关于基层法医病理检验的思考

随着社会发展和公民法律意识的提高。要求尸体检验的人数逐年增加，同时，社会对公安机关尸体检验中各个方面的要求也在逐渐提高，但在我国特别是欠发达的基层公安机关，法医病理检验仍存在很多问题，笔者就几个主要问题展开讨论。     

加强法医病理工作标准化、规范化提高法医学鉴定质量

为提高法医检案质量 ,使法医检验鉴定工作标准化、规范化 ,充分发挥法医鉴定工作在维护社会稳定、促进经济发展中的作用 ,1996年以后 ,全国刑事技术标准化技术委员会组织我国部分单位起草了一系列有关法医病理学检验的公共安全行业标准 ,经批准 ,于 1997年后实施[1,2 ] 。但近年来 ,我们在实际检案工作中 ,仍经常遇到某些基层法医单位 ,由于主观因素或客观条件的影响 ,在法医病理工作中因未严格执行上述行业标准 ,以致鉴定失误甚至造成错案 ,因而在刑事或民事案件中直接影响到法律责任或赔偿金额的正确判定。其中有的案例由于死因及死亡方式…     

影响法医病理检验的因素

法医尸检过程中难辨或易混尸体现象、操作中人为现象均影响病理解剖结论的正确性和客观性,总结尸体搬运、生前抢救、尸体腐败及解剖、切片制作观察过程中造成的常见人为现象及难辨尸体现象,并提出相应干预措施以期得出合理的鉴定结论.     

影响法医病理检验的因素

法医尸检过程中难辨或易混尸体现象、操作中人为现象均影响病理解剖结论的正确性和客观性，总结尸体搬运、生前抢救、尸体腐败及解剖、切片制作观察过程中造成的常见人为现象及难辨尸体现象，并提出相应干预措施以期得出合理的鉴定结论。     

从法医病理角度探讨老年人肺动脉栓塞

目的：从法医病理角度探讨老年人肺动脉栓塞临床特点，为临床准确诊断肺动脉栓塞疾病提供可靠依据，降低误诊、漏诊几率。方法：对7例老年肺动脉栓塞死亡患者临床资料进行回顾性分析，内容包括患者临床表现、临床检查结果等，之后对其进行尸检。记录尸检病理结果，对肺动脉栓塞临床特征进行总结。结果：老年人肺动脉栓塞患者临床表现为突发性胸膜痛、心悸、冷汗、胸闷、咯血、突发劳力性呼吸困难甚至晕厥等，最终因肺部出现急性循环衰竭导致死亡。尸检结果为将老年肺动脉栓塞患者心脏及肺动脉切开后均可见血栓形成，且数量较多或体积较大，血栓可呈现出红色或混合性质。结论：老年人具有肺动脉栓塞多种危险因素，因此肺动脉栓塞疾病发生率较高，易形血栓成胁健康及生命安全，应引起临床医务工作者及法医工作者高度重视。     

冠状动脉支架植入术中死亡法医病理检验4例

目的 总结冠状动脉支架（coronary stent,CS）植入术中死亡者法医病理检验的要点。方法 回顾了4例CS植入术中死亡者法医病理尸检资料。结果 急性心肌梗死紧急行冠状动脉左旋支CS植入术1例,择期手术3例。发现冠状动脉夹层2例、血管破裂1例。冠状动脉破裂患者同时发现支架内急性血栓形成。三例患者5处新近安置CS部位血管狭窄程度较生前造影报告轻。未安置CS的血管生前造影检查报告的病变部位狭窄程度较死后病理检验重。结论 死后病理检验可有效检出冠状动脉损伤、支架血栓形成,但需解决冠状动脉腔内支架原始形态观察的难题。     

法医病理司法鉴定纠纷产生的原因及其防范

法医病理司法鉴定在刑事案件、民事纠纷、保险理赔等方面发挥着重要的作用。通过鉴定工作实践,总结出法医病理司法鉴定纠纷产生的各种原因,结合中华人民共和国司法部第107号令《司法鉴定程序通则》第17条规定,在进行司法鉴定前必须签署司法鉴定协议书的实施情况,同时借鉴医疗活动中知情同意的做法,针对性地提出预防法医病理司法鉴定纠纷的对策。     

宁夏第二次法医临床法医病理司法鉴定培训班圆满举办

2019年12月14日、15日,由宁夏司法鉴定协会主办、宁夏法庭科学司法鉴定中心协办的2019年全区第二次法医临床、法医病理司法鉴定培训班在宁夏财政干部教育中心开班并集中授课。来自宁夏各市县(区)法医临床、法医病理执业司法鉴定人及宁夏全区公安、法院系统的法医共162人参加此次培训。     

窒息死亡的法医病理学分析

目的探讨窒息死亡的法医病理学特点。方法对四川大学华西法医学鉴定中心1982年10月1日-2006年9月30日所作160例窒息死亡尸体剖验病理材料进行统计分析。结果窒息死亡案例占整个法医学检案的9．9％，年龄：30-39岁的死者占整个研究对象的29．4％，平均年龄为31．25岁。性别：男性103例，女性57例。男女比例1．81：1。死亡方式：意外死亡最多（63．1％），其次为自杀（24．4％）和他杀（12．5％）。死亡原因：缢死最多（21．9％），其次为CO中毒（17．5％）、溺死（16．25％）等。医疗纠纷共计39例，均为新生儿窒息，主要发生在乡镇医院和县级医院（76．92％）。结论加强法制教育，提高安全隐患意识等是减少窒息死亡的重要手段。提高城乡医疗水平，加强窒息急诊抢救的临床技能是防止窒息引起医疗纠纷的关键。     

道路交通事故法医检验技术的研究进展

近年来,经济快速发展和机动车数量急剧增多,道路交通事故频发和伤亡人数不断上升已经成为备受关注的全球性问题。法医检验作为交通事故处理中重要的证据,其鉴定意见直接影响着当事方的权益和事故处理。不容置疑,法医检验技术的运用对鉴定意见有十分重要的影响作用。本文对国内外法医检验技术的最新研究进展和应用进行综述,供同行实践工作中参考。     

法医病理检案工作中的人为现象

目的 研究法医病理检案工作中常见的人为现象及其造成法医学鉴定结论错误的原因。方法 收集13例法医病理复核鉴定案例,并对其进行回顾性分析。结果 胸外心脏按压所致肋骨骨折,胸、腹腔出血及肺动脉栓塞栓子破碎,误认为生前外伤或死因不明5例;胰腺死后变化(自溶和被膜下及间质出血),误认为急性出血坏死性胰腺炎4例;死后动物咬伤误认为生前损伤2例;腐败尸斑误认为皮下出血1例;死后颈部解剖不当造成颈部肌肉出血,影响死因分析1例。结论 法医病理检案工作中的人为现象,常导致法医学鉴定的结论错误。     

Evaluating expertise in forensic anthropology

The medicolegal system relies on the ability of experts and non-experts alike to make judgments about expertise and use those judgments to reach consequential decisions. Given the lack of standard criteria, mandatory certification, or licensure for establishing expertise required to practice forensic anthropology and testify as an expert witness, we sought to understand how individuals assess and identify expertise in forensic anthropology by using a social science tool called the Imitation Game. This tool assesses immersion in a specific area of study via discourse, with the premise that some individuals lacking expertise themselves imitate or attempt to pass as experts. For this project we recruited volunteers with varying expertise in forensic anthropology to participate in interviews which asked questions about the practice and structure of the discipline. Those interviews were transcribed, anonymized, and evaluated by other recruited individuals with varying expertise in forensic anthropology. Results found that judges who were experts in forensic anthropology performed better than non-expert judges in determining who was not an expert in forensic anthropology based on their anonymized responses; however, nearly half of the non-experts were still able to pass as experts in forensic anthropology. The difficulties in assessing expertise based on discourse interactions demonstrates the value and need for well-defined credentials and mandatory certification to practice forensic anthropology. This study demonstrates that accurately identifying expertise in forensic anthropology may be challenging for both experts and non-experts, especially when relying solely on interactional expertise rather than formal assessments of competency which directly elucidate contributory expertise.     

医疗纠纷的法医学鉴定

目的研究医疗纠纷法医学鉴定的特点,并讨论医疗纠纷法医学鉴定的重点及难点。方法将医疗缺陷分为责任性缺陷、技术性缺陷、管理性缺陷、学科性缺陷和其他缺陷,对36件案例分别进行分类并进行统计。其中把18例由医疗事故鉴定委员会鉴定的结论与我室的鉴定结果进行比较分析,其他18例另行统计。结果36例案件中存在医疗缺陷的占86.11%,其中技术性缺陷66.67%,责任性缺陷和管理性缺陷均占25%。18例由医疗事故鉴定委员会鉴定的结论与我室的鉴定结果进行比较,医疗缺陷的认定两者有明显差异(P<0.05),对于医疗缺陷已对患者造成不良影响的认定,两者具有显著性差异(P<0.01)。结论法医进行医疗纠纷的鉴定,对医疗纠纷诉讼案件的处理起着积极的作用。目前,医疗纠纷的法医学鉴定仍存在许多问题需要进一步讨论。     

Efficiency of hardware-assisted tools in forensic expertise

The authors analyze the efficiency of special-purpose hardware-assisted tools (SHT) in forensic expertise. Unlike clinical medicine, in which the methods of quantitative and qualitative analysis are comprehensively used in choosing drugs, issues related with providing the state forensic-expertise facilities with specialized equipment have not been virtually elaborated up to now. The qualitative analysis based on the subjective evaluation of experts is used presently for the purposes. Therefore, development of objective criteria of evaluation of SHT for forensic expertise is an important and topical issue.     

Visual attention and expertise for forensic signature analysis

Eye tracking was used to measure visual attention of nine forensic document examiners (FDEs) and 12 control subjects on a blind signature comparison trial. Subjects evaluated 32 questioned signatures (16 genuine, eight disguised, and eight forged) which were compared, on screen, with four known signatures of the specimen provider while their eye movements, response times, and opinions were recorded. FDEs' opinions were significantly more accurate than controls, providing further evidence of FDE expertise. Both control and FDE subjects looked at signature features in a very similar way and the difference in the accuracy of their opinions can be accounted for by different cognitive processing of the visual information that they extract from the images. In a separate experiment the FDEs re-examined a reordered set of the same 32 questioned signatures. In this phase each signature was presented for only 100 msec to test if eye movements are relevant in forming opinions; performance significantly dropped, but not to chance levels indicating that the examination process comprises a combination of both global and local feature extraction strategies.     

Diatoms in forensic expertise of drowning--a Macedonian experience

Results obtained by examination of 22 human cases suspected for drowning, one human case of death other than drowning and several tests on laboratory rats were used as a basis for evaluation of diatom method as supportive in forensic expertise of drowning. The recovery of diatoms from various examined organs, their qualitative and quantitative composition, if properly treated without the possibility of contamination, can be a reliable proof of the time and place of drowning. The priority of organ examination (external microflora determination, lungs, brain, heart (and/or blood), stomach, liver and kidney, and finally bone marrow) is discussed and established as well as the basic future research on cases suspected of drowning, but also on non-drowned victims and laboratory animals.