Peculiar approaches to the estimation of the severity of harm to health in children with non-fatal injuries

The medico-legal estimation of non-fatal injuries in the children and adolescents is presented. The data obtained have been used to develop and substantiate the algorithm of forensic medical expertise of such injuries. Scientifically sound criteria have been proposed to be used for the purpose of expert estimation of the severity of harm to health associated with non-fatal injuries taking into consideration their clinical manifestations. The procedures of forensic medical expertise for the estimation of the harm to health have been analysed with special reference to non-fatal injuries in children and adolescents. Main attention was given to the accompanying strategic, organizational, and methodological errors. The approaches to their prevention and correction are described.     

Detection of microRNAs in DNA Extractions for Forensic Biological Source Identification

Molecular‐based approaches for biological source identification are of great interest in the forensic community because of a lack of sensitivity and specificity in current methods. MicroRNAs (miRNAs) have been considered due to their robust nature and tissue specificity; however, analysis requires a separate RNA extraction, requiring an additional step in the forensic analysis workflow. The purpose of this study was to evaluate miRNA detection in blood, semen, and saliva using DNA extraction methods commonly utilized for forensic casework. RT‐qPCR analysis revealed that the tested miRNAs were consistently detectable across most tested DNA extraction methods, but detection was significantly reduced compared to RNA extracts in some biological fluids. DNase treatment was not necessary to achieve miRNA‐specific results. A previously developed miRNA panel for forensic body fluid identification was evaluated using DNA extracts, and largely demonstrated concordance with results from samples deriving from RNA extracts of semen, blood, and saliva.     

Validation studies of an immunochromatographic 1-step test for the forensic identification of human blood.

An immunochromatographic 1-step test for the detection of fecal occult blood was evaluated for applicability for the forensic identification of human blood in stained material. The following experiments were conducted: 1) determination of the sensitivity and specificity of the assay; 2) evaluation of different extraction media for bloodstains (sterile water, Tris buffer pH 7.5 provided in the test kit, 5% ammonia); 3) analysis of biological samples subjected to a variety of environmental insults; and 4) evaluation of casework samples. This immunochromatographic 1-step occult blood test is specific for human (primate) hemoglobin and is at least an order of magnitude more sensitive than previous methods for detecting human hemoglobin in bloodstains. The antigen is insensitive to a variety of environmental insults, except for exposure to certain detergents and household bleaches and prolonged exposure to certain preparations of luminol. The entire assay can be conducted in field testing conditions within minutes. When in the laboratory the supernatant from a DNA extraction is used for the assay, there is essentially no consumption of DNA for determining the presence of human hemoglobin in a forensic sample. The data demonstrate that this test is robust and suitable for forensic analyses.     

ELISA-based determination of opiates in purulent transformation of cadaveric material

Abuse of drugs has been a topical issue up to the present-day. Opiates like morphine and heroin are still prevalent. The routine methods of determination of drugs in blood made within the forensic medical expertise are time-consuming and samples must be specially prepared for them. ELISA, when used for the determination of opiates in blood and urine, significantly cuts the test time. According to our research results, the diagnosis of opiates by ELISA is advisable at the preliminary stage of the forensic expertise of cadaver; the method is informative, which is of extra importance in cases of purulent transformation of cadaveric material.     

The modern concepts of placental pathology and its role in perinatal mortality in the context of forensic medical practice

The modern concepts of placental pathology are considered and analysed in the context of forensic medical practice. The most promising approaches to the application of fundamental knowledge of placental pathology (including morphometric methods) for the purpose of forensic medical expertise are discussed.     

Forensic medical aspects of bone tissue injuries and pathology

This paper reports the results of a number of investigations into forensic medical aspects of bone tissue injuries and pathology that may be of value, both theoretical and practical, for the further studies in this field. The data obtained shed light on the influence of bone porosity on the mechanism of fractures and processes of reparation in the bone tissue. Moreover, they can be used for the purpose of forensic medical expertise.     

妇产科医疗纠纷司法鉴定82例分析

目的研究妇产科医疗纠纷鉴定案件的一般规律及其医疗过失的特点．为法医学鉴定提供理论支持。方法对2002--2008年在华西法医学鉴定中心鉴定的82例妇产科医疗纠纷医疗过失案例进行回顾性分析。结果妇产科医疗纠纷司法鉴定案例逐年增多;发生纠纷的医院以市（区）级与县级医院为多见,发生纠纷的案件中又以分娩和手术者为多见;医疗过失的主要原因为医疗技术缺陷与医疗管理缺陷。结论法医学鉴定时应参照临床医疗规范,考察医师义务履行情况,重点观察有无医疗技术缺陷或管理缺陷。     

A new algorithm for the establishment of blood relationship based on the application of the dermatoglyphic technique

An original classification of dermatoglyphic features is proposed taking into consideration their inter-relations in conjunction with the new principles of comparative studies. A new and improved algorithm for the establishment of blood relationship has been developed based on the application of the dermatoglyphic technique. The method is recommended for the use in forensic medical expertise for the purpose of estimation of the probability of paternity, maternity, and substitution of children. Moreover, it may find application for the indirect (via establishment of blood relationship) identification of personality of an unknown subject.     

试论法医学鉴定和医学鉴定之差异

随着司法鉴定制度改革的不断深入,越来越多的临床医学从业人员加入到法医学鉴定的队伍中来。在这种大趋势下,一个极易形成的误区就是把医学鉴定与法医学鉴定混淆起来。事实上,两者虽然在许多方面有相似之处,但毕竞有本质的不同。医学鉴定重视的是损伤本身,而法医学鉴定则是在医学鉴定基础之上,从法律规定的角度为损伤定性。因此,要求我们的法医学鉴定人既要重视医学知识的培训和提高,也要学习法律知识和法医学知识,才能更好地完成司法鉴定工作。     

Glycated hemoglobin: a useful post-mortem reference marker in determining diabetes

Glycated hemoglobin (HbA(1c)) has been demonstrated to be a useful marker for long-term glucose control in diabetes. This parameter characterizes each non-enzymatic fixation of glucose on hemoglobin. It is a useful test in addition to periodic glycemia controls since it reflects the mean glycemia of the past 60 days. We studied the conservation of HbA(1c) at 4 degrees C as a function of time with different anti-coagulants and preservatives (3, 6 months, 1 year). A total of 106 tests were performed using the high performance liquid chromatography (HPLC) method dedicated to the semi-automatic analysis of HbA(1c) (Bio-Rad) and we applied the method in forensic cases. Conservation at 4 degrees C was good for as long as 3 months in blood samples collected with fluoride and 6 months in samples collected in a dry or in a heparinized tube. In non-diabetic subjects, HbA(1c) reference values obtained from forensic samples were identical to those of living controls (3.5-6.25% of total hemoglobin). All positive HbA(1c) results were confirmed by a medical evaluation. This method was successfully applied to five forensic cases. In cases of increased acetonemia, acetone or isopropanol are easily measured. However, in some unexplained post-mortem circumstances, increased HbA(1c) permits to differentiate alcoholic or starvation ketoacidosis from the diabetic cases. Glycated hemoglobin should, therefore, be considered the forensic marker of choice in the post-mortem diagnosis of a diabetic disorder and demonstrates its usefulness in post-mortem validation.     

Use of amelogenin test for DNA sex appurtenance in analysis of mixed biological traces

Theoretical and experimental study of amelogenin tests system for identification of DNA sex appurtenance has been performed. In many cases amplification can fail to reflect the true quantitative ratio between the mixture components during typing sex-specific variants of amelogenin gene in DNA preparations of mixed sex appurtenance. In practical studies these properties of the amelogenin system can lead to difficulties and errors in interpretation of the results of forensic medical expert evaluations, and we therefore studied the use of amelogenin DNA test for identification of sex appurtenance of mixed biological traces and compared the characteristics of autosomal PDAF system and amelogenin system for sex identification in analysis of DNA mixtures.     

25例医疗纠纷的法医临床学鉴定回顾性分析

目的探讨医疗纠纷的法医临床学鉴定及其相关问题。方法对25例医疗纠纷案例资料进行了回顾性整理分析。结果医疗失误16例,其中有不良后果的10例,均发生于手术科室;无医疗失误9例。结论医疗纠纷法医学鉴定过程中认定医疗失误是基础,认定医疗失误与不良后果的关系是关键。     

ABO genotyping by polymerase chain reaction.

ABO blood group system's genotyping by polymerase chain reaction in genomic DNA level is developed. The positions of nucleotide 258 and 700 of cDNA from A transferase were used to distinguish A, B, and O alleles by restriction enzyme digestion. To identify the 258th nucleotide, a 199- or 200-bp DNA fragment was amplified by PCR and digested with Kpn I. For the 700th nucleotide, a 128-bp PCR amplified fragment was designed and digested with Alu I. By examining the DNA fragment digested patterns, ABO genotypes were easily determined. Results obtained using this method on 20 ABO-known peripheral blood samples showed that this new technique could provide accurate ABO genotype. Biologic forensic samples, such as, blood stains, saliva stains, semen stains, hair, bone tissue, and semen contaminated with vaginal secretion were also successfully typed. This rapid, sensitive and reliable method should be applicable not only in forensic identification but also in medical examination.     

A novel method for ABO genotyping using a DNA chip

ABO genotyping is often performed to identify the blood type of decomposed samples, which is difficult to be determined by a serological test. In this study, we developed a simple method for ABO genotyping using a DNA chip. In this method, polymerase chain reaction-amplified and fluorescent-labeled fragments in the ABO gene and primate-specific D17Z1 were hybridized with DNA probes on a chip designed to detect single nucleotide polymorphisms (SNPs) in the ABO gene and part of the D17Z1 sequence. Using blood samples from 42 volunteers and 10 animal species, we investigated whether the chip could be used to detect SNPs in the ABO gene and the D17Z1 sequence. This method was then applied to various forensic samples, and it was confirmed that this method was suitable for the simultaneous analyses of ABO genotyping and species identification. This method fulfills the recent need for the development of rapid and convenient methods for criminal investigations.     

Using hydrophilic adhesive tape for collection of evidence for forensic DNA analysis

Known exemplar samples of human DNA have traditionally been body fluids, such as blood, saliva, and semen. In each case, the presence of water is a risk for the bacterial growth, which may degrade the DNA evidence. In this study, the authors have developed a method that employed a hydrophilic adhesive tape (HAT) for collecting DNA evidence. The HAT method was used to remove surface cells from relatively hairless areas on the body. The area examined were ankle, arm, behind the ear, between fingers and back of the neck. The HAT was then dissolved in the extraction buffer. DNA typing was performed at vWA, THo1, F13A1, and FES loci using the short tandem repeat (STR) analysis. Our results show that the samples collected from ear give the best results with a success rate of 100%. All subjects tested by this method had known STR genotypes established from buccal swabs. The authors' results suggest that the HAT method can be used as a less invasive method for collecting biological evidence for forensic DNA analysis. In addition, this collection method should reduce the risk of DNA degradation due to the moisture, which is encountered using conventional collecting methods.     

一例药物过敏性休克死亡的医疗问题鉴定分析

目的探讨药物（低分子右旋糖酐）过敏性休克医疗纠纷案件的法医学鉴定思路及关键点，从而为审判提供划分侵权责任及医疗赔偿的科学依据。方法详细报道一例低分子右旋糖酐药物过敏性休克死亡的两级医疗事故鉴定，法医学鉴定及二次不同的法院判决结果的医疗纠纷案例。结果两级医疗事故鉴定均认为该例属医疗意外，不属医疗事故，一审判决驳回起诉。法医学鉴定认为在对该例的抢救过程中确存在不当之处；患者确因药物（低右）过敏性休克死亡，未发现院方有违反医疗常规的行为，对该例的治疗方案属非必要治疗措施。在抢救过程中，肾上腺素没有作为首选用药，肾上腺素应用不及时，药量不充足。因抢救地点的限制致使抢救质量不好。据此，二审判决被告院方对患者方予以赔偿。结论药物过敏性休克的法医学鉴定应注重：①全面审查所提供的详细医疗材料，分析整个医疗过程的临床变化特点；②全面尸检；③进行药品检验、毒物分析；④排除疾病及其它死因；⑤进行确证死因的检验。在此基础上分析确定死因及医疗过程是否存在问题，如存在医疗不当之处，分析此种医疗不当在患者的死亡中的关系比例，并适当表述鉴定意见。     

Typing of mitochondrial DNA from isolated cells of the human buccal epithelium

The authors have developed a method for molecular-genetic analysis of DNA from isolated cells for the purpose of forensic medical diagnostics. The method is based on the use of the laser capture microdissection (LCM) technology in combination with typing of mitochondrial DNA. Optimization of the conditions for amplification of polymorphic mtDNA loci in preparations containing minimal amounts of the genetic material was accomplished at the initial stage of the work. To this effect, the two-round polymerase chain reaction was employed that allowed the amplified material to be accumulated in the amount sufficient for sequenation. At the next stages, the system thus obtained was tested on the cell model (using isolated cells of human buccal epithelium). It was shown that the proposed method is suitable for the analysis of specific mtDNA characteristics in a single human cell.     

Development of the Investigator STR GO! Kits for the direct amplification of reference samples

STR analysis of forensic reference samples can be performed using a novel direct amplification method. Two assays have been developed for this purpose. One covers the CODIS set of markers and the other covers the ESS including SE33. The method gives balanced DNA profiles with high first pass rates for buccal swabs and blood and buccal cells on FTA paper. The addition of SNP primers compensates for profile imbalances caused by three known binding site mutations.     

Shrunken head (tsantsa): A complete forensic analysis procedure

Based on the analysis of shrunken heads referred to our forensic laboratory for anthropological expertise, and data from both anthropological and medical literature, we propose a complete forensic procedure for the analysis of such pieces. A list of 14 original morphological criteria has been developed, based on the global aspect, color, physical deformation, anatomical details, and eventual associated material (wood, vegetal fibers, sand, charcoals, etc.). Such criteria have been tested on a control sample of 20 tsantsa (i.e. shrunken heads from the Jivaro or Shuar tribes of South America). Further complementary analyses are described such as CT-scan and microscopic examination. Such expertise is more and more asked to forensic anthropologists and practitioners in a context of global repatriation of human artifacts to native communities.     

Forensic pitfalls

The lives of forensic psychiatrists are complicated and subject to stressful experiences because they have elected to interact with a social system very different from their own. This article presents discussion of these frequently troublesome areas commonly encountered by forensic psychiatrists in trying to respond to the law's requests and needs without sacrificing their medical integrity: (1) legitimate definition of expertise; (2) reasonable medical certainty; (3) generally accepted standard of care. They are explored with emphasis on the exercise of self-assessment by the involved forensic psychiatrists lest their incautious application of knowledge and expertise become pitfalls of their own making.