardial interstitium of the right ventricular wall. In addition, slight atherosclerosis of the coronary artery and intimal thickening of the sino-atrial node were observed. It is believed that there are no marked differences in the pathological changes of ARVC between Chinese patients and patients from western countries. The etiology and pathogenesis of ARVC could not be explained by a single cause or factor and they are probably related to various congenital and acquired causes or factors.

[Influence of triptolide on neuronal apoptosis in rat with cerebral injury after focal ischemia reperfusion].

OBJECTIVE: To study effect of triptolide (TL) on neuronal apoptosis in cerebral tissue of rat after ischemia-reperfusion. METHOD: Triptolide at dose 0.2 or 0.4 mg x kg(-1) was intraperitoneally injected once a day for 4 d. The focal cerebral ischemia-reperfusion model was established with thread embolism in middle artery before triptolide injection on the fourth day. Neurological deficit score of rats was evaluated; and immunohistochemical techniques were used to count positive cells of express of MPO and TUNEL in cerebraltissue. RESULT: Compared with the control group, the deficit of neural function was significantly improved, and the number of infiltrate of neutrophil and neuronal apoptosis in cerebral tissue was remarkably reduced in two TL-treated groups. CONCLUSION: The results suggested that TL can inhibit infiltration of neutrophil and decrease the degree of neuronal apoptosis in cerebral tissue.