非法行医罪主体论纲——兼论我国非法行医罪的立法完善

刑法设置非法行医罪的目的主要是为了防范非法行医行为的发生,因此,“四类主体”可以成为非法行医罪的主体。我国现行刑法对非法行医罪主体的规定存在着明显缺陷,建议将单位纳入非法行医罪的主体之中,并出台相关的司法解释,明确“未以合法方式取得法定资质而非法行医”中的“未以合法方式取得法定资质”的含义及“非法”的含义,以完善相关规定。     

中国司法鉴定的古代史

公元前7世纪至公元前5世纪,是我国司法物证出现的萌芽时期,我国司法鉴定活动中以法医学为代表的最早时期也是出现在周朝。秦代在审理案件时,已相当重视和广泛使用各种司法物证,指纹的运用就出现在该时代。东汉时已形成简单的法医检验初步方法。三国时期司法物证检验的范围较前代有所发展扩大,从死因检验、伤痕鉴定,到笔迹检验、弹丸鉴定均有出现。以后各代出现了大量法医学著作。     

强直性脊柱炎的磁共振成像炎症分期与中医证型和临床特征关系

目的 探讨强直性脊柱炎（ankylosing spondylitis, AS）的磁共振成像（magnetic resonance imaging, MRI）炎症分期与中医证型和临床特征的关系。方法 采用骶髂关节MRI扫描技术将40例AS患者分为骨髓水肿组（早期炎症组）或脂肪浸润组（晚期炎症组）,比较两组患者中医证型分布情况、强直性脊柱炎病情活动度 C反应蛋白（ankylosing spondylitis disease activity score C reactive protein,ASDAS CRP）积分和血沉（erythrocyte sedimentation rate, ESR）、CRP水平。结果 早期炎症组共24例患者,晚期炎症组共16例患者。早期炎症组以肾虚湿热证为主（占91.7%）,晚期炎症组以肾虚督寒证为主（占87.5%）,差异具有统计学意义（P<0.05）。早期炎症组较晚期炎症组ASDAS CRP积分及ESR、CRP水平显著升高（P<0.05）。Pearson相关分析显示,肾虚湿热证证候积分与加拿大脊柱关节炎研究协会（Spondyloarthritis Research Consortium of Canada,SPARCC）MRI积分具有正相关性（n=24,r=0.627,P<0.05）,肾虚督寒证证候积分与SPARCC MRI积分无相关性（n=16,r=0.167,P＞0.05）。结论 AS的MRI炎症分期对中医辨证、病情活动度及炎性指标的预测具有指导意义。     

Portable high‐resolution automated 3D imaging for footwear and tire impression capture

The forensic science community raised the need for improved evidence recognition, collection, and visualization analytical instrumentation for field and laboratory use. While the 3D optical techniques for imaging static objects have been extensively studied, there is still a major gap between current knowledge and collecting high‐quality footwear and tire impression evidence. Among optical means for 3D imaging, digital fringe projection (DFP) techniques reconstruct 3D shape from phase information, achieving camera‐pixel spatial resolution. This paper presents a high‐resolution 3D imaging technology using DFP techniques dedicated to footwear and tire impression capture. We developed fully automated software algorithms and a graphical user interface (GUI) that allow anyone without training to operate for high‐quality 3D data capture. We performed accuracy evaluations and comparisons comparing with the commercial high‐end 3D scanner and carried out qualitative tests for various impressions comparing with the current practices. Overall, our technology achieves similar levels of accuracy and resolution with a high‐end commercially available 3D scanner, while having the merits of being (1) more affordable; (2) much easier to operate; and (3) more robust. Compared with the current practice of casting, our technology demonstrates its superiority because it (1) is non‐destructive; (2) collects more evidence detail than casts, especially when an impression is fragile; (3) requires less time and money to collect each piece of evidence; and (4) results in a digital file that can easily be shared with other examiners.     

美国管理式医疗的发展历程及对国内医保的借鉴

从理论和实证的研究表明,管理式医疗曾被当作美国医疗保险改革的典范,甚至有人尊其为有效降低医疗费用和成本的灵丹妙药。在有效控制节节攀升的医疗服务费用方面,管理式医疗确实达到了非常好的效果。但是,医疗服务需要关注的不仅是费用,还有医疗服务的质量、服务的可及性以及临床医疗的长远发展等方面。而美国管理式医疗的发展历程生动地诠释了普通民众需要的不仅仅是"廉价"的医疗服务这一现实。     

数字图像处理技术的优势

随着计算机应用软件多种类的开发 ,利用计算机来处理图像已成现实。计算机图像处理技术(也称数字图像处理技术)相对于传统的暗房技术 ,不但具备传统暗房技术制作影像的所有的技巧 ,而且还有许多传统暗房技术不可比拟的优势。数字图像处理技术是摄影艺术再创造的技术 ,可制作完美无暇的照片 ,照片质量比传统暗房技术制作的质量更高,对环境无污染 ,出片速度快、省时、省财、省力、省地方。数字图像处理技术必将取代传统的暗房技术     

Chemical Imaging of Human Fingermark by X-ray Photoelectron Spectroscopy (XPS)

X-ray photoelectron spectroscopy (XPS) is a widely used technique to characterize the surface chemistry of materials. It plays a crucial role in accessing qualitative and quantitative information and in detecting the presence of chemical functional groups on the surface of any material. The forensic methods available to detect and identify elements and organic/inorganic compounds are often destructive, so evidence cannot be re-analyzed. However, XPS allows rapid analysis of samples without damaging them. Recently, an increasing number of forensic researchers have begun to study certain chemical information on fingermarks. In this study, the authors aimed to present the applicability and power of XPS imaging in fingermark analysis which can also provide specific information about the fingermark chemical composition. Herein, monochromated X-ray (Al Kα) spot size was fixed at 50 μm. XPS mapping resulted in the acquisition of spectra at each pixel, in an array of 41 × 30 pixels with a step size of 50 μm. Then, a simple discussion has been made about how the scanned surface spectrum and basic snapshot spectra are used to identify different components at a fingertip of a scanned surface area (~3 mm²). Hence, a fingermark pattern contaminated with caffeine, TiO₂, and Pb/PbO deposited on the silicon wafer can be chemically mapped and visualized by XPS using principal component analysis (PCA). Thus, the present study showed the possible applicability of XPS for the identification of illicit drugs of abuse, gunshot residue, and skin care products on latent fingermark by mimicking a crime scene evidence.     

Postmortem Computed Tomography and Magnetic Resonance Imaging of Gunshot Wounds to the Neck

Postmortem magnetic resonance imaging (MRI) is rarely used for the radiologic assessment of gunshot injuries, although it has clear advantages over postmortem computed tomography (CT) with regard to the imaging of soft tissue injuries. Another benefit in using MRI is that lodged projectiles composed of nonferromagnetic material such as lead present only marginal metal artifacts compared with severe artifacts on CT. This case report presents CT and MRI findings in a case with two gunshot wounds to the neck: a perforating wound and a nonperforating wound with a lead bullet lodged in the cervical spine. The decedent underwent CT and MRI before the scheduled autopsy. A ring of radiopaque material under the dermis in the fatty tissue was identified at both entrance wounds on CT, which was indicative of contact shots. The perforating gunshot was clearly indicated on CT by bullet fragments along the wound channel through the perforated 6th cervical vertebra and the fractured cricoid cartilage at the exit wound. The second trajectory, however, was only assumed based on the presence of gunshot residues at the entrance wound and the position of the lodged bullet. The radiologic assessment was severely impeded by the metal artifacts on CT. Barely noticeable metal artifacts on MRI allowed for clear visualization of the soft tissue injuries and the ruptured medulla oblongata. Only MRI clarified the soft tissue injuries of the brainstem noninvasively, which could provide specific and graphic information on the rapidity of death and the incapacitation of the victim.     

医疗责任保险制度初探

笔者从医疗风险、医疗责任保险的可保性及医疗责任保险的性质与意义等方面多角度的进行详细的论述,对医疗责任保险制度在国内外的发展及现状进行了较为客观的分析,最后结合我国实际,在借鉴国内外成功经验的基础上提出了我国建立医疗责任保险制度的初步构想。     

人工智能医疗影像诊断侵权损害赔偿法律问题

人工智能医疗影像诊断侵权损害是指临床医生根据人工智能医疗影像辅助诊断结论所实施的医疗行为对患者造成的损害。人工智能与医疗影像技术的融合应用,大大提高了疾病诊断的效率与质量,其诊断错误所引发的侵权损害赔偿问题也不容忽视。人工智能医疗影像诊断模式多样、责任主体多元、损害原因各异、责任份额不同,其引起的侵权责任错综复杂。人工智能医疗影像诊断侵权应定性为多数人侵权中的分别侵权行为。现阶段人工智能医疗影像诊断侵权损害赔偿的判定,应以人工智能医疗影像诊断设备的民事法律关系客体定位为逻辑起点,根据人工智能医疗影像诊断模式、侵权场景、错误发生原因等因素来判定责任主体,综合原因力大小、过错程度等因素来确定赔偿份额,并从“利益平衡”视角对侵权损害赔偿的责任范围进行适当限制,以促进人工智能技术在医疗影像行业的广泛应用和大健康产业的长足发展。