目的 对影响四肢长骨骨折术后愈合的原因进行分析,为四肢长骨骨折不愈合相关医疗损害鉴定提供借鉴或思路.方法 选取本中心2011-2018年间办理的及"中国裁判文书网"2017-2018年度公布的175例四肢长骨骨折术后不愈合医疗损害责任纠纷案例进行分析总结.结果 影响四肢长骨骨折愈合的原因较多,以骨折内固定相关因素为主,该类医疗损害鉴定意见认定的医疗过错参与度相对较为集中(多在40％左右).结论 四肢长骨骨折术后不愈合医疗损害的鉴定需重点关注手术相关因素,同时还需注意术后处理措施,结合患者外伤及其自身健康因素,综合分析,对过错参与度作出客观评价.

随着日益增长的医疗保健服务需求与医疗资源相对有限的矛盾日益突出,《医疗纠纷预防和处理条例》(国令第701号)新增申请人民调解和法律法规规定的其他途径来解决医疗纠纷.仲裁作为法律法规规定的其他解决途径,是指由双方当事人协议将争议提交给第三方,由该第三方对争议进行评判并作出裁决的一种解决争议的方法.通过探讨医事仲裁的可行性、仲裁运用于医疗纠纷案件中所具有的优势以及其优势在医疗纠纷案件处理中的作用,以期探求一种更为完善、更有效且快捷的医疗纠纷解决方式.

因果关系是侵权责任构成中的核心要件,也是侵权行为归责的基础和前提.相当因果关系说作为我国目前的主流学说之一,由“条件关系”和“相当性”两个部分组成,其基本思路与英美法系的二分法相似.医疗损害纠纷案件具有复杂性、不确定性、未知性等特点,从而使得如何判断因果关系及原因力始终是医疗损害纠纷案件中的难题.而目前司法鉴定的专业性、客观性已经在医疗损害案件中发挥了越来越多的作用,司法鉴定意见可作为重要证据供法官参考.

•We investigated the genetic polymorphism of 16 X-STR loci in a Han population in Central South China.•508 male blood samples were amplified using the Multiplex PCR System Goldeneye 17X Kit.•Forensic parameters were calculated to assess the forensic application values of the 16 X-STR loci.•Allelic frequencies of the 16 X-STR loci in this study with previously published populations in China were compared.

The Microreader™ 23SP ID System is a novel STR kit, but there are no Mongolian data related to this kit. In this study, allelic frequencies and forensic parameters were obtained from 505 unrelated healthy Mongolians. These samples were amplified using the kit. The dataset successfully passed quality control after being submitted to STRidER (STRidER dataset reference STR000198). A total of 264 alleles were observed, with corresponding allelic frequencies ranged from 0.001 to 0.378. The combined power of discrimination (CPD) and combined probability of exclusion (CPE) of the 22 autosomal STR loci were 0.999999999999999999999999999217318 and 0.999999999776042, respectively. Furthermore, population differentiation comparisons involving previously reported groups were conducted.

1 案 例 1.1 简要案情 某年7月,本鉴定中心受当事人孔某文的委托,受理了孔某文及其双胞胎孩子孔某萌(女)和孔某祥(男)有无血缘关系的案件.采集孔某文、孔某萌和孔某祥的血样进行STR基因座分型检测.

1 案例 1.1 简要案情 委托人熊某自述其与熊某亮为姑侄关系,因需要更改户口信息,委托本单位证明二人为非母子关系.本中心采集熊某与熊某亮的口腔拭子和血痕,因二联体亲子鉴定未能排除母子关系,本中心又补采了熊某亮亲生父亲熊某明的血痕及头发.

Estimation of postmortem interval （PMI） plays a crucial role in forensic study and identification work. Because of the unique anatomy location, vitreous humor is considered to be used for estima- ting PMI, which has aroused interest among scholars, and some researches have been carried out. The detection techniques of vitreous humor are constantly developed and improved which have been gradually applied in forensic science, meanwhile, the study of PMI estimation using vitreous humor is updated rapidly. This paper reviews various techniques and instruments applied to vitreous humor detection, such as ion selective electrode, capillary ion analysis, spectroscopy, chromatography, nano-sensing technology, automatic biochemical analyser, flow cytometer, etc., as well as the related research progress on PMI estimation in recent years. In order to provide a research direction for scholars and promote a more accurate and efficient application in PMI estimation by vitreous humor analysis, some inner problems are also analysed in this paper.

A one-step, visual and sensitive aptasensor based on DNA–AgNCs can be used to detect phorate in blood.

A sensitive and selective aptasensor based on DNA–silver nanocluster probes has been proposed for the simple and efficient detection of malathion in biological samples.

1 简要案例 当事人刘某因需要了解自己与孩子之间是否有父子关系,委托我中心进行亲缘关系鉴定.本中心采集两位被鉴定人的手指尖血样进行 STR 分型检测.使用常规 Chelex-100 法提取被鉴定人血样DNA[1].在 9700 型扩增仪(美国 AB 公司)上分别采用 AGCU EX22、AGCU 21+1(无锡中德美联生物技术有限公司)、Investigator HDplex 试剂盒(德国 Qiagen 公司)对被鉴定人 DNA 样本进行扩增.使用 310 型基因分析仪(美国 AB 公司)对扩增产物进行毛细管电泳,使用 GeneMapper v3.2 软件(美国 Thermo Fisher Scientific 公司)对数据进行分析处理.结果发现同一个体在试剂盒 AGCU 21+1与 Investigator HDplex 间出现了基因座 D5S2500 和D6S474 等位基因分型结果不一致现象(表 1).为查明原因并明确被鉴定人正确的基因分型,我们重新设计了基因座 D5S2500 和 D6S474 的引物,PCR扩增后进行Sanger测序及TA克隆后进行测序分析.

In recent years, drug abuse has been considered as a most challenging social problem that aroused public attention. Ketamine has increased in unregulated use as a ‘recreational drug’ in teenagers. However, there is no suitable and maneuverable detection method for ketamine in situ at the moment. Fluorescence sensor technique, with predominant recognition and simple operation, is a good potential application in drug detection. Here, we first reported a highly sensitive and selective fluorescence genosensor for rapid detection of ketamine based on DNA-templated silver nanoclusters (DNA-AgNCs) probes, in which the DNA sequence could specially recognize ketamine with high affinity. Parameters affecting detection efficiency were investigated and optimized. Under optimum conditions, the as-prepared genosensor can allow for the determination of ketamine in the concentration range of 0.0001–20 μg/mL with two linear equations: one is y = 2.84x-7.139 (R2 = 0.987) for 0.0001–0.1 μg/mL, and the other is y = 1.87x-0.091 (R2 = 0.962) for 0.1–20 μg/mL, and the estimated detection limit of ketamine is 0.06 ng/mL. Moreover, the feasibility of this proposed method was also demonstrated by analyzing forensic blood samples. Compared with official gas chromatography/mass spectrometry (GC/MS), this fluorescence genosensor is simple, rapid, and accurate for quantitative determination of ketamine in blood for pharmaceutical and forensic analysis. Overall, it is the first report on a fluorescence genosensor for detecting ketamine directly in blood. This research may provide a new insight for the analyst to band fluorescence genosensor technology together with drug monitoring in the battle against drug abuse and forensic examination.

Nonbinary single-nucleotide polymorphisms (SNPs) are potential forensic genetic markers because their discrimination power is greater than that of normal binary SNPs, and that they can detect highly degraded samples. We previously developed a nonbinary SNP multiplex typing assay. In this study, we selected additional 20 nonbinary SNPs from the NCBI SNP database and verified them through pyrosequencing. These 20 nonbinary SNPs were analyzed using the fluorescent-labeled SNaPshot multiplex SNP typing method. The allele frequencies and genetic parameters of these 20 nonbinary SNPs were determined among 314 unrelated individuals from Han populations from China. The total power of discrimination was 0.9999999999994, and the cumulative probability of exclusion was 0.9986. Moreover, the result of the combination of this 20 nonbinary SNP assay with the 20 nonbinary SNP assay we previously developed demonstrated that the cumulative probability of exclusion of the 40 nonbinary SNPs was 0.999991 and that no significant linkage disequilibrium was observed in all 40 nonbinary SNPs. Thus, we concluded that this new system consisting of new 20 nonbinary SNPs could provide highly informative polymorphic data which would be further used in forensic application and would serve as a potentially valuable supplement to forensic DNA analysis.

OBJECTIVES:To investigate the genetic polymorphisms of 21 short tandem repeat （STR） loci （D3S1358, D13S317, D7S820, D16S539, Penta E, D2S441, TPOX, TH01, D2S1338, CSF1PO, Penta D, D10S1248, D19S433, vWA, D21S11, D18S51, D6S1043, D8S1179, D5S818, D12S391 and FGA）.METHODS:A total of 560 blood samples were collected from unrelated healthy individuals of Han population in Hunan Province. Chelex-100 extraction method was applied to the extraction of genomic DNA, and an AGCU EX22 Kit and 9700 STR amplification was used in amplification reactions. The products were separated and analyzed on 310 Genetic Analyzer.RESULTS:A total of 248 alleles were observed, the allelic frequencies ranging from 0.001 to 0.518. Observation of genotype distributions for each locus showed no deviations from Hardy-Weinberg equilibrium except Penta E （P=0.023）. The combined power of discrimination, combined power of exclusion, and combined matching probability of the 21 STR loci were approximately 0.999 999 999 999 999 999 999 999 8, 0.999 999 998, and 1.36×10⁻²⁵, respectively.CONCLUSIONS:The 21 STR loci show high polymorphisms in the Han population, which can provide valuable data and a theoretical basis for forensic individual identification and paternity testing.

In this study, we sequence the complete mitochondrial genome of Muscina stabulans (Diptera: Muscidae), a forensically important entomology, for the first time. The 15,933 bp circular genome contains the 37 genes found in a typical metazoan genome: 13 protein-coding genes, 2 ribosomal RNA genes, 22 transfer RNA genes and 1 non-coding A + T-rich region. All the protein initiation codons are ATN, except for cox1 and ND1 that begin with TCG and TTG. The arrangement of the genes was the same as that found in the other insect. The overall base composition on heavy strand was as follows A: 40.00%, G: 8.80%, C: 13.34%, T: 37.86% and the A + T content 77.86%. The mitochondrial genome of Muscina stabulans presented will be valuable for resolving phylogenetic relationships within the family Muscidae and order Diptera, and could be used to identify favourable genetic markers for species identifications for forensic purposes.

Some data about autosomal and Y chromosome-specific short tandem repeat (STR) loci in the Chinese Li ethnic group have been published [ 1 Li D.N. Ying D.J. Ou C.Y. Chen L. Zhou Z.J. Fu S.M. Y-chromosome-specific microsatellite variation in Li ethnic groups of Hainan Island, China. Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 2003; 20 (in Chinese): 46-48 PubMed Google Scholar , 2 Tang Y. Zhao Y. Zhong L. Fu S.D. Polymorphisms of 9 short tandem repeat loci in Chinese subjects of Li nationality in Hainan Province. Nan Fang Yi Ke Da Xue Xue Bao. 2009; 29 (in Chinese): 1223-1225 PubMed Google Scholar ]. However, to the best of our knowledge, nothing has been documented about the 21 autosomal STR loci of the AGCU 21+1 STR Fluorescence Assay Kit in the Li nationality. Hence, we first investigated the allele frequencies and forensic parameters of 21 STR loci (D1GATA113, D1S1627, D1S1677, D2S1776, D2S441, D3S4529, D4S2408, D5S2500, D6S1017, D6S474, D9S1122, D10S1248, D10S1435, D11S4463, D12ATA63, D14S1434, D17S1301, D18S853, D19S433, D20S482, and D22S1045) in a sample of 504 unrelated healthy individuals from the Chinese Li ethnic group.

近年来日益增多的医疗纠纷和医疗诉讼,使医院和医务人员陷入尴尬的境地.越来越多的证据表明,医疗纠纷鉴定制度自身的冲突不仅导致医患双方的矛盾尖锐化,同时使患方对现有医疗纠纷解决机制的信任缺失.本文围绕我国医疗纠纷鉴定体系,结合《中华人民共和国侵权责任法》的医疗损害相关内容,分析我国医疗损害鉴定制度的现状,并对医疗损害鉴定的前景和走向进行讨论.

OBJECTIVE To explore the application of a 289bp fragment of the 16S rDNA gene to identify various species of sarcosaphagous Calliphorid flies. METHODS Twenty-six Calliphorid flies were collected from 14 Chinese provinces. All specimens were properly assigned into three genera and six species. The DNA of the pectoralis was extracted using CTAB method. Then PCR amplification was done for the 289 bp fragment of the 16S rDNA gene. The PCR products were then purified and sequenced, and the obtained sequences were uploaded to GenBank. The phylogenetic tree was built by the neighbor-joining method and intraspecific and interspecific divergences were calculated by sequence analysis. RESULTS The above 26 sarcosaphagous flies could be well clustered according to different genera and species. The evolutional intraspecific values were all zero, the evolutional interspecific variations varied from 0.3% to 6.5%. CONCLUSION The 289 bp fragment of the 16S rDNA of sarcosaphagous flies can be effectively used to identify most of the flies at species level. This method appears to be fast and low dissipative, which might be used to estimate postmortem interval by sarcosaphagous flies.