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Revolutionizing forensic DNA analysis: The potential of CRISPR-Cas9 technology in genetic investigations 革命性的法医DNA分析:CRISPR-Cas9技术在遗传调查中的潜力
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-12-05 DOI: 10.1016/j.jflm.2025.103047
Pallavi Kumari , Vinayak Gupta , Anjali Chhikara , Jyoti Dalal
The newest achievements in the field of molecular biology and gene-editing technologies have transformed the paradigm of forensic DNA analysis. However, there are still great difficulties in interpreting degraded, low-template, mixed genetic samples. The review critically evaluates the transformative potential of Clustered Regularly Interspaced Short Palindromic Repeats and an associated protein 9 (CRISPR-Cas9) as an accurate, effective, and cost-efficient system of genome-editing in the field of forensic science. Based on the evidence of the current literature, the paper critically analyzes the mechanisms of CRISPR-Cas9 activity, its RNA-guided specificity, dual-strand cleavage, and high-fidelity targeting, and compares its functionality with other standard methods like the STR and SNP profiling. The review also discusses more complex CRISPR-based diagnostic systems, such as SHERLOCK, DETECTR, and HOLMES that allow the analysis of DNA rapidly, without amplification, and in a portable format. Among major discoveries, there is the ability of CRISPR to increase the accuracy of DNA profiling, resolve mixture, recapitulate damaged genetic material, and reduce the possibility of contamination. In addition to genetic analysis, it has applications in forensic epigenetics, prediction of phenotypes, microbial forensics and environmental trace analysis. The review also covers the ethical, legal and governance implications of implementing CRISPR-based evidence in the judicial process especially in as far as data privacy; admissibility and equity of access are concerned. In general, CRISPR-Cas9 is a paradigm shift in forensic genomics, the one that has the potential to transform personal identification, reconstruction of the crime scene, and the interpretation of molecular evidence. Future efforts should focus on method validation, standardization, and ethical governance to ensure the responsible and sustainable implementation of this technology in forensic practice.
分子生物学和基因编辑技术领域的最新成就改变了法医DNA分析的范式。然而,在解释降解的、低模板的、混合的基因样本方面仍然存在很大的困难。这篇综述批判性地评估了集群规则间隔短回文重复序列和相关蛋白9 (CRISPR-Cas9)作为一种准确、有效和成本效益高的基因组编辑系统在法医学领域的变革潜力。基于现有文献的证据,本文批判性地分析了CRISPR-Cas9活性的机制、其rna引导的特异性、双链切割和高保真靶向,并将其功能与STR和SNP分析等其他标准方法进行了比较。本综述还讨论了更复杂的基于crispr的诊断系统,如SHERLOCK、DETECTR和HOLMES,它们允许快速分析DNA,无需扩增,并且以便携式格式。在重大发现中,CRISPR能够提高DNA分析的准确性,分解混合物,概括受损的遗传物质,并减少污染的可能性。除遗传分析外,它还应用于法医表观遗传学、表型预测、微生物法医和环境痕迹分析。审查还涵盖了在司法程序中实施基于crispr的证据的伦理、法律和治理影响,特别是在数据隐私方面;涉及可采性和公平获取。总的来说,CRISPR-Cas9是法医基因组学的一个范式转变,它有可能改变个人身份,重建犯罪现场,以及解释分子证据。未来的努力应该集中在方法验证、标准化和道德治理上,以确保在法医实践中负责任和可持续地实施这项技术。
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引用次数: 0
Histological insights in decomposed bodies: A case report challenging the homicide hypothesis 在腐烂的尸体组织学见解:案件报告挑战谋杀的假设
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-12-04 DOI: 10.1016/j.jflm.2025.103046
Cecilia Frigerio , Jean-Loup Gassend , Katarzyna Michaud
European recommendations regarding medico-legal autopsies indicate that specimens from the main organs should be sampled for histology in all cases. In reality however, depending on local practices, available funding and personal choice by the physician, these recommendations are not always followed. The National Association of Medical Examiners (USA) guidelines indicate that histological examinations should be performed if no obvious cause of death is found at autopsy, and that histology is not recommended in severely decomposed bodies. With this case report, we present the case of a suspected homicide involving a severely decomposed body, in which histological examinations of the heart revealed unexpected information that significantly changed the interpretation of the case, highlighting the importance of performing histological examinations in all cases.
欧洲关于法医解剖的建议表明,在所有情况下,都应对主要器官标本进行组织学取样。然而,在现实中,根据当地的做法,可用的资金和医生的个人选择,这些建议并不总是遵循。国家医学检查员协会(美国)的指导方针指出,如果在尸检中没有发现明显的死亡原因,则应进行组织学检查,并且不建议对严重腐烂的尸体进行组织学检查。在本病例报告中,我们提出了一起涉及严重腐烂尸体的疑似杀人案,其中心脏的组织学检查揭示了意想不到的信息,这些信息显着改变了对案件的解释,强调了在所有病例中进行组织学检查的重要性。
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引用次数: 0
Salivary biomarkers in forensic science: Bridging molecular biology and legal medicine 唾液生物标志物在法医学:连接分子生物学和法律医学
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-11-26 DOI: 10.1016/j.jflm.2025.103044
Arathi Padutholil Ajith Kumar , Premalatha Bidadi Rajashekaraiah , Sheethal Chandra Aralaguppe Chandraprakash , Parvathy Beena Chandran , Vaishaka Ashok Malali , Vidyadevi Chandavarkar
Saliva has emerged as a versatile and non-invasive biological specimen in forensic science. It is a rich source of genomic, transcriptomic, proteomic, metabolic, and microbiomic factors, offering significant potential in forensic investigations. This review explores the multi-dimensional aspects of salivary biomarkers in forensic science, integrating molecular biology with legal medicine.
It provides a comprehensive overview of the saliva composition, highlighting its biochemical constituents and the methodologies employed for its effective collection in forensic scenarios. From a molecular and analytical perspective, we delve into the diverse classes of salivary biomarkers, including genomic markers that enable individual and kinship profiling; transcriptomic and proteomic biomarkers that reveal gene expression and protein profiles that contribute in post-mortem interval estimation and physiological state evaluation; and metabolomic and microbiomic signatures which offer additional discriminatory power to infer health, lifestyle, and even geographic origins.
The forensic applications of these biomarkers and their growing acceptance in judicial proceedings, where the admissibility and evidential value of saliva-derived data are critically assessed, are discussed. Supported by relevant case studies, this review highlights the real-world utility and impact of salivary biomarkers in forensic practice. The challenges and limitations of saliva in forensics are addressed. Additionally, insights into future prospects, such as salivaomics, lab-on-a-chip platforms, and AI-driven data interpretation, are provided.
In conclusion, by mapping the intersection of molecular diagnostics and legal frameworks, this review underscores that saliva can be a revolutionary medium that advances the accuracy and accessibility of forensic identification by bridging its biological complexity with forensic applications.
唾液作为一种用途广泛、非侵入性的生物标本在法医学中已经出现。它是基因组、转录组、蛋白质组、代谢和微生物组因子的丰富来源,在法医调查中提供了巨大的潜力。本文将分子生物学与法医学相结合,从多方面探讨唾液生物标志物在法医学中的应用。它提供了唾液成分的全面概述,突出其生化成分和在法医场景中有效收集唾液的方法。从分子和分析的角度来看,我们深入研究了不同类别的唾液生物标志物,包括能够进行个体和亲属分析的基因组标记;转录组学和蛋白质组学生物标志物,揭示基因表达和蛋白质谱,有助于死后时间间隔估计和生理状态评估;代谢组学和微生物组学特征提供了额外的歧视性力量来推断健康,生活方式,甚至地理来源。讨论了这些生物标志物的法医应用及其在司法程序中的日益接受,其中唾液衍生数据的可采性和证据价值被严格评估。在相关案例研究的支持下,本综述强调了唾液生物标志物在法医实践中的现实效用和影响。解决了唾液在法医学中的挑战和局限性。此外,还提供了对未来前景的见解,如唾液组学、芯片实验室平台和人工智能驱动的数据解释。总之,通过绘制分子诊断和法律框架的交叉点,本综述强调了唾液可以成为一种革命性的媒介,通过将其生物学复杂性与法医应用联系起来,提高法医鉴定的准确性和可及性。
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引用次数: 0
Age estimation based on Demirjian's method using third molars in individuals from Southeastern Brazil 基于Demirjian方法的年龄估计,使用来自巴西东南部个体的第三磨牙
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-11-24 DOI: 10.1016/j.jflm.2025.103045
Amanda Farias-Gomes , Maria Luíza dos Anjos Pontual , Thaísa Pinheiro Silva , Maria Fernanda Silva Andrade-Bortoletto , Matheus L. Oliveira , Francisco Haiter-Neto , Cleber Zanchettin , Deborah Queiroz Freitas
This study assessed the applicability of third molar mineralization stage for estimating chronological age in a Southeastern Brazilian population and tested a previously developed age estimation formula from a Northeastern Brazilian population. Digital panoramic radiographs of 1570 individuals aged 7–22 years were analyzed; 1260 radiographs were used to create the new formula, and 310 to test it. Two independent examiners classified the third molars on the radiographs according to Demirjian's developmental stages. Paired t-test compared chronological and estimated ages; Mann-Whitney test assessed sex differences in mineralization stages (α = 0.05). Multiple linear regression was used to develop a new age estimation formula. Chronological age was similar across all four third molars for different developmental stages, with no sex-related significant differences (p > 0.05). The initial appearance of third molar formation (stage A) and root apex closure (stage H) occurred at mean ages of 8.6 and 19.8 years, respectively. A strong correlation (R = 0.925) was found between chronological age and third molar mineralization stages. The previously developed formula significantly overestimated chronological age by approximately one year (p < 0.05). In contrast, the new formula achieved strong performance, explaining 85 % of the variance in the outcome (R2 = 0.85), with low prediction errors (MAE = 1.35; RMSE = 1.71), with no significant differences between estimated and chronological age for most age groups (p > 0.05). This study confirms the strong correlation between third molar mineralization stages and chronological age in a Southeastern Brazilian population. It also underscores the need for population-specific models, as the previously developed formula led to overestimation. The new formula provides a more accurate method for age estimation in this subpopulation, supporting its forensic and clinical applicability.
本研究评估了第三磨牙矿化阶段在巴西东南部人群中估计实足年龄的适用性,并测试了先前在巴西东北部人群中开发的年龄估计公式。分析了1570例7 ~ 22岁人群的数字全景x线照片;1260张x光片被用于创建新公式,310张用于测试。两名独立的检查人员根据Demirjian的发育阶段在x光片上对第三颗磨牙进行了分类。配对t检验比较了实际年龄和估计年龄;Mann-Whitney检验评价矿化阶段的性别差异(α = 0.05)。采用多元线性回归方法建立了新的年龄估计公式。所有四颗第三磨牙在不同发育阶段的实足年龄相似,没有性别相关的显著差异(p > 0.05)。第三磨牙形成(A期)和根尖闭合(H期)分别发生在平均8.6岁和19.8岁。年龄与第三磨牙矿化阶段有很强的相关性(R = 0.925)。先前开发的公式显著高估了实足年龄约1岁(p < 0.05)。相比之下,新公式取得了很好的效果,解释了85%的结果方差(R2 = 0.85),预测误差低(MAE = 1.35; RMSE = 1.71),大多数年龄组的估计年龄和实际年龄之间没有显著差异(p > 0.05)。这项研究证实了巴西东南部人群中第三磨牙矿化阶段与实足年龄之间的强烈相关性。它还强调需要针对特定人口的模型,因为以前开发的公式导致高估。新的公式提供了一个更准确的方法,年龄估计在这个亚群,支持其法医和临床适用性。
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引用次数: 0
A systematic review about the evolving role of artificial intelligence in various fields of forensic medicine 系统回顾了人工智能在法医学各个领域的发展作用
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-11-24 DOI: 10.1016/j.jflm.2025.103043
Uzma Zaheen , Allah Rakha , Qudsia Hassan , Muhammad Farhan Khan , Sareen Akhtar , Anam Munawar

Objective

This study systematically reviews the applications and impact of artificial intelligence (AI) in forensic medicine, focusing on its role in mimicking human cognitive processes, enhancing diagnostic accuracy, pattern recognition, and operational efficiency across forensic domains.

Methodology

A systematic search was conducted in PubMed and Google Scholar using keywords including "AI in forensics" and "machine learning forensic analysis," covering publications from 2014 to 2024. A total of approximately 1000 articles were initially identified, of which 100 met the inclusion criteria after screening for relevance, study design, and quality.

Results

AI applications in forensic medicine were categorized into key domains: personal identification, forensic pathology, radiology and imaging, digital forensics, toxicology, and forensic anthropology. Machine learning, deep learning, and neural network models demonstrated improvements in accuracy, reproducibility, and efficiency compared with conventional approaches. For example, AI-assisted imaging techniques reduced inter-observer variability in postmortem fracture detection, while predictive models for postmortem interval estimation showed mean error reductions of up to 15 %. Despite these advances, challenges such as small, non-representative datasets, limited external validation, and ethical concerns remain.

Conclusion

AI has significantly enhanced multiple areas of forensic practice by improving diagnostic capabilities, streamlining workflows, and supporting decision-making. However, wider adoption requires rigorous validation, standardization, and ethical oversight. Future research should focus on integrating multimodal data, expanding dataset diversity, and addressing legal and ethical implications to maximize the utility of AI in real-world forensic investigations.
目的系统综述了人工智能(AI)在法医学领域的应用及其影响,重点介绍了人工智能在模仿人类认知过程、提高法医领域诊断准确性、模式识别和操作效率方面的作用。方法以“AI in forensics”、“machine learning forensic analysis”等关键词在PubMed和谷歌Scholar中进行系统检索,检索时间为2014 - 2024年。最初共确定了约1000篇文章,其中100篇符合相关性、研究设计和质量筛选后的纳入标准。结果将其在法医学中的应用划分为个人鉴定、法医病理学、放射学与影像学、数字法医学、毒理学和法医人类学等重点领域。与传统方法相比,机器学习、深度学习和神经网络模型在准确性、可重复性和效率方面都有所提高。例如,人工智能辅助成像技术减少了死后骨折检测中观察者之间的差异,而死后间隔估计的预测模型显示平均误差降低了15%。尽管取得了这些进步,但仍然存在一些挑战,如小而非代表性的数据集,有限的外部验证和伦理问题。结论人工智能通过提高诊断能力、简化工作流程和支持决策,显著增强了法医实践的多个领域。然而,更广泛的采用需要严格的验证、标准化和道德监督。未来的研究应侧重于整合多模态数据,扩大数据集的多样性,并解决法律和伦理问题,以最大限度地发挥人工智能在现实世界法医调查中的效用。
{"title":"A systematic review about the evolving role of artificial intelligence in various fields of forensic medicine","authors":"Uzma Zaheen ,&nbsp;Allah Rakha ,&nbsp;Qudsia Hassan ,&nbsp;Muhammad Farhan Khan ,&nbsp;Sareen Akhtar ,&nbsp;Anam Munawar","doi":"10.1016/j.jflm.2025.103043","DOIUrl":"10.1016/j.jflm.2025.103043","url":null,"abstract":"<div><h3>Objective</h3><div>This study systematically reviews the applications and impact of artificial intelligence (AI) in forensic medicine, focusing on its role in mimicking human cognitive processes, enhancing diagnostic accuracy, pattern recognition, and operational efficiency across forensic domains.</div></div><div><h3>Methodology</h3><div>A systematic search was conducted in PubMed and Google Scholar using keywords including \"AI in forensics\" and \"machine learning forensic analysis,\" covering publications from 2014 to 2024. A total of approximately 1000 articles were initially identified, of which 100 met the inclusion criteria after screening for relevance, study design, and quality.</div></div><div><h3>Results</h3><div>AI applications in forensic medicine were categorized into key domains: personal identification, forensic pathology, radiology and imaging, digital forensics, toxicology, and forensic anthropology. Machine learning, deep learning, and neural network models demonstrated improvements in accuracy, reproducibility, and efficiency compared with conventional approaches. For example, AI-assisted imaging techniques reduced inter-observer variability in postmortem fracture detection, while predictive models for postmortem interval estimation showed mean error reductions of up to 15 %. Despite these advances, challenges such as small, non-representative datasets, limited external validation, and ethical concerns remain.</div></div><div><h3>Conclusion</h3><div>AI has significantly enhanced multiple areas of forensic practice by improving diagnostic capabilities, streamlining workflows, and supporting decision-making. However, wider adoption requires rigorous validation, standardization, and ethical oversight. Future research should focus on integrating multimodal data, expanding dataset diversity, and addressing legal and ethical implications to maximize the utility of AI in real-world forensic investigations.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103043"},"PeriodicalIF":1.2,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
An investigation of shored gunshot exit wound morphologies using a range of forensically relevant surfaces 使用一系列法医相关表面对射击出口伤口形态进行调查
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-11-21 DOI: 10.1016/j.jflm.2025.103035
Bandula Nishshanka , Chris Shepherd , Randika Ariyarathna , Paranitharan Paranirubasingam , Amila Rathnayaka
Shored exit wounds are produced when the skin at the point of the bullet exit is supported or buttressed by some object or surface, causing an abraded ring around the shored exit wound. This work looks to add critical understanding of shored wound processes on a range of surface types, expanding on the currently limited literature that focuses only on soft shoring materials. This large empirical study was conducted to develop a deeper understanding of shored exit wounds for a range of common surface types available in contemporary urban environments. To facilitate this, two ammunition types (5.56 mm and 7.62 mm) were fired into a porcine model designed to simulate the downward force of a human body pressing into various modern building materials. The exit wounds produced by shoring the porcine model on wall tiles, concrete, and two engineered wood types (MDF and Melamine) significantly contrast with the existing, more generalised explanation of shored exit wounds. This highlights the necessity for a more valid, target-type-specific approach to interpreting shored exit wound characteristics. The study highlights that hard-shoring surfaces produce comparatively larger exit wounds, while irregular surfaces give rise to increased shoring and soft surfaces under pressure, produce less shoring. It also reports novel shored exit wound features and wounding mechanisms not documented previously that have potential forensic investigative value in helping determine if a gunshot wound has resulted from a shored scenario or not. While significantly adding to the understanding of shored exit wounds for forensic pathology practice, the study's findings suggest that the shored exit wound characteristics can be interpreted according to different target types, such as yielding and non-yielding surfaces.
当子弹出口处的皮肤受到某种物体或表面的支撑或支撑时,就会产生一种擦伤性伤口。这项工作旨在增加对一系列表面类型的支撑伤口过程的批判性理解,扩展目前有限的文献,仅关注软支撑材料。这项大型实证研究旨在对当代城市环境中一系列常见表面类型的岸边出口伤口进行更深入的了解。为了方便起见,两种弹药(5.56毫米和7.62毫米)被发射到猪模型中,以模拟人体压入各种现代建筑材料的向下力。将猪模型支撑在墙砖、混凝土和两种工程木材(中密度纤维板和三聚氰胺)上产生的出口伤口与现有的、更普遍的关于支撑出口伤口的解释明显相反。这凸显了需要一种更有效的、针对目标类型的方法来解释岸边出口伤的特征。该研究强调,硬支撑表面会产生相对较大的出口伤口,而不规则表面会增加支撑,而软表面在压力下会减少支撑。报告还报告了以前没有记录的新的受冲击出口伤口特征和伤害机制,这些特征和机制在帮助确定枪伤是否由受冲击情景引起方面具有潜在的法医调查价值。虽然在法医病理学实践中显著增加了对岸边出口伤的理解,但研究结果表明,岸边出口伤的特征可以根据不同的目标类型(如屈服面和非屈服面)来解释。
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引用次数: 0
Hemorrhage in cervikal muscles: A case of drowning in the River 颈肌出血:坠河溺水1例。
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-11-20 DOI: 10.1016/j.jflm.2025.103038
Abuzer Gülderen , Tuba Şahinoğlu Güneş , Sertaç Dalgıç , Veysel Gürbüz , Selçuk Çetin

İntroduction and Aim

Ecchymosis and intramuscular hemorrhages seen in the superficial and deep muscle groups of the neck are instructive findings in terms of detecting and defining the pressure and trauma applied to the neck area. In our study, we aimed to present a drowning case in which bilateral sternocleidomastoid muscle bleeding was detected without any findings indicating neck compression or trauma.

Case

30-year-old man was found dead in a river near our city. He was referred to us by the prosecutor's office for an autopsy and to determine the cause of death. At autopsy; Bleeding was observed in the part of the sternocleidomastoid muscle close to the clavicle, under the fascia and within the muscle. Comprehensive examination, crime scene examination and autopsy findings were evaluated together. Bleeding that occurred in the neck region of the patient without external trauma was evaluated as intramuscular bleeding that rarely developed in the neck muscles during the drowning.

Discussion and conclusion

Forced inspiratory muscles do not function during normal breathing. They function in physiological and pathological conditions where respiratory volume must be increased. Among these muscles, the sternocleidoimastoid muscle is responsible for increasing the toraks volume by lifting the sternum up. It is an expected situation to see forced inspiration-expiration and related findings in deaths due to drowning. However, intramuscular hemorrhages that may occur due to forced inspiration-expiration are rare findings. In such cases, external neck trauma and compression should be excluded before making a decision.
İNTRODUCTION目的:颈部浅肌群和深部肌群的瘀斑和肌内出血对检测和确定颈部区域的压力和创伤具有指导意义。在我们的研究中,我们的目的是提出一个溺水病例,双侧胸锁乳突肌出血,没有任何发现表明颈部压迫或创伤。案例:30岁的男子被发现死在我们城市附近的一条河里。检察官办公室将他转介给我们,以便对他进行尸检并确定死因。尸检;胸锁乳突肌靠近锁骨、筋膜下及肌内出血。综合检查、现场检查和尸检结果一起评估。没有外伤的患者颈部出血被评估为溺水期间颈部肌肉很少发生的肌肉内出血。讨论与结论:在正常呼吸过程中,强制吸气肌不起作用。它们在必须增加呼吸量的生理和病理条件下起作用。在这些肌肉中,胸锁乳突肌负责通过提升胸骨来增加toraks的体积。在溺水死亡中看到强制吸气-呼气和相关发现是一种预期的情况。然而,肌肉内出血,可能发生由于强迫吸气呼气是罕见的发现。在这种情况下,在做决定之前应排除颈部外伤和压迫。
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引用次数: 0
Medical liability related legislation and insurance policies around the world: A narrative literature review 世界各国医疗责任相关立法与保险政策:叙述性文献回顾
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-11-19 DOI: 10.1016/j.jflm.2025.103040
Ioannis Ketsekioulafis , Konstantinos Katsos , Dimitrios Kouzos , Chara Spiliopoulou , Theodoros Lytras , Emmanouil I. Sakelliadis
<div><h3>Introduction</h3><div>Medical law defines the rules of healthcare by specifying the rights of healthcare consumers while at the same time defining the obligations of healthcare providers. When clinicians fail to provide the standard of care, medical malpractice claims arise, leading to medical liability. While many malpractice claims allege deviation from the <em>lex artis</em>, a substantial proportion do not ultimately establish negligence and are dismissed or settled without a finding of fault. Due to the significant impact of medical negligence on the quality of medical care, as well as on the domestic and global economy, different countries adopt different systems for managing these disputes. Finally, the mandatory or non-mandatory medical malpractice insurance makes doctors carry out their medical work without the fear of medical liability. In fact, in most countries today, doctors are given the opportunity to choose between claims-made and occurrence-based policies of medical malpractice insurance.</div></div><div><h3>Materials and methods</h3><div>The study is a narrative review of scientific and legal works from different countries. For the comparison of medical liability systems and insurance policies a comprehensive review of databases and legal texts was conducted.</div></div><div><h3>Results</h3><div>This study compares medical liability and malpractice insurance systems across countries, examining variations in the handling of malpractice claims and their implications. The system is adversarial in many countries, especially in the United States, to allow for a substantial compensation, while other countries, such as the United Kingdom and Germany, focus on mediation and structured compensation processes. Notably, France, Japan and other countries follow a no-fault system, of reasoning that the system is more efficient in the sense that it reduces the patient's burden of proving negligence and thus expedites the compensation. These findings reveal how each country negotiates the balance between patient rights and healthcare provider protections, and, in turn, how these negotiations affect malpractice insurance costs and legal reforms.</div></div><div><h3>Discussion</h3><div>The analysis contrasts fault-based systems which offer large compensation awards with no-fault systems which focus on quick compensation but may lack accountability. Countries with high litigation rates like the US and Brazil have higher insurance costs, while countries like Canada and Australia have stabilized their systems through reforms. Medical liability insurance options, claims-made versus occurrence-based, raise different economic and legal concerns. Occurrence-based policies are more expensive for younger professionals, but they provide longer-term coverage than claims-made policies.</div></div><div><h3>Conclusion</h3><div>Global medical liability frameworks vary considerably, reflecting cultural, economic and legal contexts. However, the compari
医疗法律规定了医疗保健规则,具体规定了医疗保健消费者的权利,同时规定了医疗保健提供者的义务。当临床医生不能提供标准的护理,医疗事故索赔出现,导致医疗责任。虽然许多医疗事故索赔声称违反了《劳动法》,但相当大比例的索赔最终没有确立过失,在没有发现过失的情况下被驳回或解决。由于医疗过失对医疗质量以及对国内和全球经济的重大影响,不同的国家采用不同的制度来管理这些纠纷。最后,强制性或非强制性医疗事故保险使医生在进行医疗工作时不必担心医疗责任。事实上,今天在大多数国家,医生都有机会在医疗事故保险的索赔政策和基于事故发生的政策之间作出选择。材料与方法本研究是对各国科学和法律著作的叙述性回顾。为了比较医疗责任制度和保险政策,对数据库和法律文本进行了全面审查。结果本研究比较了各国的医疗责任和医疗事故保险制度,检查了处理医疗事故索赔的差异及其影响。在许多国家,特别是在美国,该制度是对抗性的,以允许大量赔偿,而其他国家,如英国和德国,则侧重于调解和有组织的赔偿程序。值得注意的是,法国、日本和其他国家采用无过错制度,理由是该制度更有效,因为它减少了患者证明过失的负担,从而加快了赔偿。这些发现揭示了每个国家如何在患者权利和医疗保健提供者保护之间进行谈判,以及这些谈判如何影响医疗事故保险成本和法律改革。该分析对比了基于故障的系统(提供大量补偿)和无故障系统(侧重于快速补偿,但可能缺乏问责制)。美国和巴西等诉讼率较高的国家的保险成本较高,而加拿大和澳大利亚等国则通过改革稳定了其制度。医疗责任保险的选择,无论是索赔还是事故发生,引起了不同的经济和法律问题。对于较年轻的专业人员来说,以事件发生为基础的保单较为昂贵,但它们比索赔保单提供更长期的保险。全球医疗责任框架差异很大,反映了文化、经济和法律背景。然而,比较表明,没有一个系统是完美的,每个系统都有值得学习的地方。
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引用次数: 0
Assessing the role of cardiovascular diseases in drowning: A case-control study 评估心血管疾病在溺水中的作用:一项病例对照研究
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-11-19 DOI: 10.1016/j.jflm.2025.103041
Cemyigit Deveci , Saime Gizem Tezgel , Mehmet İlhan , Mehmet Atilgan
Drowning is a serious public health problem that can lead to morbidity or mortality. The study aims to describe the postmortem cardiovascular findings and investigate the impact of cardiovascular diseases on the mortality associated with drowning, employing a control group for comparison. The null hypothesis of our investigation suggested that there would be no statistically significant disparity in cardiovascular findings between cases of drowning and deaths resulting from other non-toxicological and non-pathological incidents. A study group (n = 109) from the deaths due to drowning were composed and a comparable control group (n = 218) by selecting two cases for each case in the study group with matching age and gender, with non-toxicological and non-pathological causes of death were created, in order to reduce potential confounding. The demographic and physical properties, and the cardiovascular autopsy findings were compared between the groups.
The study revealed a male predominance (73.4 %), with a median age of 55 (study) and 56 (control). Cardiovascular alterations (hypertrophy, scarring, fibrosis, stenosis) exhibited no significant differences between groups. Cardiac hypertrophy correlated positively with age. Higher BMI were detected in individuals over 40 years old in the study group compared to control group. No significant differences were detected between the groups in terms of cardiovascular findings. However, in the younger population (<40 years old), although not statistically significant, the study group showed higher percentages compared to the control group for both perivascular-interstitial fibrosis and ventricular hypertrophy.
溺水是一个严重的公共卫生问题,可导致发病或死亡。该研究旨在描述死后心血管发现,并调查心血管疾病对溺水相关死亡率的影响,采用对照组进行比较。本研究的原假设表明,溺水病例与其他非毒理学和非病理性事件导致的死亡在心血管方面的发现没有统计学上的显著差异。为减少潜在的混淆,我们从溺水死亡病例中选择一个研究组(n = 109)和一个可比较的对照组(n = 218),在研究组中每个病例选择两个年龄和性别匹配的病例,并创建非毒理学和非病理性死亡原因。比较两组之间的人口统计学和物理特性以及心血管解剖结果。该研究显示男性优势(73.4%),中位年龄为55岁(研究)和56岁(对照组)。心血管改变(肥大、瘢痕、纤维化、狭窄)各组间无显著差异。心肌肥厚与年龄呈正相关。与对照组相比,研究组中40岁以上的个体BMI较高。在心血管方面,两组之间没有发现显著差异。然而,在年轻人群中(
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引用次数: 0
Validation of forensic cleaning processes undertaken within Sexual Assault Referral Centres 验证在性侵犯转介中心内进行的法医清洁程序。
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-11-17 DOI: 10.1016/j.jflm.2025.103023
Michelle Gaskell , Lesley Clifford , Aaron Jones , Guylaine. O Hanford , Kevin Sullivan
This paper describes the retrospective validation of long-established cleaning processes used within Sexual Assault Referral Centres (SARCs), for which there are variations between facilities in the detail of the cleaning approach that is applied, including whether bleach/hypochlorite cleaning reagents are permitted depending on local health and safety requirements. Six cleaning reagents commonly used within UK SARCs and Forensic Science Providers were assessed in this validation study: Chemgene HLD4H, Virkon, Microsol, Selgiene, Virusolve were tested along with Presept which was the only reagent containing bleach. Additional comparison testing was also conducted on Chemgene Medlab. These were evaluated for their DNA decontamination capability by cleaning dried-on body fluid stains deposited on typical examination room surfaces and then assessing the level of DNA remaining (percentage yield). Impact of changing different cleaning parameters were assessed against an environmental indicator guide that provides insight into SARC facility cleanliness. Differences in effectiveness of decontamination varied according to body fluid type with DNA in blood being most readily removed followed by saliva, and semen was the hardest to decontaminate. Likewise, different surfaces varied in their resilience to decontamination with Formica being the easiest to clean and vinyl the hardest. Bleach-based reagent Presept gave the best decontamination test results overall, whilst non-bleach cleaners Virkon and Selgiene were also very effective. However, as a general rule, provided double spray/wipe cycles are performed using manufacturers’ recommended concentrations and a 30 s contact time, the cleaning effectiveness of all reagents were assessed to be generally acceptable in most circumstances. The exception to this rule was cleaning dried semen on vinyl, which was the most challenging body fluid/surface combination to decontaminate. It is recommended that extra care is taken in cleaning vinyl surfaces such as the examination couch and consider additional measures if necessary.
本文描述了对性侵犯转介中心(SARCs)使用的长期建立的清洁程序的回顾性验证,在不同的设施中,所采用的清洁方法的细节有所不同,包括是否允许使用漂白剂/次氯酸盐清洁试剂,这取决于当地的健康和安全要求。在这项验证研究中评估了英国SARCs和法医科学提供商常用的六种清洁试剂:Chemgene HLD4H, Virkon, Microsol, Selgiene, Virusolve以及Presept(唯一含有漂白剂的试剂)进行了测试。在Chemgene Medlab上也进行了额外的比较测试。通过清洁沉积在典型检查室表面的干燥体液污渍,然后评估剩余DNA水平(百分比产量),评估这些产品的DNA去污能力。根据环境指标指南评估了改变不同清洁参数的影响,该指南提供了对SARC设施清洁度的见解。去污效果的差异因体液类型而异,血液中的DNA最容易去除,其次是唾液,精液最难去污。同样,不同的表面对去污的恢复能力也各不相同,胶木最容易清洁,乙烯基最难清洁。基于漂白剂的Presept总体上给出了最好的去污测试结果,而非漂白剂Virkon和Selgiene也非常有效。然而,作为一般规则,如果使用制造商推荐的浓度和30秒的接触时间进行两次喷雾/擦拭循环,所有试剂的清洁效果在大多数情况下都是可以接受的。这条规则的例外是在乙烯基上清洁干精液,这是最具挑战性的体液/表面组合去污。建议在清洁检查椅等乙烯基表面时格外小心,并在必要时考虑采取其他措施。
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引用次数: 0
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Journal of forensic and legal medicine
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