In medical disputes, medical damage appraisal plays a crucial role in determining such aspects as the fault of medical behaviors, causation, scope of damage compensation, and liability allocation. However, predicaments such as difficulties in submitting cases for appraisal and long duration of appraisal have become prominent issues restricting the quality and efficiency of the trial of medical dispute cases in courts. Through an empirical analysis of medical dispute cases in the two-level courts of City H since 2024, it is found that medical damage appraisal has problems including an imbalance between supply and demand for appraisal, difficulties in initiating appraisal procedures, long appraisal cycles, and widespread disputes over appraisal conclusions. The root causes of the difficulties in submitting cases for medical damage appraisal lie in the non-smooth operation of the system, insufficient resource guarantee, and the failure to effectively establish a social trust mechanism. Therefore, it is necessary to take multiple measures in terms of integrating resources, improving systems, strengthening guarantees, tightening supervision, and diversifying dispute resolution, so as to solve the problem of difficulties in submitting cases for medical damage appraisal, enhance the quality and efficiency of the trial of medical dispute cases, and build a scientific and efficient medical damage appraisal system.

The reform of China’s forensic appraisal management system is facing the contradiction between an increasingly growing demand for standardized and unified management and the unordered and decentralized management supply. Over the past ten years of the “delegation of powers, improvement of regulation, and optimization of services” reform, the decentralization of forensic appraisal management power has, to a certain extent, solved the drawback of insufficient management supply in the old management system. However, in the reform, problems have emerged, such as the absence of an ability assessment for the main bodies undertaking administrative licensing rights, the lack of a legal basis for the delegation of administrative penalty powers, inconsistent contents of the decentralized management power, and non-unified ways of decentralizing the management power. There is an urgent need for unified management rules for forensic appraisal to make effective regulation. Therefore, when formulating the “Forensic Appraisal Law”, it is necessary to consider four aspects: constructing a pre-entrustment evaluation and demonstration procedure, supplementing the legal basis for delegation, clarifying the content of the decentralized management power, and unifying the ways of decentralizing the management power. This is expected to absorb the practical effects of the local decentralization reform and improve the quality and efficiency of forensic appraisal management.

Forensic clinical and forensic pathological identifications focus on analyzing and assessing damages to an individual’s life, health and functions resulting from external injurious factors. Among them, the causal relationship between damages and their consequences in forensic clinical and forensic pathological appraisals often gives rise to disputes due to the empirical and subjective nature of the judgment criteria and analytical methods involved. The main purpose of forensic appraisal is to assist in resolving specialized issues at the factual level and in providing technical support for the determination of legal causation and the assessment of legal liability in judicial trials. In the assessment of human injury severity, analyzing the relationship between injury and illness and conducting downgrade evaluations when necessary are rights and responsibilities entrusted to the assessors by the assessment standards. In the assessment of human disability levels, objectively explaining the extent to which the injury contributes to the disability outcome is a fundamental requirement for the assessors as stipulated by the law and the assessment standards. In cases involving death, it is also necessary to clearly explain the causal relationship between bodily injuries and the resulting death in accordance with judicial requirements.Accordingly, further refinement of techniques and standards for causal-relationship appraisal is required to achieve their consistent implementation in relevant appraisals and improve the uniformity of forensic opinions.

Due to the diversity and complexity of the objects and content involved in forensic appraisal, appraisers face greater difficulties in understanding the appraisal issues and conducting the assessment. In particular, under the influence of appraisal standards with legal attributes and related legal factors, there is a substantial gap between the reality of forensic appraisal and the ideal goals presupposed by the institutional framework. Forensic appraisal not only requires the use of forensic medical knowledge to communicate objective facts and legal facts, but also needs the results of communication between forensic medicine and law to meet the requirements of legal facts. Furthermore, the facts established through forensic knowledge and judgment must be subject to scrutiny by non-experts under legal standards. Given the differences in the nature of criminal and civil cases, forensic appraisal in ambiguous areas or within ranges of discretion should not only consider the exogenous, endogenous, and intervening factors of existing facts, but also make value choices based on different concepts of rule of law. This realizes the goal of incorporating forensic knowledge cognitive judgment into legal value judgment, thereby giving full play to the functions of forensic medicine in cognitive judgment of objective facts and interpreting specialized issues as evidence, and providing key opinion evidence for the determination of legal facts of cases.

The determination of causation in forensic appraisal of personal injury is essentially a process of medical fact-finding that connects with legal value judgment, and its results directly or indirectly influence judicial decisions on personal injury cases. Medical causation focuses on the objective causal link between the harmful outcomes and the injurious act, emphasizing scientific explanation and empirical probability. Legal causation, by contrast, focuses on the reasonableness of attributing liability, highlighting normative choice and value assessment. The currently effective standards in the field of forensic appraisal provide technical norms for causation assessment in different cases, the core of which lies in the scientific evaluation of the underlying objective connections. Meanwhile, it is necessary to consider the boundaries between forensic appraisal and legal judgment and their reasonable coordination. The objectivity of medical evidence should serve as the foundation to avoid legal interference in factual determination, and it is also important to prevent forensic appraisal from substituting judicial adjudication. This paper discusses the layered structure of causation analysis, clarifies the positioning principle for determining factual causation, and proposes mechanisms to optimize the coordination between factual causation and legal evaluation. Additionally, this paper explores the technical support through information-based tools and the role of the expert assistant system, with the aim of achieving an effective integration of scientific rationality and legal values in causation determination.

Forensic clinical appraisal serves as a crucial link between medical facts and judicial judgments. Its core mission is to precisely define the causal relationship between the injurious act and harmful outcomes from a medical perspective. In judicial practice, the objective reconstruction of factual causation and the normative judgment of legal causation are invariably intertwined. The application of the legal concept of causative potency in the field of forensic appraisal further highlights the deep integration of technical judgment and legal thinking. Factual causality and legal causality differ essentially in the judging subject, criteria, and objectives. In scenarios such as single causality and multiple-cause-single-effect causality, practitioners confront difficulties in distinction, including the conflict between technical boundaries and legal demands, and the cross-border application of causal potency.This paper systematically reviews the theoretical differences between factual causation and legal causation, analyzes their specific manifestations in forensic clinical appraisal, and focuses on the evolutionary trajectory and practical challenges of the distinction pathway. According to the current application status of causative potency assessment, it proposes a balancing strategy between technical rationality and legal thinking in appraisal, providing theoretical support and practical reference for enhancing the scientific robustness and legal applicability of forensic clinical appraisal opinions.

Appraisal opinions assist in identifying specialized facts in litigation, protecting the parties’ rights to question and defend, and clarifying the correct distinction between the functions of forensic appraisal and judicial adjudication. However, as all litigants’ understanding of forensic appraisal increases, the phenomenon of “generalized appraisal” has become more pronounced in practice. Forensic appraisal gradually replaces judicial decisions in some cases. Meanwhile, there is a lack of effective cross-examination of appraisal opinions in litigation, and prosecuting agencies sometimes substitute thorough reasoning and analysis with repeated appraisals. This results in forensic appraisals exceeding their technical boundaries and encroaching on matters that should be decided by courts. Undoubtedly, this undermines judicial authority and fairness. Of course, the causes of this problem are multifaceted, including factors related to the users of appraisal opinions, the quality of appraisers themselves, as well as imperfections in litigation and appraisal rules. To prevent such problems, it is necessary to strengthen the reasoning in judicial documents when adopting appraisal opinions, improve appraisal and litigation rules, and establish a sound case guidance system. These measures will comprehensively clarify the use of appraisal opinions from the root, throughout the process, and from a preventive perspective, ensuring that appraisal opinions carry out true evidential effect within the appraisers’ professional scope.

Medical damage appraisal, one of the crucial links in medical disputes, serves as the scientific basis for resolving such disputes and is also one of the major issues in medical dispute complaints. This paper focuses on the dual structure of medical damage appraisal entities, namely the coexistence of medical associations and judicial appraisal institutions, and delves into its formation background, operational drawbacks, and core issues. The study reveals that the dual structure suffers from problems such as unequal legal status, inefficient resource allocation, intensified doctor-patient confrontation, and frequent conflicts in conclusions, leading to practical predicaments such as the lack of neutrality, absence of uniformity, procedural obstacles, and deficiencies in quality assurance mechanisms. Therefore, taking the medical damage appraisal work in Shanghai as a sample, and combining judicial practice with theoretical research, this paper proposes an optimization path oriented towards neutrality, uniformity, and professionalization. It aims to establish a scientific and reasonable system for medical damage appraisal entities, provide theoretical support and practical solutions for resolving the predicament of “difficult and disorderly appraisal”, and facilitate the efficient resolution of medical disputes and the improvement of doctor-patient relationships.

Objective To investigate the feasibility of surface-enhanced Raman spectroscopy (SERS) combined with chemometric methods for the nondestructive and rapid identification of black pen inks. Methods By optimizing silver nanoparticle substrates and spectral acquisition parameters, SERS spectra of 30 black pen inks were collected. Classification models were constructed using K-means clustering algorithm (K-Means), K-nearest neighbor classification algorithm (KNN), and random forest (RF) algorithm, with their performance evaluated based on accuracy and F1-score. Results SERS effectively suppressed fluorescence background and enhanced Raman signals, yielding distinct characteristic peaks for all tested samples. The carbon material D band and G band located at 1 338~ 1 392 cm-1 and 1 583~1 619 cm-1 were also identified. The KNN demonstrated optimal classification performance, as its results were fully consistent with those obtained from direct SERS discrimination. Conclusion The combination of SERS technology and chemometric methods can be applied to the accurate classification of black pen inks, providing a nondestructive, rapid and reliable approach for forensic questioned document examination.

Objective This study established qualitative analytical methods for 2-Ethylamino-2- (2-fluorophenyl)cyclohexan-1-one (2-FXE) in e-liquid using gas chromatography-mass spectrometry (GC-MS) and high resolution-liquid chromatography-mass spectrometry (HR-LC-MS). Corresponding quantitative analytical methods were established using high performance liquid chromatography (HPLC) and gas chromatography (GC). Methods The seized e-liquid sample was extracted with methanol and subjected to qualitative analysis using HR-LC-MS and GC-MS. Furthermore, the content of the target substance in e-liquid was quantitatively analyzed using HPLC and GC. Results The mass fragment information of HR-LC-MS indicated that the unknown substance may be 2-FXE, an analog of Fluoroketamine. Combined with the retention time and the relative ion abundance ratio of the reference standard analyzed by GC-MS, the unknown additive was determined to be 2-FXE. At the same time, the quantitative results of HPLC and GC showed that the illegal addition of 2-FXE in e-liquid was 8.22% and 8.35%, respectively. The relative deviation between the two results was less than 5%. Conclusion This approach can meet the qualitative and quantitative analysis requirements of 2-FXE in e-liquid, and also provides a reference method for the analysis of other similar phencyclidine-type new psychoactive substances.

Objective To evaluate the potential of stable isotope analysis for determining the geographic provenance of aged human remains, and to assess its effectiveness as a screening tool in forensic identification when prior information is limited. Methods Enamel samples from twelve aged human remains were analyzed for strontium isotopes (87Sr/86Sr) and stable carbon and oxygen isotopes (δ13C, δ18O). Geographic assignment was conducted using the assignR package by integrating isotopic data with global isoscapes to generate probabilistic provenance maps. Results The 87Sr/86Sr ratios of enamel samples ranged from 0.708 647 to 0.717 172, while δ13C and δ18O values indicated substantial inter-individual variation in diet and environmental conditions. Isotopic assignment effectively excluded incompatible regions and significantly narrowed the range of possible origins. Among the twelve individuals, eight showed concordance between isotopic predictions and known places of origin, demonstrating the method’s relatively high accuracy. Conclusion Multi-isotope analysis provides an effective approach for determining the geographic provenance of aged human remains, particularly in cases where DNA evidence is unavailable or limited. The reliability of isotopic assignments depends on the quality of isoscapes, individual life history, the preservation state of samples, and rigorous laboratory quality control. Future work should focus on improving baseline datasets, standardizing analytical protocols, and integrating multidisciplinary data to enhance the precision and applicability of isotope-based provenance methods.

Objective Given the limitations of conventional methods for the quantitative assessment of the perception capability of advanced driver assistance systems (ADAS), an investigation and analysis technology was established to retrospectively evaluate the object recognition functional performance prior to a crash, providing technical support for accident causation determination and ADAS-related function investigation. Methods On-board video from the accident vehicle was used as the primary data source. A YOLOv8 object detection model was trained using the publicly available KITTI 2D dataset and a traffic cone dataset. Frame-by-frame detection was performed, and the detection time, model output category, and temporal changes of key objects were extracted and cross-compared with the ADAS perception data recorded in the accident vehicle’s operation log. Results The YOLOv8 model detected the vehicles, the road workers, and the traffic cones in the accident vehicle’s on-board video, with the first detection frame of the vehicle object approximately 4.97 s from the collision frame. At each sampling time within 7 s before the collision, the accident vehicle’s operation log recorded the object recognition type as “no object”. Comparison of the two sets of data showed differences between the external video detection results and the object recognition records in the log data, and the accident vehicle missed relevant objects in the actual scenario, indicating that the accident vehicle’s perception system may have deficiencies in the perception and recognition of critical objects, including stationary vehicles, traffic cones, and road workers. Conclusion The method proposed in this study can reconstruct the detection history of key objects in accident videos and analyze differences in ADAS object recognition before the accident, enabling retrospective analysis of the object recognition function of the accident vehicle’s perception system. It provides technical support for accident investigation involving assisted-driving vehicles and for the improvement of ADAS perception performance.