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    Comparison of Medical Dispute Resolution Mechanisms in China and Abroad
    Xu-dong ZHANG, Tian TIAN, Xu-fu YI, Jun-hong SUN
    2022, 38(2): 150-157.  DOI: 10.12116/j.issn.1004-5619.2022.220106
    Abstract ( 2329 )   HTML ( 278 )   PDF (740KB) ( 1088 )  

    Medical disputes are one of the common problems concerned by the whole world. All countries and regions have established their own medical dispute resolution mechanisms, in accordance with their own national conditions. Medical dispute identification opinions, as one of the important bases for identifying the responsibilities of both doctors and patients, play a pivotal role in the process of dispute settlement. A reasonable medical dispute resolution mechanism and standardized medical dispute identification model can help resolve disputes flexibly and reduce the conflict between doctors and patients. This paper briefly compares the medical dispute resolution mechanism and identification mode of China and several other representative countries (the United States, Britain, France, Germany, Italy, Japan, etc.), and discusses their respective characteristics and shortcomings, to bring some enlightenment to the medical dispute resolution and identification in our country.

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    Research on the Identification Model of Medical Damage
    Tian TIAN, Xu-dong ZHANG, Li-bing YUN, Ming LI, He-wen DONG, Ning-guo LIU, Min LIU
    2022, 38(2): 158-165.  DOI: 10.12116/j.issn.1004-5619.2022.220105
    Abstract ( 1778 )   HTML ( 199 )   PDF (765KB) ( 748 )  
    Objective

    To understand the perceptions of doctors, patients and forensic examiners on the current situation of medical disputes and medical damage identification in China, and to explore the medical damage identification model that is more conducive for the resolution of medical disputes.

    Methods

    A questionnaire was designed, and in-service clinicians, forensic examiners and inpatients in Sichuan Province and Chongqing City were randomly selected from April to November 2019. SPSS 22.0 software was used to analyze the data of various survey results.

    Results

    Compared with patients (24.92%), doctors (61.72%) believed that the current doctor-patient relationship was more tense than before; both doctors and patients were more inclined to choose voluntary consultation and people’s mediation to resolve medical disputes; forensic examiners have the highest level of cognition of medical and health-related laws and regulations, followed by doctors and patients; 66.72% of doctors and 78.41% of patients believed that medical damage identification was necessary, and they were more inclined to entrust forensic identification institutions; different groups all believed that forensic examiners and doctors should participate in the identification together, 80.94% of doctors believed that the appraisal institutions should be responsible for the forensic opinion, not the appraiser.

    Conclusion

    It is suggested that the Medical Association identification and forensic identification should learn from each other and formulate basic unified rules for the identification of medical damage. It is suggested to standardize the behavior of medical damage forensic identification institutions and appraisers, to improve their own appraisal level, actively invite clinical medical experts for consultation in identification, and promote the standardized, scientization of forensic identification.

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    Identification Principle and Thought of “Medical Malpractice” Based on Theoretical Analysis
    Xu WANG, Xiao-hua LIU
    2022, 38(2): 166-172.  DOI: 10.12116/j.issn.1004-5619.2022.220203
    Abstract ( 1427 )   HTML ( 23 )   PDF (680KB) ( 889 )  

    At present, medical disputes are still widely-concerned social problems and occasionally evolve into severe social events. In the dispute settlement mechanism, forensic identification opinion is the important technical support. Due to the high professionalism and complexity of medicine, the identification of medical malpractice has become major and difficult problem in the identification. This paper systematically analyze the concept of medical malpractice and five legal theories of malpractice determination, pointing out that China’s forensic identification of medical damage should be led by the theory of “medical standards”, supplemented by “prudent patient” standard and strengthen “peer review” in form. At the same time, seven main identification principles should be followed in practice: (1) take “obligation of diagnosis and treatment” as the basic principle of medical malpractice identification; (2) take whether to fulfill the obligation of diagnosis and treatment corresponding to current medical level as the specific principle; (3) take diagnosis and treatment routine, norms and guidelines as the main basis; (4) the principle of “peer review”; (5) the principle of “the generality of medical emergency action”; (6) the principle of “notification-informed-consent”; (7) the principle of “review of complications”. This paper also puts forward the corresponding identification ideas in view of the above principles, hoping this helps standardize medical damage forensic identification activities.

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    Comparation between Guidance for Judicial Expertise of Medical Malpractice and Medical Association Identification Rules of Medical Damage
    Zi-hui CHENG, Lu ZHANG, Liang WANG, Jie ZHANG, Ling-jie KONG, Long YU, Song-yue HE
    2022, 38(2): 173-181.  DOI: 10.12116/j.issn.1004-5619.2022.220205
    Abstract ( 2514 )   HTML ( 41 )   PDF (773KB) ( 843 )  

    On the basis of retaining the technical identification system of medical negligence, the Medical Association Identification Rules of Medical Damage mainly provides technical services for various types of conciliation work about doctor-patient dispute. Its identification work is still influenced by the thinking of medical negligence technical identification and has certain administrative color. Guidance for Judicial Expertise of Medical Malpractice is mainly reflected that the trial of civil cases and pre-trial mediation of courts need service. Its procedures and evidence review are strictly required by the litigation rules and has the characteristics of public legal services provided as a third-party neutral institution. Technical identification of medical damage, whether organized by the Medical Association or the forensic identification institutions, is carried out under the background of the current Regulations on the Prevention and Treatment of Medical Disputes and the Civil Code of the People’s Republic of China; both have a corresponding positive role in regulating the medical damage identification activities, and have also laid a certain foundation for the establishment of a unified identification system in the future in China. To understand the different characteristics of the medical damage identification rules issued by the Chinese Medical Association and the Ministry of Justice, and to improve the understanding of the standardization of the forensic identification of medical damage, a comparative study was conducted on Medical Association Identification Rules of Medical Damage and Guidance for Judicial Expertise of Medical Malpractice from seven aspects: Concept and legal status, entrust of identification, identification acceptance, identification procedures, identification presentation meeting, theory of medical malpractice evaluation, consequences and causality of medical damage. The subject of evaluation, the function of evidence review, the role of consulting experts, the technical standard system of malpractice evaluation and other contents were emphatically analyzed.

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    Informed Consent in Medical Damage Identification
    2022, 38(2): 198-201.  DOI: 10.12116/j.issn.1004-5619.2022.220112
    Abstract ( 1558 )   HTML ( 30 )   PDF (613KB) ( 613 )  
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    Original Articles
    Detection of Exogenous γ-Hydroxybutyric Acid in Rat Blood Exosomes
    Zheng-xiang GAO, Qi-zhi LUO, Liang ZHANG, Mao-qing PEI, Hui-jun WANG, Xia YUE
    2022, 38(2): 212-216.  DOI: 10.12116/j.issn.1004-5619.2021.410116
    Abstract ( 203 )   HTML ( 15 )   PDF (823KB) ( 581 )  
    Objective

    To find a method to distinguish exogenous gamma-hydroxybutyrate (GHB) from endogenous GHB by establishing ultra-high performance liquid chromatography-mass spectrometry (UPLC-MS) based on exosome for quantitative detection of GHB in the rat blood.

    Methods

    Adult male SD rats were divided into 1 h, 5 h, 10 h administration group and control group. After 1 h, 5 h and 10 h of single precursor of GHB gamma-butyrolactone (GBL) intraperitoneal injection in administration groups, 5 mL blood was collected from the abdominal aorta. Meanwhile, the control group was given a same dose of normal saline, and 5 mL blood was collected at 1 h. Among the 5 mL blood, 0.5 mL was directly detected by HPLC-MS after pretreatment, and exosomes were extracted from the remaining blood by differential centrifugation and detected.

    Results

    The concentration of GHB in the control group was (87.36±33.48) ng/mL, and the concentration with administration at 1 h, 5 h and 10 h was (110 400.00±1 766.35) ng/mL, (1 479.00±687.01) ng/mL and (133.60±12.17) ng/mL, respectively. The results of exosome detection showed that no peak GHB signal was detected in the control group and the 10 h administration group, and the concentrations of GHB at 1 h and 5 h administration groups were (91.47±33.44) ng/mL and (49.43±7.05) ng/mL, respectively.

    Conclusion

    GHB was detected in blood exosome by UPLC-MS, which indicated that exogenous GHB could be detected in plasma exosomes, while endogenous GHB could not be detected, suggesting that this method may be used as a basis to determine whether there is exogenous drug intake.

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    Logistic Regression Analysis of the Mechanism of Blunt Brain Injury Inference Based on CT Images
    Xue-yang SUN, Qi-fan YANG, Yun-liang ZHU, Yan-bin WANG, He-wen DONG, Ming-zhen YANG, Zhi-ling TIAN, Lei WAN, Dong-hua ZOU, Xiao-tian YU, Ning-guo LIU
    2022, 38(2): 217-222.  DOI: 10.12116/j.issn.1004-5619.2021.410809
    Abstract ( 219 )   HTML ( 23 )   PDF (706KB) ( 547 )  
    Objective

    To study the correlation between CT imaging features of acceleration and deceleration brain injury and injury degree.

    Methods

    A total of 299 cases with acceleration and deceleration brain injury were collected and divided into acceleration brain injury group and deceleration brain injury group according to the injury mechanism. Subarachnoid hemorrhage (SAH) and Glasgow coma scale (GCS), combined with skull fracture, epidural hematoma (EDH), subdural hematoma (SDH) and brain contusion on the same and opposite sides of the stress point were selected as the screening indexes. χ2 test was used for primary screening, and binary logistic regression analysis was used for secondary screening. The indexes with the strongest correlation in acceleration and deceleration injury mechanism were selected.

    Results

    χ2 test showed that skull fracture and EDH on the same side of the stress point; EDH, SDH and brain contusion on the opposite of the stress point; SAH, GCS were correlated with acceleration and deceleration injury (P<0.05). According to binary logistic regression analysis, the odds ratio (OR) of EDH on the same side of the stress point was 2.697, the OR of brain contusion on the opposite of the stress point was 0.043 and the OR of GCS was 0.238, suggesting there was statistically significant (P<0.05).

    Conclusion

    EDH on the same side of the stress point, brain contusion on the opposite of the stress point and GCS can be used as key indicators to distinguish acceleration and deceleration injury mechanism. In addition, skull fracture on the same side of the stress point, EDH and SDH on the opposite of the stress point and SAH were relatively weak indicators in distinguishing acceleration and deceleration injury mechanism.

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    Original Article
    Automatic Identification of Brain Injury Mechanism Based on Deep Learning
    Qi-fan YANG, Xue-yang SUN, Yan-bin WANG, Zhi-ling TIAN, He-wen DONG, Lei WAN, Dong-hua ZOU, Xiao-tian YU, Guang-zheng ZHANG, Ning-guo LIU
    2022, 38(2): 223-230.  DOI: 10.12116/j.issn.1004-5619.2021.410923
    Abstract ( 241 )   HTML ( 18 )   PDF (2215KB) ( 591 )  
    Objective

    To apply the convolutional neural network (CNN) Inception_v3 model in automatic identification of acceleration and deceleration injury based on CT images of brain, and to explore the application prospect of deep learning technology in forensic brain injury mechanism inference.

    Methods

    CT images from 190 cases with acceleration and deceleration brain injury were selected as the experimental group, and CT images from 130 normal brain cases were used as the control group. The above-mentioned 320 imaging data were divided into training validation dataset and testing dataset according to random sampling method. The model classification performance was evaluated by the accuracy rate, precision rate, recall rate, F1-value and AUC value.

    Results

    In the training process and validation process, the accuracy rate of the model to classify acceleration injury, deceleration injury and normal brain was 99.00% and 87.21%, which met the requirements. The optimized model was used to test the data of the testing dataset, the result showed that the accuracy rate of the model in the test set was 87.18%, and the precision rate, recall rate, F1-score and AUC of the model to recognize acceleration injury were 84.38%, 90.00%, 87.10% and 0.98, respectively, to recognize deceleration injury were 86.67%, 72.22%, 78.79% and 0.92, respectively, to recognize normal brain were 88.57%, 89.86%, 89.21% and 0.93, respectively.

    Conclusion

    Inception_v3 model has potential application value in distinguishing acceleration and deceleration injury based on brain CT images, and is expected to become an auxiliary tool to infer the mechanism of head injury.

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    Establishment of Multiplex Amplification System of STR Loci in Felis Catus and Its Forensic Application
    Shi-han XI, Yi-ling QU, Ruo-cheng XIA, Lei XIONG, Si-yu CHAI, Chun-lan TONG, Rui-yang TAO, Cheng-tao LI
    2022, 38(2): 231-238.  DOI: 10.12116/j.issn.1004-5619.2021.511104
    Abstract ( 305 )   HTML ( 23 )   PDF (1078KB) ( 647 )  
    Objective

    To construct a Felis catus STR loci multiplex amplification system and to evaluate its application value by testing the technical performance.

    Methods

    The published Felis catus STR loci data were reviewed and analyzed to select the STR loci and sex identification loci that could be used for Felis catus individual identification and genetic identification. The fluorescent labeling primers were designed to construct the multiplex amplification system. The system was validated for sensitivity, accuracy, balance, stability, species specificity, tissue identity and mixture analysis, and investigated the genetic polymorphisms in 145 unrelated Felis catus samples.

    Results

    Sixteen Felis catus autosomal STR loci and one sex determining region of Y (SRY) were successfully selected, and constructed a multiplex amplification system containing the above loci. The complete profile of all alleles could still be obtained when the amount of DNA template was as low as 0.25 ng. There was no specific amplification peak in other common animal samples. Population genetic surveys showed that total discrimination power (TDP) of the 16 STR loci was 1-3.57×10-20, the cumulative probability of exclusion (CPE) was 1-6.35×10-5 and the cumulative probability of matching was 3.61×10-20.

    Conclusion

    The Felis catus STR multiplex amplification system constructed in this study is highly sensitive, species-specific, and accurate in typing results, which can provide an effective solution for Felis catus species identification, individual identification and kinship identification in the field of forensic science.

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    An Epidemiologic Survey and Violent Behavior Analysis of Antisocial Personality Disorder in Young Men in Chengdu
    Ruo-chen CAO, Xia-can CHEN, Lu YIN, Hao-lan HUANG, Wei-zhi WAN, Yan LI, Jun-mei HU
    2022, 38(2): 239-245.  DOI: 10.12116/j.issn.1004-5619.2020.100802
    Abstract ( 257 )   HTML ( 44 )   PDF (709KB) ( 518 )  
    Objective

    To investigate the epidemiological characteristics of antisocial personality disorder (ASPD) in young men in Chengdu and explore the characteristics and risks of violence.

    Methods

    Stratified random sampling was used to conduct a self-assessment questionnaire survey in 4 108 males aged from 18 to 34 in Chengdu, including general demographic characteristics, structured clinical interview for the diagnostic and statistical manual of mental disorders-Ⅳ axis Ⅱ disorders (SCID-Ⅱ) personality disorder screen questionnaire, violence questionnaire, psychosis screening questionnaire (PSQ), Alcohol Use Disorders Identification Test (AUDIT) and drug use. χ2 test, univariate and multivariate logistic regression were used for analysis and odds ratio (OR) was calculated.

    Results

    The positive rate of ASPD was 5.91%, which was associated with young age, unmarried, unemployment state, low educational level, violent behavior, psychotic symptoms, alcohol and drug use (P<0.05). Young men with ASPD also had a risk (P<0.05) of violence (OR was 8.51), multiple violence (OR was 16.57), injury (OR was 6.68), intentional violence (OR was 11.41), etc., the risk decreased after controlling for psychotic symptoms and substance abuse, but was still statistically significant.

    Conclusion

    The risk of violence, severe violence and intentional violence in young men in Chengdu is high, and psychotic symptoms and substance abuse increase the risk of ASPD violence and relate characteristics.

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    Cases Study
    Epidemiology of Sports-Related Sudden Death in Guangdong Province
    Cheng-dong MA, Qiu-ping WU, Qian-hao ZHAO, YIN-Kun, Nan ZHOU, Sai-qun WU, Jian-ding CHENG
    2022, 38(2): 246-253.  DOI: 10.12116/j.issn.1004-5619.2021.410908
    Abstract ( 483 )   HTML ( 35 )   PDF (771KB) ( 708 )  
    Objective

    By retrospective study of the epidemiological characteristics of sports-related sudden death (SrSD), the risk factors associated with SrSD were analyzed and explored to provide a scientific basis for comprehensive prevention and treatment of SrSD.

    Methods

    The personal information (sex, age, occupation, etc.), case information (time, place, type of sports, relative time between SrSD occurrence and exercise, etc.), death related information (sign or prodrome, medical history and surgical history, etc.), rescue situation (witnesses, on-site assistance, the availability of paramedics, etc.) of 374 SrSD cases in Guangdong Province from 2017 to 2021 were collected. Statistical analysis was conducted aiming at the key factors.

    Results

    In the 374 cases, there were significantly more males than females (19.78:1); the number of people aged between >39 and 59 was the largest (151, 40.37%); non-manual workers (68.98%) were more than manual workers; the top three sports with the highest number cases were basketball (34.49%), running (19.52%) and badminton (12.03%); from 3 pm to 9 pm (63.10%) was the time period with the highest incidence of events; sudden death mainly occurred during exercise (75.27%) and within 1 h after exercise (20.05%); the on-site rescue rate was very low (6.15%); the rate of autopsies was extremely low (1.07%); sudden cardiac death was the most common cause (67.11%).

    Conclusion

    SrSD is most common in males aged >39 to 59 years old, mostly in non-manual workers, and usually occurs in basketball and running. Sudden death is more likely to occur during exercise and within 1 h after exercise. Therefore, the above potential risk factors should be focused on and studied in daily comprehensive prevention and treatment to provide scientific basis for accurate prevention and first aid of such sudden death.

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    Analysis of the Distribution of Total Phosphine and the Characteristics of Phosphine Poisoning in 29 Victims
    Hui YAN, Meng DU, Zheng QIAO, Ping XIANG, Bao-hua SHEN, Min SHEN, Wei LIU
    2022, 38(2): 254-257.  DOI: 10.12116/j.issn.1004-5619.2020.300901
    Abstract ( 391 )   HTML ( 28 )   PDF (597KB) ( 722 )  
    Objective

    To study the distribution of total phosphine in phosphine poisoning victims and summarize the characteristics of phosphine poisoning cases.

    Methods

    The phosphine and its metabolites in the biological samples of 29 victims in 16 phosphine poisoning cases were qualified and quantified by headspace gas chromatography-mass spectrometry.

    Results

    Five victims among 29 were poisoned by ingestion of aluminium phosphide and 24 by inhalation of phosphine gas. Phosphine metabolites were detected in the biological samples of 23 victims, and the concentrations of total phosphine in blood ranged 0.5-34.0 μg/mL. The total concentration of phosphine in liver tissue was up to 71.0 μg/g. Phosphine was not detected in the blood of the other six survived victims, which may be related to the small amount of phosphine exposure and the delay in blood sampling.

    Conclusion

    The total concentration of phosphine in blood and tissues caused by aluminum phosphine ingestion is higher than that caused by phosphine gas inhalation. The death cases of phosphine inhalation are characterized by long exposure time, repeated exposures and age susceptibility.

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    Review
    Research Progress of Exosomal microRNA in Cardiovascular Disease and Its Forensic Application Prospects
    Xiao-nan MA, Lu LU, Yan-tong HUANG, Chang-qian CEN, Feng-yuan SU, Yi SHI, Zhi-peng CAO
    2022, 38(2): 258-262.  DOI: 10.12116/j.issn.1004-5619.2020.400911
    Abstract ( 304 )   HTML ( 12 )   PDF (564KB) ( 643 )  

    Exosomal microRNAs (miRNAs) are miRNAs that are mediated by exosomes to achieve cell-to-cell communication, and they are widespread in organisms. In recent years, the key role of the multiple biological functions of exosomal miRNAs in the occurrence and development of cardiovascular diseases has been confirmed by a large number of studies, which has become a hot spot in clinical and basic research. Sudden cardiac death caused by cardiovascular disease is one of the important contents in forensic medical identification. This article introduces the research progress of cardiovascular disease prediction, treatment and prognosis on exosomal miRNA. The prospects of the application in forensic medical identification are discussed.

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    Research Status and Prospects of Non-Traumatic Fat Embolism in Forensic Medicine
    Meng-zhen ZHANG, Yun-le MENG, Hao-sen LING, Shen HUANG, Qi MIAO, Yan-lin ZHANG, Xing-an YANG, Dong-ri LI
    2022, 38(2): 263-266.  DOI: 10.12116/j.issn.1004-5619.2020.401002
    Abstract ( 384 )   HTML ( 20 )   PDF (546KB) ( 752 )  

    In the practice of forensic pathology, fat embolism is one of the common causes of death, which can be divided into two categories: traumatic and non-traumatic. Non-traumatic fat embolism refers to the blockage of small blood vessels by fat droplets in the circulatory blood flow caused by non-traumatic factors such as underlying diseases, stress, poisoning and lipid metabolism disorders. At present, it is believed that the production of non-traumatic fat embolism is related to the disturbance of lipid metabolism, C-reactive protein-related cascade reaction, the agglutination of chylomicron and very low-density lipoprotein. The forensic identification of the cause of death of non-traumatic fat embolism is mainly based on the case, systematic autopsy, HE staining and fat staining, but it is often missed or misdiagnosed by forensic examiners because of its unknown risk factors, hidden onset, the difficulty of HE staining observation and irregular implementation of fat staining. In view of the lack of attention to non-traumatic fat embolism in forensic identification, this paper reviews the concepts, pathophysiological mechanism, research progress, existing problems and countermeasures of non-traumatic fat embolism, providing reference for forensic scholars.

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    Application Progress of Massively Parallel Sequencing Technology in STR Genetic Marker Detection
    Rui-yang TAO, Xin-yu DONG, An-qi CHEN, Ye-hui LÜ, Su-hua ZHANG, Cheng-tao LI
    2022, 38(2): 267-279.  DOI: 10.12116/j.issn.1004-5619.2020.500502
    Abstract ( 550 )   HTML ( 42 )   PDF (3575KB) ( 943 )  

    In recent years, more and more forensic genetics laboratories have begun to apply massively parallel sequencing (MPS) technology, that is, next-generation sequencing (NGS) technology, to detect common forensic genetic markers, including short tandem repeat (STR), single nucleotide polymorphism (SNP), the control region or whole genome of mitochondrial DNA (mtDNA), as well as messenger RNA (mRNA), etc., for forensic practice, such as individual identification, kinship analysis, ancestry inference and body fluid identification. As the most widely used genetic marker in forensic genetics, STR is currently mainly detected by capillary electrophoresis (CE) platform. Compared with CE platform, MPS technology has the advantages of simultaneous detection of a large number of genetic markers, massively parallel detection of samples, the polymorphism of sequence detected by NGS makes STR have the advantages of higher resolution and system efficiency. However, MPS technology is expensive, there is no uniform standard so far, and there are problems such as how to integrate MPS-STR data with the existing CE-STR database. This review summarizes the current status of the application of MPS technology in the detection of STR genetic markers in forensic genetics, puts forward the main problems that need to be solved urgently, and prospects the application prospect of this technology in forensic genetics.

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    A Case of Suicide by Taking Lime Sulfur
    2022, 38(2): 291-292.  DOI: 10.12116/j.issn.1004-5619.2019.491018
    Abstract ( 300 )   HTML ( 67 )   PDF (437KB) ( 621 )  
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    Continued Tab. 1
    2022, 38(2): 301-302.  DOI: 10.12116/j.issn.1004-5619.2020.500706
    Abstract ( 546 )   HTML ( 102 )   PDF (473KB) ( 879 )  
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