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AIM: To explore the value of ocular trauma score(OTS), initial visual acuity, and ocular structural parameters in the assessment of healing visual acuity from ocular trauma.METHOD: A total of 302 cases(302 eyes)of ocular trauma were selected as subjects, which were accepted and issued clear appraisal opinions by the Academy of Forensic Science from June 2015 to June 2021. The subjects were grouped according to the healing best corrected visual acuity(BCVA)from ocular trauma. Group Ⅰ included 63 cases(63 eyes)with BCVA <3.7; Group Ⅱ included 70 cases(70 eyes)with 3.7≤ BCVA <4.5; Group Ⅲ included 78 cases(78 eyes)with 4.5≤ BCVA <4.9; Group Ⅳ included 91 cases(91 eyes)with BCVA≥4.9. In addition, 77 cases(77 healthy eyes)of ocular trauma were selected as the control group, namely Group Ⅴ. The healing BCVA and ocular structural parameters from ocular trauma and theirs correlation were analyzed, and the random forest(RF)and support vector machine(SVM)model of healing visual acuity was established by the IBM SPSS Modeler 18.0.RESULTS: The initial visual acuity, OTS, the grading of corneas, lenses, and fundus, and the thickness of the retinal never fiber layer of ocular trauma patients were correlated with the healing BCVA(P<0.01). There were significant differences in ocular structural parameters among groups, except the central subfield thickness(P<0.001). The SVM model had higher accuracy of predicting healing visual acuity than the RF model, and the accuracy rate was over 80% when the error was within 0.15.CONCLUSION:OTS and ocular structural examination can provide effective information for the clinical forensic medicine appraisal of visual dysfunction after ocular trauma, and they are valuable in discriminating camouflage of visual dysfunction.
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Objective:To discuss the technical standards of disability assessment in personal injury compensation in China, and to put forward the conception of standard construction. Methods:The disability assessment technical standards in China were systematically reviewed, as well as the contents of the United States Guides to the Evaluation of Permanent Impairment (GEPI) and the United Kingdom Guidelines for the Assessment of General Compensation in Personal Injury Cases (GAGD). Results:There were six standards for disability assessment and three of them were commonly used in China at present, coming from different departments. There were some repeated, intertwined, contradictory contents. The disabilities were graded in ten grades, and the disability rate was difference of 10% between two successive grades. The determination of disability grades came from the consensus of specialists, and was little scientific. In comparison, GEPI was developed according to the ICF standards formulated by the World Health Organization, which contained continuous disability value instead of disability grade, along with the weight of organs to calculate synthetically. GEPI emphasizes objective indicators. GAGD directly gave the financial amount of disability compensation. Conclusion:It is needed to integrate the standard management departments of technical standards for disability assessment in China to link standards up; strengthen macro plan and establish the system table of forensic disability assessment standards; carry out international exchanges of technical standards and refer to the concept and data of foreign standards when revising standards.
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The article is study about range of motion on lower extremities on Guides to the Evaluation of Permanent Impairment. We reviewed the latest range of motion concept about lower extremities evaluation of GEPI. We also introduced measurement and procedure of range of motion evaluation. To provide advice for construction of disability evaluation system in China.
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Objective To discuss the relationship between thickness of RNFL and visual field, and its application in forensic identification. Methods Using the GDxVCC and Octopus automatic perimeter to check on 52 optic nerve lesion cases. The data is grouped according to valid value of visual field (Group1- severe injury group, Group2-minor injury group, Group3- slight and following slight injury group) , calculated for the averaged RNFL thickness, and analyzed by ANOVA. Meanwhile, the correlation between RNFL thickness and visual field indices(effective value of visual field, MD, MS, sLV) was analyzed with Pearson's correlation and described in scattered plot. Results Group 1 to 3 average RNFL thickness was 60.9036±9.53514μm, 53.6474±15.45306μm, 36.3±8.45695μm accordingly. Through ANOVA we can see that differences wer significant between every group. The valid value of visual field and MS were positively with the average RNFL thickness with a correlation of 0.543, 0.400, respectively(P<0.05). The MD and sLV were negatively correlated with the average RNFL thickness with correlation -0.450、-0.440, respectively(P<0.05). Linear relationship between the average RNFL thickness and effective value of visual field, MD, MS, sLV were Y=0.967X+19.508, Y=0.095X-10.858, Y=0.175X+9.187, Y=-0.205X+20.215accordingly. Nonlinear relationship between the average RNFL thickness and effective value of visual field, MD, MS, sLV were Y=-0.037X2+5.208X-93.795, Y=0.010X2-1.325X+50.111, Y=-0.008X2+1.103X-15.606, Y=0.004X2 -0.520X+22.232. Conclusion RNFL thickness measurement is expected to be an objective assessment in visual field, a new morphological methods.
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Objective To analyze types, mechanism and forensic identification for traumatic visual loss. Methods 109 cases of the evaluation for impairment and disability on traumatic visual loss were retrospectively analyzed, including interocular differences, anisometropia, left or right eye and the distributions of visual acuity, etc. Results The male-to-female ratio was 5.8:1, mainly 30~59 years of age. The ratio of monocular versus binocular injuries was 17.17:1. The ratio of left versus right injured eye was 1.39:1 in intentional injury cases. 115 eyes were injured, 83 of which were in low vision or blindness. 95 patients(87.16%) had large interocular differences( ≥ 3 lines). There were 9 patients with anisometropia from 2.25D to 6.00D and 23 patients with anisometropia larger than 6.00D. Conclusion Interocular differences and anisometropia are common in practice, which are not included in the expertise standard yet. Functional vision should be considered when developing the expertise standard.
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The article is comparative study about spine and extremities on clause for the identification of the body injured and The classification of the body impairment. We reviewed the terms and provisions about spine and extremities as follows, amputation impairment, function impairment, and amputation impairment combined function impairment. This paper provides a comprehensive access and analysisofthe similarities and differences between the two standards.
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Evaluation of visual impairment is the fundamental research of visual impairment standards and appropriate application. In the absence of basic study, impairment standard is in the trouble of formulating, understanding and apply, the accuracy and scientific of appraisal opinion is also weakened. The following five key problems should be resolved above all, definition of visual function of disability, the proportion between visual impairment and individual dysfunction, appropriate examinations, quality of life investigation of disability and the integrated measure of vision damages. Assessment research and cross-over study of law, forensic science and clinical medicine should be enhanced. Developing of impairment evaluation theory is needed to the standardization and standardization of permanent impairment assessment guides.
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The article is study about principle of lower extremities on Guides to the Evaluation of Permanent Impairment. We reviewed the latest concept in lower extremities evaluation of GEPI, such as regional impairment, diagnosis based impairment and grade modifier. We also introduced maximum medical improvement and conversion from lower extremities impairment to whole person impairment. To provide advice for construction of disability evaluation system in China.
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Objective To explore the application value of psychophysiological test technique in identification of artificial injury and malingering. Methods CQT test was conducted on 50 students with camouflaged pain and tympanic membrane perforation, respectively, using Tongfang Shenhuo Polygraph Tester (TH 4.0.0.15). T-test and χ2 test were adopted for data analysis. Results The accuracy rate of honest group was higher than that of lying group (P<0.01). There were no significant differences in accuracy rates between automatic scoring and manual scoring,and so were that between mask pain problems' testing and tympanic membrane perforation problems' testing. Conclusion This experiment provides a good research basis for the subsequent real case test.
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Objective To explore MSCT optimal examination time window for patients with occult rib fracture, and provide objective evidence for forensic injury. Methods Totally 105 cases with chest trauma were retrospectively analysed. They were examined in the first week after trauma and re-examined in different time windows by MSCT. The quantities of occult rib fractures in the first examination were compared to those in re-examinations. Results The quantities of occult rib fractures at different inspection time windows were mostly different. There was no statistically significant between the quantities of rib fractures in the first week and the second week, the first week and the sixth week later, the fourth week and the fifth to sixth weeks (P>0.05). There was statistically significant between the quantities of rib fractures in the first week and the thrid to sixth weeks, the second week and the third to sixth weeks, the third week and the fourth to sixth weeks (P<0.05). Conclusion The result of the study imply that the fourth to sixth week is the optimal time window of MSCT examination in the occult rib fracture.
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Objective To research the relationship between binocular acuity and monocular acuity,and their effect on the evaluation of visual impairment and disability. Methods 1006 patients, aged between 18 and 60 years, are measured monocular and binocular acuities after the best lens correction. Results Binocular vision is higher than, equal to and less than monocular vision, three accounted for 27.14%, 70.78% and 70.78% respectively. Interocular difference has certain correlation with binocular interactions (χ2=54.939,P<0.05,r=0.228). Thirty-three patients have same binocular acuity but different monocular acuity. Conclusion Binocular acuity associated with the monocular acuity and the better eye vision plays a special role in visual disability evaluation.
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Objective It aims to investigate the relationships among the categories of Comprehensive Version for Stroke as described in the International Classiifcation of Functioning, Disability and Health (ICF) Core Set, and to provide new supports for Judicial Appraisal of functioning in stroke by ICF functioning mapping.Methods The variables of 59 categories of ICF assessment scale and the samples of 106 persons’ are selected and used in the least absolute shrinkage and selection operator (LASSO) for mining dependencies among those variables. The graphical modeling and analyzing with the software Gephi provides a visual map of the correlations among those classiifcations. Results 59 interconnected categories which organized into the functioning mapping. b340, b735, b175 and b152 are centrally positioned categories because of their high correlation.Conclusion Functioning mapping by graphical modeling can reveal complex relational structures embedded in functioning classiifcations, which provides the support for using ICF to appraisal stroke.
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Objective To explore the clinical significance of detecting serum levels of IL-6 and TNF-α in patients with intracranial hemorrhage.Methods The serum levels of IL-6 and TNF-α in different period were detected in patients with intracranial hemorrhage, by enzyme-linked immunosorbent assays (ELISA), and compared with those of healthy subjects (the control group).ResultsThe serum levels of IL-6, TNF-α in the severe and slight patients of study group on 1st, 3rd, 5th and 7th were signiifcantly higher than those in the control group (all withP<0.05). The serum levels of IL-6, TNF-α in the severe patients of study group were signiifcantly higher than those in slight patients of study group (all withP<0.05) on 5th and 7th. The serum levels of IL-6 and TNF-α in dead cases on 5th, 7th days admission were significantly higher than those in survival cases (P<0.05). The serum levels of IL-6 was positively correlated with TNF-α (r=0.721,P<0.05).Conclusion The detection of dynamically serum levels of IL-6 and TNF-α is of great clinical value for assessing the disease development therapeutic efifcacy and prognosis of brain injury patient with intracranial hemorrhage.
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Objective The aim of this study was to analyze the effect of gender and age on shoulder and hip range of motion (ROM) and to determine the differences of ROM of normal side shoulder and hip joints between the data we collected and the published standards (Guideline of Examination for Body Impairment in Clinical Forensic Medicine SF/ZJD0103003-2011) in China. Methods We collected cases with unilateral injury of shoulder or hip from clinical forensic medicine. The differences of ROM of normal side joint between the data we collected and the published standards were studied. Descriptive statistics was calculated between male and female subjects in ifve age groups including 0~25, 26~40, 41~50, 51~60 and >60 years, and the ROM changes with age were also studied. Results The data collected in this study was signiifcantly different from the published standard. With age growth, the ROM of shoulder and hip were decreased and a significant difference between genders in partial activity direction of shoulder and hip was found in the individuals who were over 50 years. Conclusion Gender and age appear to be inlfuential factors to determine the normal ROM of the shoulder and hip joint, and there is signiifcantly difference of ROM of normal side shoulder and hip joints between the data we collected and the published standards (Guideline of Examination for Body Impairment in Clinical Forensic Medicine SF/ZJD0103003-2011).
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Technical standards were supports that not only for any profession’s development, but also for the basic means of modern quality control.Forensic clinical medicine has developed nearly 40 years in china, there are 23 normative technical documents at present, the range of its application has been expanding with time, the caseload has been more than 1 million pieces per year all the country. Reviewing these standards, it can be seen: Technital standard of forensic clinical medicine has absorbed a large number of advanced international ideas, assimilating plenty of practice experience at the same time, standard's system has been initially formed, it has become one of the important means to guarantee the quality of medicolegal expertise. Certainly, the construction of forensic clinical standardization in China is still an arduous task, there are also many outstanding contradiction in the existing standards, our studies on international standards were not in-depth, and so on. In the future, forensic science experts still need to strengthen the companion study of technical standards and laws or regulations, intensify tracing and evaluating of international standards in order to form more adaptive and advanced technical standards.
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Objective To observe the expression of S100β protein in the traumatic brain injury and investigate its relation to the severity of the TBI patients.Methods To collect 30 volunteer controls,30 patients with traumatic brain injury and 30 patients with trauma expect traumatic brain injury.according Glasgow Coma Scale(GCS),TBI patients were divided into tow groups,the minor group is GCS≥8,the severegroup is GCS<8.ELISA method was used for observing the expression of S100β protein in serum from the controls and patients.Results Within 6 hours after TBI,the concentration of S100β protein increased higher in patients of TBI than the others(P<0.05).The concentration of S100β protein increased higher in the severe group(GCS<8)than the minor group(P<0.05).The higher level of seium S100β protein,the more severe of TBI patients,the higher level of serum S100β protein.Conclusion The serums S100β protein can be a special index for the early diagnosis of TBI,the higher level of it,The more severe of patients.
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Objective The CT values and glial fibrillary acidic Drotein (GFAP) expression changes within 24 hours in the cerebral infarction of rats were observed in order to evaluate the time of infarction indirectly. Methods The animal models of cerebral infarction due to the embolism of middle cerebral arteries were replicated reference to Longa’s thread embolism method. The rats with cerebral infarction in right hemisphere and without cerebral infarction in left cerebral hemisphere were scanned with CT at different time after cerebral infarction,then the CT values were measured and their differences were calculated. At the same time,the GFAP expression changes were detected by immunohistochemical technique (SP method). Results The infarction focuses were observed in all rats in 6 hours group. The differences of the CT values in the infarction hemisphere (right side in brain) and non-infarction (left side in brain) hemisphere had in linear relationship,and the GFAP expression also related to the time of infarction to certain degree. Conclusion Cerebral infarction due to embolism of blood vessel could be diagnosed at least 6 hours after middle cerebral artery occlusion. The time of cerebral infarction could be inferred by the difference of CT values between the infarction and non-infarction hemispheres and the changes of GFAP expression.
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When auditory organ is stimulated by some tones,there will be a series of electric activities in our auditory systems,we call them auditory evoked potentials.we can divide them short,middle and long latency response by their latencies.Different potentials can reflect brain function activities in different pathes of auditory nerve.In forensic medicine expertise,they can be objective evaluation in audition function and handicap of pathes of auditory nerve brain function.In this article,we summarized the mechanism and characters of different auditory evoked potentials,sumed up their application value in forensic medicine.
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0.05 ). Conclusion The NPT test is simple and practical, and its diagnostic accuracy is comparable to that of the combined test. The NPT test should be used as an examination of choice for the primary etiological diagnosis in ED after trauma.