PTSD及其法医学相关问题

随着国外对PTSD(posttraumatic stress disorder)的深入研究以及中国心理卫生事业与法医学事业的发展,相关领域的学者开始从事这一方面的研究并取得了不少成就。本文结合国内外的一些理论研究与实践成果,对PTSD的概念、诊断与鉴别以及相关法医学问题作一综述和探讨。     

DNA甲基化标记法医学应用探讨

CpG的胞嘧啶在DNA复制后多数被甲基化,5-甲基胞嘧啶的分布是贮存表遗传信息的主要形式。近年来研究表明,DNA甲基化标记具有信息含量丰富、相对稳定、检测和结果处理方便、可与SNP联合分析等优点,是一种新的强有力的遗传分析工具。基因组的甲基化差异可用甲基化敏感性限制酶、重亚硫酸盐转化、Maxam-Gilbert裂解等技术来分析。人类基因组甲基化谱有时空特异性、亲源特异性、病理特异性等特征,在法医亲子鉴定、个人识别等方面有潜在应用价值。     

表观遗传学在法医学应用探讨

表观遗传学指没有DNA序列变化的、可遗传的基因表达改变。主要包括DNA甲基化、X染色体剂量补偿、组蛋白修饰、基因组印记、表观基因组学和人类表观基因组计划等方面的内容。在法医实际检案中常遇到一些特殊问题,如妊娠期胎儿父权的认定,单亲鉴定中亲代必需等位基因的确定,同卵双生子的区分,微量组织来源的鉴定等。本文对表观遗传学的基本内容和在法医学中的应用进行综述,以期为相关研究及实践提供参考。     

性染色体及线粒体DNA遗传标记的法医学应用

对性染色体及线粒体DNA的结构特征、遗传特征等相关基础知识及其遗传标记在法医学领域应用的研究进展等进行了综述,分析了上述各类遗传标记在法医学领域应用的利弊,以促进非常染色体DNA遗传标记在法医学实践中的应用。     

法医骨组织学研究

在实际检案中 ,当现场发现的骨骼残片体积较小时 ,用解剖学观察无法进行骨骼残片的法医鉴定 ,需使用骨组织学的方法进行骨骼残片的个体识别。目前 ,这是法医人类学中一门较活跃的领域 ,即法医骨组织学。法医骨组织学的内容主要包括两个方面 :(1)骨骼残片是否属于人类骨骼 ,或属于何种动物骨骼。这方面的研究包括人类骨骼的组织学特征研究及不同动物的组织学特征研究。 (2 )人类骨骼个体识别的组织学研究。这方面的研究主要包括 ,人类骨骼的组织学特征的年龄判断 ,例如股骨、胫骨、肱骨、锁骨等 ,以及使用骨组织学方法 ,进行人类骨骼的年龄评价的准确性研究。本文对上述内容进行了综述。     

Process-related and criminalistic problems of forensic medicine experts in criminal offenses

The Stockholm Syndrome seems to be an automatic, probably unconscious emotional response to the traumatic experience of being a victim. It affects hostage and hostage-taker alike and serves to unite both, being victims of the siege environment, against outsiders. This positive emotional bond between victim and subject is a defense mechanism of the ego under stress. The priority in dealing with hostage situations is the survival of all participants. The Stockholm Syndrome may save the life of victim and subject alike, as it reduces the subjects tendency towards violence and thus the possible necessity for a seizure by the security forces.     

法医临床学与新冠疾病有关的鉴定问题及思考

2020年1月爆发新型冠状病毒,由疫情引发的各种问题引起社会各界高度重视,疫情过后,相关法律争议会有出现。本文针对疫情可能带来的法医临床鉴定相关问题予以思考,给出了法医临床学鉴定流程管理以及鉴定机构法律风险防控的基本思路。关于人身损害赔偿及工伤补偿中的伤残评定问题,作者具体梳理了7个可能相关的鉴定标准,并指出,肺功能障碍的条款是我们需要重点关注的内容。面对因疫情爆发而引发的医疗损害鉴定问题,作者认为,针对特殊时期的医患纠纷,鉴定人在评价医方的专家注意义务时,应充分考量各种影响因素,提倡对医疗行为相对宽松的处理原则,宜适用合理医师标准(即Bolam标准),来体现对医疗行业的尊重。本文针对新冠疾病疫情可能带来的法医学鉴定问题给予了建议和解决路径,旨在为疫情过后鉴定工作提供新思路。     

骨密度测定在外伤后骨折法医临床学鉴定中的意义

目的测定外伤后骨折者的骨密度,探讨骨折鉴定中骨质疏松和外伤的关系。方法应用双能X线骨密度吸收仪进行骨密度测定,参照世界卫生组织制定的骨质疏松症诊断标准和外伤参与度评定的一般原理,对15例外伤后骨折者的临床法医学鉴定进行分析。结果15例伤者:男6例,女9例,年龄在43~85岁之间;骨密度值在0.354~1.067 g/cm2之间;7例诊断骨质疏松症,外伤参与度为50%,其中5例评定为轻微伤,2例评定为轻伤;其余8例均为骨量减少,评定为轻伤。结论骨密度测量可预测骨折危险性,有助于骨折临床法医学鉴定的伤病关系分析。     

Interpretation problems in a forensic case of abstinence determination using alcohol markers in hair

In a child custody case a mother with a longstanding history of alcohol misuse had to show absolute abstinence for one year. She entered a residential rehabilitation for six months and was tested two months later by way of a hair test for ethyl glucuronide (EtG) with the result of 22 pg/mg in the proximal 0-1cm segment and the segments 1-2 cm and 2-3 cm being negative. This was interpreted as a minimum alcohol intake of 20-50 units per week in the month before sampling. Since the mother denied any alcohol intake a second hair sample was collected seven weeks after the first and analyzed for fatty acid ethyl esters (FAEEs) by a second laboratory. A low concentration of 0.03 ng/mg was measured within the 0-6 cm segment of recently bleached hair and was interpreted as showing no evidence of alcohol use during the last six months. Three further hair samples were analyzed during the next nine months with low EtG values (<2.4-3.3 pg/mg, 0-3 cm segment) and low FAEE values (0.27-0.53 ng/mg, 0-6 cm segment). These findings were summarized as indicating continued low alcohol consumption over the past one year period. As a consequence of the conflicting results, the case was dealt with in a hearing before the Family Division of the High Court of London. It was concluded in the judgment that the evidence did not indicate that the mother had consumed alcohol in the period tested by the hair samples. It was stated that the evidence in this case highlighted the need for the exercise of considerable caution when hair tests for alcohol are being interpreted and relied upon, both generally and particularly in isolation, and that this case is a proper reminder of the need for expert evidence to be given in a manner according to the Practice Direction.     

当前人身伤害赔偿鉴定的几个问题

在审判实践中,涉及刑事、民事人身伤害赔偿案件不断增多.法医鉴定在案件审理中的重要地位已匆庸置疑,审判人员对法医鉴定的要求也越来越高,越来越细.从笔者本地区赔偿案件鉴定情况看,近几年除要求对伤者进行伤情程度鉴定外,还要求对伤残程度、医疗时限、医疗费用等进行鉴定.实践中,法医技术人员与审判人员在对上述问题的认识还不尽一致,有些问题上认识差距较大,确需不断探讨、研究,逐步统一认识,以使案件得以合理公正地解决.     

骨折愈合评估方法的研究进展及其法医学意义

在法医学鉴定中经常需要对骨折形成时间进行鉴定,因此,研究和探讨骨折形成时间的评定方法有着重要的临床及法医学意义.本文综述了超声测量、脉冲测定、数字影像学技术和骨密度检测技术等在评估骨折愈合程度中的应用及其价值.认为综合利用多种评定手段,能为骨折形成时间的法医学鉴定提供科学依据.     

Tasks of research in forensic medicine - different study types in clinical research and forensic medicine

In the last years the research output of forensic medicine has sometimes been regarded as insufficient and as of poor quality, especially when parameters as impact factors and external funding were taken into account. However, forensic medicine has different tasks compared to clinical medicine. The main difference between basic subjects, clinical and forensic medicine is not a lack of scientific efficiency in forensic medicine but is a result of the questions asked, the available methods and specific aims. In contrast to natural-scientific research, forensic science has furthermore important intersections with arts and socio-scientific disciplines. Etiologic and pathogenetic research is of only limited relevance in forensic medicine. Thus, forensic medicine is excluded from these research fields, which are mainly supported by external funding. In forensic medicine research mainly means applied research regarding findings, the probative value and reconstruction as well as examination at different points of intersection between medicine and law. Clinical types of research such as controlled randomised, prospective cross-sectional, cohort or case-control studies can only rarely be applied in forensic medicine due to the area specific research fields (e.g. thantatology, violent death, vitality, traffic medicine, analytical toxicology, hemogenetics and stain analysis). The types of studies which are successfully established in forensic medicine are comparison of methods, sensitivity studies, validation of methods, kinetic examinations etc. Tasks of research in forensic medicine and study types, which may be applied will be addressed.     

Teaching forensic medicine after the reorganization of higher medical education

It is stressed that the Departments of legal medicine in medical institutes can make a valuable contribution to the advancement of physician training in the condition of perestroika in high medical education in our country. The list and method of performing practical studies on legal medicine are presented.     

Frequencies of salivary genetic marker systems in the Japanese population and their application to forensic medicine

Seven salivary polymorphic systems were studied using whole and parotid saliva from random Japanese individuals. The gene frequencies obtained were: Pa⁺ = 0.212, Pb¹ = 1.000, Pb² = 0, Pr¹ = 0.763, Pr² = 0.237, Db⁺ = 0.051, Pm⁺ = 0.409, Ph⁺ = 0.026 and Amy₁^v = 0.013, respectively. Based on these gene frequencies, the chances for exclusion of falsely alleged fathers were calculated. The chance of exclusion on the basis of five salivary polymorphic systems was 0.305. The combined chance of exclusion utilizing only blood, serum and red-cell enzyme polymorphic systems among the Japanese population was 0.919; however, by applying salivary polymorphic systems to the calculation, the total exclusion rose to 0.944.     

类胰蛋白酶及其法医学应用

类胰蛋白酶由肥大细胞表达,以活性形式储存在肥大细胞的脱颗粒中。作为肥大细胞及其脱颗粒的标志,类胰蛋白酶具有多种生物活性,可以促进气道的恢复,调节气道平滑肌细胞的张力和反应性,提高毛细血管的通透性,刺激新生血管的生成,进而启动和加速多种疾病的进程,并与过敏反应、羊水拴塞、注射海洛因过量、外伤致死及SIDS等有关,因而在法医学中有重要的意义。     

allo-HSCT受者DNA嵌合状态研究进展及法医学意义

随着医疗新技术的迅速发展,造血干细胞移植在临床上的用途越来越广泛。移植后供者源细胞几乎存在于受者所有组织,必然对个人识别和亲权鉴定产生重要影响,应引起法医工作者的重视,避免因此而产生错误的司法鉴定结论。本文就近年来allo-HSCT受者不同组织DNA嵌合状态的研究进展及其对法医物证鉴定的影响作一综述,希望能对相关研究和实践提供参考。     

移植时间和检测方法与allo-HSCT受者的DNA嵌合率及法医学意义

影响allo-HSCT受者DNA嵌合率的因素有很多:如受者的疾病类型、移植前预处理方案、移植时病情的严重程度、造血干细胞来源、局部的GVHD、HLA是否相合等。本文主要讨论与法医学关系最为密切的2个影响因素,即移植后时间和检测方法的灵敏度。法医物证学工作者在检案实践中,对allo-HSCT受者进行亲权鉴定或个体识别时,需注意移植后时间和检测方法的灵敏度对嵌合率的影响。女性受者接受男性供者HSCT的情况下,受者毛囊中可以检出供者Y染色体DNA,检案实践中来源于犯罪现场的生物检材不能仅仅检测Y染色体特异遗传标记,以免导致错误判断。