INTRODUCTION: In a subset of adults with non-rapid eye movement (NREM) parasomnias, clinical variants might be violent in nature and can potentially result in unintentional but considerable harm. As such, there is substantial interest on the forensic ramifications of these sleep behaviours. METHODS: This review examined the diagnostic criteria for parasomnias established in the context of international classification systems; medicolegal case reports; legal frameworks; and court cases in and outside of Singapore, to provide an overview of the implications of NREM parasomnias. RESULTS: Violent or injurious behaviours that occurred in the context of somnambulism, otherwise known as sleepwalking, have challenged traditional legal theories of criminal culpability. Yet little has changed in the application of sleep science to criminal responsibility. In Singapore, the defence of somnambulism has hitherto not been directly raised. Nonetheless, sleep medicine practitioners may increasingly be requested to render their opinions on legal issues pertaining to violent or injurious behaviours allegedly arising during sleep. Although the understanding of NREM parasomnias has improved, there is still a dearth of evidence to support both medical and legal decisions in this area. CONCLUSION NREM parasomnias come with disquieting legal and forensic implications for adjudicating criminal responsibility. There is a need to critically examine legal perspectives on behaviours occurring during sleep. More reliable empirical studies investigating the pathophysiology of NREM parasomnias can offer clearer diagnostic guidelines and address complex behaviours of NREM that often come with medicolegal implications.
Adult ; Humans ; Parasomnias/diagnosis* ; Singapore ; Sleep/physiology* ; Somnambulism/diagnosis*

Objective:To investigate the effect of Comprehensive Reminder System Based on Health Belief Model (CRS-HBM) on health knowledge, belief, behaviors, utilization of health services and clinical outcomes in stroke patients after discharge. Methods:From February, 2015 to March, 2016, 174 stroke patients with hypertension were divided into control group (n = 87) and intervention group (n = 87). The control group received routine stroke health education, and the intervention group received the CRS-HBM program in addition. They were investigated with Stroke Knowledge Questionnaire (SKQ), Short Form Health Belief Model Scale for Stroke Patients (SF-HBMS-SP), Health Behavior Scale for Stroke Patients (HBS-SP), and the utilization of health services and clinical outcomes (emergency, re-hospitalization, recrudescence and death) were recorded six months after discharge. Results:A total of 75 cases in the control group and 76 in the intervention group finished the research. The total scores of SKQ (U = 903.000), SF-HBMS-SP (t = -9.099) and HBS-SP (t = -7.786) were more in the intervention group than in the control group (P < 0.001). The outpatient re-visit rate was more in the intervention group (97.37%) than in the control group (76.00%) (P < 0.001). The incidence of emergency, re-hospitalization, recrudescence and death were not significantly different between the two groups (P > 0.05). Conclusion:The application of CRS-HBM can improve the health knowledge, belief, behaviors for stroke patients after discharge, but there are not enough effects on clinical outcomes.

OBJECTIVES: To explore the assessment method of original height of L_1-2 after vertebral compression fracture and its application value in forensic clinical practice. METHODS: A total of 154 normal thoracic and lumbar X-ray films were collected, and 140 cases were used as experimental group while 14 cases as validation group. The heights of anterior （Ha） and posterior （Hp） vertebral body of T₁₂-L₃ vertebrae in each X-ray image were measured. In the experimental group, the correlation analysis between Ha_L₁ and Ha_T₁₂, Hp_T₁₂, Hp_L₁, Ha_L₂ and Hp_L₂ was carried out, and regression equation was established via fitting. The correlation analysis between Ha_L₂ and Ha_L₁, Hp_L₁, Hp_L₂, Ha_L₃, Hp_L₃ was performed, and the regression equation was also established via fitting. The difference between the predicted and measured values of Ha_L₁ and Ha_L₂ in validation group was compared. RESULTS: In the 140 normal subjects, Ha_L₁ （y₁） was well correlated with Ha_T₁₂ （x₁） and Ha_L₂（x₂）, and the multiple linear regression equation was y₁=2.545+0.423 x₁+0.486 x₂ （determining coefficient R²=0.712, P<0.05; F=169.206, P<0.05）. There was no significant difference between the predicted and actual measured values of Ha_L₁ in the validation group （ P>0.05）. HaL₂ （y₂） was well correlated with Ha_L₁ （x₃） and Ha_L₃ （x₄）, and the multiple linear regression equation was y₂=4.354+0.530 x₃+0.349 x₄ （determining coefficient R²=0.689, P<0.05; F=151.575, P<0.05）. There was no significant difference between the predicted and actual measured values of Ha_L₂ in the validation group （ P>0.05）. CONCLUSIONS It is more appropriate to evaluate the original height of L₁ or L₂ single vertebrae by comparing with the height of the anterior edge of the upper and lower adjacent vertebral bodies.
Aged ; Fractures, Compression ; Humans ; Lumbar Vertebrae/diagnostic imaging* ; Middle Aged ; Spinal Fractures/surgery* ; Thoracic Vertebrae/diagnostic imaging*

OBJECTIVETo examine the incidence of congenital heart disease (CHD) in children aged 0-3 years in the rural areas of Chongqing, and to determine the suitable "screening-diagnosis-follow-up" system and screening indicators for CHD in these areas.

METHODSChildren aged 0-3 years from rural areas of the Fuling Disctrict of Chongqing were selected by cluster sampling. Using the "screening-diagnosis-evaluation system" employed at the levels of village/town, district/county, and province/city, the children were screened for seven indicators, i.e., family history of CHD, dyspnea, cyanosis, unique facial features, other congenital malformations, heart murmurs, and blood oxygen saturation (SpO<95%). Children who were positive for one or more indicators accepted echocardiography (ECG) for the diagnosis of CHD. CHD patients were evaluated for disease progression, given guided treatments, and followed-up by pediatric cardiologists.

RESULTSScreening was performed for 10 005 out of the 10 281 children enrolled in the study (97.32% response rate). Among the 175 children who were positive for the indicators, 166 underwent ECG and 60 (0.6‰) were diagnosed with CHD, including 46 cases of simple CHD (76.65%), 11 cases of combined CHD (18.33%), and 3 cases of complex CHD (5.00%). Of the 7 screening indicators, heart murmur had the largest area under the ROC curve for the diagnosis of CHD. In addition, a combination of screening indicators (heart murmur, unique facial features, and other congenital malformations) was most effective for screening out CHD. The CHD patients were given surgical or intervention treatments, and followed up for 6 to 18 months. Ten patients improved without treatment, 13 patients received interventional or surgical treatment, 1 patient died of non-cardiac reasons. The remaining 36 patients were subjected to further follow-up.

CONCLUSIONSHeart murmur alone and in combination with unique facial features and other congenital malformations are valuable tools for CHD screening in children aged 0-3 years. The "village/town-district/county-province/city" screening-diagnosis-evaluation systems are useful for the early detection, diagnosis, and treatment of CHD in infants and young children from the rural areas of Chongqing.

Child, Preschool ; Female ; Follow-Up Studies ; Heart Defects, Congenital ; diagnosis ; Heart Murmurs ; diagnosis ; Humans ; Infant ; Infant, Newborn ; Male ; Oxygen ; blood

A series of new oxime and oxime ethers compounds were designed and virtually screened with target using the Molecular Operating Environment (MOE) software. Twelve unreported compounds including 4 oximes and 8 oxime ethers were synthesized with benzene, toluene, methoxybenzene and chlorobenzene as initial raw materials. Structures of compounds were elucidated by ¹H NMR, ¹³C NMR and MS. The results of bioactive screening showed that a part of compounds displayed obviously anti-HBV activities. Inhibitory activities of compounds 4B-2 in secretion of HBsAg and HBeAg were IC_{50 HBsAg}=81.15 μmol·L^-1, SI_HBsAg=9.20 and IC_{50 HBeAg}=90.66 μmol·L^-1, SI_HBeAg8.24, respectively. Preliminary structure-activity relationship study shows that methyl oxime ethers displayed better anti-HBV activities than the oximes.

OBJECTIVETo explore natural herbs to maintain the bactericidal activity of hydrogen peroxide (H).

METHODSEighteen extracts of Chinese herbs were prepared complying with the standard protocol. Each of the solutions was then mixed with 1% H2O2. The mixtures were handled with two approaches: autoclaved daily for one, two or three times; stored at room temperature from one through five years. Then the bactericidal activity were evaluated by assaying the minimal bactericidal concentration (MBC) and minimal inhibitory concentration (MIC) against Gram positive (Staphylococcus aureus, ATCC25923) and Gram negative (Escherichia coli, ATCC12421) bacteria.

RESULTSWhile mixed with 1% H2O2, 10 out of 18 kinds of assessed Chinese herbs displayed MBC values at 1:12800 or higher after three times of autoclaving, and 8 of them preserved such level of MBC value after stored at room temperature for three years. Some Chinese herbs, i.e. R. Scutellariae, R. Coptidis, R. Bupleuri, H. Epimedii, C. Phelledendri and F. Chrysanthemi, can significantly maintain the bactericidal activity of diluted H2O2.

CONCLUSIONSCertain Chinese herbs can effectively stabilize the bactericidal activity of H2O2 undergoing autoclave or long-term storage. This paper reported a brandnew pharmaceutical function of Chinese herbs and provided experimental data for the potential enhancement of H2O2 usage while its stability level is promoted.

Anti-Bacterial Agents ; pharmacology ; Drugs, Chinese Herbal ; pharmacology ; Escherichia coli ; drug effects ; Hydrogen Peroxide ; pharmacology ; Microbial Sensitivity Tests ; Staphylococcus aureus ; drug effects ; Sterilization ; Time Factors

Objective To investigate the plantar force characteristics during human walking and running under different gravity environment. Methods Seven healthy male volunteers walked and ran in vertical position on a weight-loss suspension treadmill under simulated Mars gravity (1/3 G) and lunar gravity (1/6 G), and traditional earth gravity (1 G) respectively at three different velocities (3, 7 and 10 km/h). During the exercise, parameters such as stance phase, plantar force, and gait balance in gait cycle were analyzed by using the F-scan insole pressure distribution measurement system. Results At the same velocity during a gait cycle, the contact phase was significantly shorter with the decrease of gravity, but the swing phase was significantly longer (P<0.01). With the increase of velocity, the contact phase was obviously reduced (P<0.01), while the swing phase was unaffected (P>0.05). The peak and average plantar force, force integrity were significantly reduced with the decrease of gravity. Under normal gravity, the increase of velocity could lead to an obvious increase in peak and average plantar force and an obvious decrease in force integrity. While under simulated lunar and Mars gravity, no significant changes were found in plantar force (P>0.05). Under the three gravities, the ratio of vertical impact was quite different in between (P<0.05), but no significant difference was found in the phase symmetry index. Conclusions As compared to normal gravity environment, parameters benefiting for skeleton and muscle function such as plantar force and contact phase were found to be much smaller under low gravity environment, indicating the necessity of considering these factors when designing countermeasures or exercise prescriptions for space flight so as to sustain the astronaut’s normal function of skeleton and muscle.

OBJECTIVETo study the effects of post-discharge formula (PDF) for preterm infants, breast milk (BM) and term infant formula (TF) on increase rates of body weight, length and head circumference in preterm and low-birth-weight infants (PLBWIs) from discharge to 3 months after birth, and to provide a reference for the choice of feeding pattern for PLBWIs.

METHODSA total of 407 PLBWIs discharged from the newborn departments of ten hospitals in Guangzhou City and Foshan City in Guangdong Province, China were chosen for this study. According to feeding pattern, they were assigned to three groups: PDF-fed (n=258), BM-fed (n=58) and TF-fed (n=91). Their body weight, length and head circumference were measured at 3 months after birth, and the increase rates of growth indices relative to baseline values (at birth) were calculated and compared.

RESULTSAt 3 months after birth, the PDF-fed group had significantly greater body weight, length and head circumference than the BM-fed and TF-fed groups (P<0.05). The increase rates of body weight and length were significantly higher in the PDF-fed group than in the BM-fed and TF-fed groups (P<0.05).

CONCLUSIONSCompared with those fed with BM and TF after discharge, the PDF-fed PLBWIs have higher increase rates of body weight and length and show greater body weight and length at 3 months after birth. However, further study is needed to investigate the long-term effects.

Body Height ; Body Weight ; Breast Feeding ; Feeding Behavior ; Female ; Humans ; Infant ; Infant Formula ; Infant, Low Birth Weight ; growth & development ; Infant, Newborn ; Infant, Premature ; growth & development ; Male

BACKGROUNDData on the epidemiology of hypertension in Chinese non-dialysis chronic kidney disease (CKD) patients are limited. The aim of the present study was to investigate the prevalence, awareness, treatment, and control of hypertension in the non-dialysis CKD patients through a nationwide, multicenter study in China.

METHODSThe survey was performed in 61 tertiary hospitals in 31 provinces, municipalities, and autonomous regions in China (except Hong Kong, Macao, and Taiwan). Trained physicians collected demographic and clinical data and measured blood pressure (BP) using a standardized protocol. Hypertension was defined as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, and/or use of antihypertensive medications. BP < 140/90 mmHg and < 130/80 mmHg were used as the 2 thresholds of hypertension control. In multivariate logistic regression with adjustment for sex and age, we analyzed the association between CKD stages and uncontrolled hypertension in non-dialysis CKD patients.

RESULTSThe analysis included 8927 non-dialysis CKD patients. The prevalence, awareness, and treatment of hypertension in non-dialysis CKD patients were 67.3%, 85.8%, and 81.0%, respectively. Of hypertensive CKD patients, 33.1% and 14.1% had controlled BP to < 140/90 mmHg and < 130/80 mmHg, respectively. With successive CKD stages, the prevalence of hypertension in non-dialysis CKD patients increased, but the control of hypertension decreased (P < 0.001). When the threshold of BP < 130/80 mmHg was considered, the risk of uncontrolled hypertension in CKD 2, 3a, 3b, 4, and 5 stages increased 1.3, 1.4, 1.4, 2.5, and 4.0 times compared with CKD 1 stage, respectively (P < 0.05). Using the threshold of < 140/90 mmHg, the risk of uncontrolled hypertension increased in advanced stages (P < 0.05).

CONCLUSIONSThe prevalence of hypertension Chinese non-dialysis CKD patients was high, and the hypertension control was suboptimal. With successive CKD stages, the risk of uncontrolled hypertension increased.

Adult ; Aged ; Awareness ; Female ; Humans ; Hypertension ; complications ; epidemiology ; therapy ; Male ; Middle Aged ; Prevalence ; Renal Insufficiency, Chronic ; complications