108例外伤后椎间盘病变法医学鉴定分析

在法医学鉴定中，经常遇到外伤后由临床医生诊断为椎间盘病变的鉴定例，即所谓外伤后椎间盘病变。由于椎间盘病变的类型不一，且原因复杂，因此，如何分析、判定椎间盘病变与外伤的关系是法医学鉴定中的难点。本文通过对108例外伤后椎间盘病变的病变类型、年龄以及外伤后临床表现等特点的分析，研究和探讨在法医学鉴定中如何分析、判定椎间盘病变与外伤之间的关系。     

中老年人腰部外伤影像学检查分析3例

中老年人腰部因外伤经影像学检查,常会发现椎体双凹变形、椎弓峡部裂、退行性脊椎滑脱等变化,需要鉴别系外伤造成,还是老年性病变所致,本文通过对相关3例的鉴定,对此进行分析探讨。1案例资料例1女,63岁。因纠纷被他人推倒后臀部着地,感觉腰部疼痛不适10d,法医学检查未发现明显外伤,无压痛及叩痛。医院诊断:腰4、腰5椎体压缩性骨折,阅伤者提供的腰椎正侧位X光片示:各椎体骨质疏松,腰4、腰5椎体双凹变形。MR I检查,未发现椎体内水肿、出血。鉴定认为:腰椎双凹变形与此次外伤无关。例2男,49岁。因口角被他人用脚踢伤腰部后疼痛6d,医院诊断:腰…     

胎盘血肿致死胎的法医学鉴定

孕妇外伤能引起胎盘血肿,但较为少见,特别是胎盘血肿与疾病共存时,各自对胎儿死亡的参与程度,与损伤程度鉴定有直接的关系.在法医学鉴定中如何全面地收集鉴定资料,如何选择最佳方法进行材料汇总,如何对它们之间的伤病关系进行客观的分析、论证,准确、及时地出具鉴定结论,是法医学鉴定中的难点.本文结合胎盘的结构和功能,综述了常见引起胎盘血肿的原因,血肿部位和时间与损伤的关系,胎盘疾病和损伤的参与度分析,以及胎儿的死亡原因、死亡机理,为胎盘血肿致死胎的法医学鉴定提供参考.     

脊柱脊髓伤与病鉴定的法医学研究

目的　研究脊柱脊髓涉及外伤鉴定的法医学特点。方法　选择活体损伤鉴定１ ０００ 例, 涉及外伤后脊柱脊髓鉴定的分成四组。Ⅰ组： 无伤无病的情况。Ⅱ组： 脊柱脊髓原有病变, 结果与外伤无关。Ⅲ组： 脊柱脊髓原有病变与此次外伤共存, 依据《损伤参与度评定标准》进行评定。Ⅳ组： 外伤导致脊柱脊髓损伤。结果　涉及脊柱脊髓鉴定的８６ 例, Ⅰ组２２ 例, Ⅱ组１３ 例, Ⅲ组１８ 例, Ⅳ组３３ 例。Ⅱ、Ⅲ组以中老年为多, 原有自身疾病共有８ 种, Ⅲ组损伤参与度１ 级（２５ ％ ） 的１０ 例, ２ 级（５０ ％ ） 的６ 例, ３级（７５ ％ ） 的２ 例。Ⅳ组２４ 例胸腰椎损伤, 颈椎／ 脊髓损伤９ 例。结论　资料表明, 法医学鉴定与临床医学有许多不同的特点, 依据临床医学的理论和经验, 研究法医学问题十分必要     

脑积水的法医学鉴定（附1例报告）

脑积水的法医学鉴定（附１例报告）刘敏，吴家脑积水为颅脑外伤后继发病变之一，但引起脑积水的病因繁多，除颅脑外伤外，尚有诸多颅脑疾病及医源性因素均可引起，且其临床病程中症状体征变化复杂。在法医学鉴定中确定脑积水的原因较为困难，作者在工作中遇到１例，现就有...     

二分髌骨影像学征象及其法医学意义

二分髌骨较罕见,系因青春期二个或多个髌骨骨化中心(化骨核)未融合而形成,临床误诊为骨折的屡有报道。为提高对二分髌骨影像征象的认识,避免法医学鉴定失误,现分析行法医学鉴定的3例二分髌骨资料并结合文献,阐述其形成原因、组织学变化、影像学征象及临床症状体征。3例被鉴定人均为成年,因膝关节外伤后出现膝部疼痛,曾被医疗单位诊断为髌骨骨折,委托损伤鉴定2例,伤残评定1例。依据Saupe’s分型法,其中Ⅲ型2例,Ⅱ型加Ⅲ型1例。在法医学鉴定实践中,熟知二分髌骨影像学征象并与髌骨骨折鉴别,可确保鉴定结论的客观、准确。     

17例颈椎外伤合并颈椎退行性病变的伤病关系分析

目的研究颈椎外伤合并颈椎退行性病变的法医学鉴定案件特点,探讨如何利用临床资料,法医学检查和影像学检查等对损伤和病变参与程度进行认定等问题。方法收集17例颈椎外伤合并颈椎退行性病变的法医学鉴定案例,对其年龄分布、损伤方式、损伤程度、影像学表现等进行分析,综合评定伤病关系。结果 17例案件以中老年为主。所有案例均存在椎间盘突出,损伤以过伸性损伤为主。按照影像学表现,将损伤程度和脊椎退变程度进行分级,综合计算伤病参与程度。结论颈椎外伤合并颈椎退行性病变的法医学鉴定案件应综合运用临床资料、法医学体格检查和影像学检查结果进行评定。     

外伤后流产23例法医学鉴定回顾性分析

目的分析外伤后流产案例法医学临床鉴定的特点,探究外伤与流产之间的因果关系。方法收集近年中国医科大学法医学院临床法医学教研室外伤后流产法医学鉴定共23例,总结和分析外伤后流产案例的特点。结果23例外伤后流产法医学鉴定例均为早期流产,体表损伤轻微,伤后短时间内出现阴道流血,并在较短时间内流产。高龄孕妇、农村人口和无业人员所占比例大。结论流产原因较多,对于外伤后流产的法医学鉴定案例,只有排除非外伤性因素后,才能认定为外伤性流产;对于不能排除非外伤性流产因素的案例,可根据具体情况分析损伤为流产的主要原因、次要原因或诱因。     

拳击伤后糖尿病视网膜脱离鉴定1例

在法医学鉴定中,与外伤有关的视网膜脱离的案例并不少见,但如何正确评定视网膜脱离与外伤的关系非常重要.作者报告一典型案例,并就此对与法医学鉴定相关的问题予以分析讨论.     

眼睑下垂的法医学鉴定

头面部外伤后主诉有一侧或双侧眼睑下垂的案件时有发生.如何确定其有无眼睑下垂及其眼睑下垂是否为外伤所致,也是法医学鉴定中的一个难点.笔者曾复核一例眼睑下垂的鉴定,现结合有关文献,就鉴定中的一些体会叙述如下.     

Bleedings into the Anterior Aspect of the Intervertebral Disks in the Lumbar Region of the Spine as a Diagnostic Sign of Hanging

Abstract: Simon’s hemorrhages are ventral intervertebral hemorrhages located beneath the anterior longitudinal ligament that have been described in cases of hanging and tend to appear in the lumbar region of the spine. There are also reports of Simon’s hemorrhages in cases of blunt trauma, asphyxia, drowning, and putrefaction. In a prospective analysis of 2226 autopsies, we found Simon’s hemorrhages in 65 out of 178 cases of hanging and also in 17 cases in a group of 350 controls with various causes of death. The relative frequency of occurrence of Simon’s bleedings in cases of hanging was 37%. Simon’s hemorrhages can be considered an objective vital finding, which is not absolutely specific for hanging. The absence of hemorrhages in intervertebral disks does not exclude death by hanging. This study suggests that Simon’s bleedings in cases of hanging are more frequent in rather young individuals, in cases with free body suspension, and in individuals with minimal degenerative changes in the lumbosacral part of the spinal column.     

Extraction of DNA from decomposed human tissue. An evaluation of five extraction methods for short tandem repeat typing

Hyperpolymorphic short tandem repetitive DNA sequences, STRs or microsatellites, have become widely used in human identification, particularly in criminal cases and in mass disasters. In such cases the substrates for the analyses may be decomposed biological material, a fact that has to be taken into account when choosing the appropriate casework methods. In this paper we report the evaluation of five different DNA extraction methods, namely the phenol-chloroform, the silica based, the InstaGene Matrix (BioTest), the glass fiber filter, and the Chelex based methods. The substrates for the analyses are decomposed human liver tissue specimens from forensic autopsy cases. Extracted DNA was quantified and DNA profiled by a set of seven STRs. We have compared laboratory time consumption and costs of the five methods, showing that the Chelex method is the more rapid and less expensive of the methods, the phenol-chlorophorm and silica extractions being the most time consuming and resource demanding ones. A full profile was obtained by the silica method in nine out of ten cases and this method failed to give a reliable type in four out of 70 STR analyses. The phenol-chlorophorm and the glass fiber filter methods failed in 16 analyses, the InstaGene Matrix (BioTest) in 25 and the Chelex extracts in 56 of the 70 STR analyses. By multiple logistic regression we show that the difference between the silica procedure and the other methods are statistically significant. In our hands, the silica gel extraction procedure is an obvious choice when the biological material available is decomposed human tissue--even if this procedure is one of the more laborious ones.     

Two anaphylactic deaths after chemonucleolysis.

Chemonucleolysis is a procedure for treatment of low back pain due to discogenic disease in which the drug chymopapain is injected into lumbar disks to produce chemical dissolution of the nucleus pulposus. More than 15,000 cases have been treated by chemonucleolysis world-wide. Anaphylaxis after the injection of chymopapain occurs in about 1% of such cases. The two cases described in this paper are the only known deaths due to anaphylaxis. Both patients suddenly became hypotensive after injection of chymopapain into a disk. One patient died shortly after this, whereas the second patient died of the complications of prolonged shock.     

Significance of inflammatory changes in the brainstem in forensic autopsy cases

Brain stem encephalitis is an uncommon disease. In order to assess the significance of inflammatory changes in the brain stem in a forensic autopsy material we reviewed the findings over a 12-year period. Between January 1st 1982-December 31st 1993, neuropathological examination of the brain was carried out in 29% of the autopsy cases from the Institute of Forensic Medicine, University of Oslo. Out of 4546 brains, 110 (2.2%) showed microglial nodules and perivascular lymphocytic cuffing in the lower brain stem. In 66 of the cases (60%), the abnormalities were limited to the nucleus and/or the spinal tract of the fifth cranial nerve. Only 16 of the 39 cases with more widespread changes, diagnosed as brain stem encephalitis, had a serious underlying or concomitant disease. Three particular cases of brain stem encephalitis are reported in more detail. In all three cases we suggest that the brain stem inflammatory changes may be either the direct or a contributory cause of death.     

Is he or is he not the father?: Pros,Cons effect of following standardized interpretations

Parentage studies in the Lebanese population, which has consanguineous marriage rates ranging from 32% up to 44% and endogamy average of 82%, could be prone to high levels of uncertainty since individuals involved in the parentage dispute may share alleles more than in random mating. Consequently, falsely alleged parents are less likely to exhibit allele mismatches with the child's genotype, in particular when the investigations is conducted in limited conditions such as Duo families and using low STR markers profile sizes. In the present study, ten informative paternity cases showing one mismatch were reevaluated. Different profiles (SGM, Identifiler, PP16HS or ESI 17 kits as well as 24 STR marker combination profile) were used throughout. Also, Duo cases were simulated out of the Trio cases. In several Duo cases, results shifted from non-parenthood to positive parentage conclusions when increasing STR markers from 12 to 16 and/or 24. However, no significant difference in the paternity conclusions could be observed for Trio families when using different profile sizes unless when using the SGM profile. When simulating Duo cases from Trio ones, compromising results were obtained under SGM, Identifiler, PP16HS and/or ESI 17 markers. All compromising cases were resolved under 24 markers. In conclusion, due to the effect of consanguinity and endogamy on the Lebanese population, we recommend the use of 24 STR markers DNA profile for any DNA interpretation, especially when accepting Duo cases requests.     

Start-up of the criminal genetic database in Mendoza,Argentina

The usefulness of DNA databases is widely known and demonstrated. After the successful experiences of the UK and the USA the creation of databases increased rapidly around the world. In Latin America the implementation was slower and more problematic, with Chile and Uruguay being the first to implement them. In Argentina the problems were greater and more persistent.Although the lack of legislation or applicable laws is a generalized problem, the most difficult one to overcome was the lack of decision, interest and resources by those responsible at an institutional level.In 2016, Mendoza province modified its database law by creating the “Registro Provincial de Huellas Genéticas Digitalizadas” which allowed the process of construction and consolidation to begin. From January 2017 all prisoners, convicted and imputed of all types of crimes began to be sampled. This made the database to grow rapidly, reaching 13.821 samples in that year.During 2018, in addition to the daily imputed individuals, we began with the sampling from all the Mendoza Police Department, including the Scientific Police that deals with the crime scene. At present the database has a total of 40.652 individuals.In August 2018, the FBI's CODIS system was installed, and later the data loading process began. In 12 months we have reached 87 match or hits of which 46 correspond to sexual assault, 17 to robbery, 16 to homicides and the rest to other cases. Given that within the sexual abuse cases we were able to identify several serial sexual offenders, the 87 hits allowed clarifying 174 criminal cases.These results reaffirm the potential of the databases and gives a light of hope for victims of crime.In this work we present the advances and challenges that we faced in a chronological order.     

现场足迹查询比对系统的可行性研究及应用

目的建立现场足迹查询比对系统,加强现场足迹的利用意识。方法以现场足迹文本查询、现场足迹图形特征查询和两者复合查询为比对系统的主要内容,并对现场足迹文本字段和足迹图形进行统一的科学界定。结果具有输入、浏览和异地查询功能。结论现场足迹查询比对系统能提高足迹的认定率,提高案件的并串质量和速度,达到破案目的。     

Mini-SGM multiplex in degraded samples

A five Mini-SGM multiplex which encompasses TH01, FGA, D18S51, D16S539 and D2S1338, common STR markers in human identity testing, have been performed. Two cases with different biological tissues were selected to illustrate the usefulness of this technique in forensic casework. The use of routine methodology can sometimes give only a partial genetic profile or no profile at all. However, using the Mini-STR technique, a full profile was obtained for the majority of the degraded samples. We conclude that the Mini-SGM methodology is more sensible than routine methodology for degraded samples, although a full genetic profile is not obtained in all cases as results are still very much sample-dependent. This Mini-SGM multiplex can be considered a useful tool to complement conventional STR analysis in degraded samples.     

Resolving relationship tests that show ambiguous STR results using autosomal SNPs as supplementary markers

When using a standard battery of STRs for relationship testing a small proportion of analyses can give ambiguous results – where the claimed relationship cannot be confirmed by a high enough paternity index or excluded with fully incompatible genotypes. The majority of such cases arise from unknowingly testing a brother of the true father and observing only a small number of exclusions that can each be interpreted as one- or two-step mutations. Although adding extra STRs might resolve a proportion of cases, there are few properly validated extra STRs available, while the commonly added hypervariable SE33 locus is four times more mutable than average, increasing the risk of ambiguous results. We have found SNPs in large multiplexes are much more informative for both low initial probabilities or ambiguous exclusions and at the same time provide a more reliable genotyping approach for the highly degraded DNA encountered in many identification cases. Eight relationship cases are outlined where the addition of SNP data resolved analyses that had remained ambiguous even with extended STR typing. In addition we have made simulations to ascertain the frequency of failing to obtain exclusions or conclusive probabilities of paternity with different marker sets when a brother of the true father is tested. Results indicate that SNPs are statistically more efficient than STRs in resolving cases that distinguish first-degree relatives in deficient pedigrees.