Forensic Science, Medicine and Pathology最新文献

Fictitious disorder by proxy (FDP) is characterized by an adult, often a parent, alleging or fabricating symptoms in a child to induce repeated diagnostic tests or treatments. This form of abuse is particularly serious and difficult to diagnose. Worldwide, it is estimated that 0.5 to 1.2 per 100,000 children are abused in this way every year. We report the case of FDP in an 8-year-old child who presented with coagulation disorders secondary to the unknowing administration of Acenocoumarin. His parents had requested seven medical consultations over a six-month period. The parents systematically reported a coagulation pathology (factor VII deficiency), prompting further investigations and treatment. Biological tests showed deficiencies of vitamin K-dependent coagulation factors, raising suspicion of vitamin K antagonists (VKA) use. Toxicological tests revealed the presence of Acenocoumarin in the child's blood three times, at levels of 0.15 mg/L; 0.06 mg/L and 0.43 mg/L. The biological abnormalities corrected spontaneously after the child was hospitalized. A family investigation led to the diagnosis of medical child abuse in the child's older sister, who presented bleeding. The severity and recurrence of this syndrome correlated with the role that caregivers play in this type of abuse deserves our full attention to prevent and manage it as effectively as possible.

A male newborn found lifeless raised the question of whether he had lived after birth. The float sample test results of both lungs and the gastrointestinal tract were positive. Microbiological examinations detected the Fusobacterium gonidiaformans, an obligate anaerobic gas-forming germ, in the lung tissue and in the heart blood, which caused the float test results to be 'false-positive'. As far as can be seen, a comparable case has not yet been reported in forensic literature.

In experimental models of deep vein thrombosis (DVT), neutrophil extracellular traps (NETs) have been established as pivotal mediators in the initial phases of thrombus formation. Through the establishment of a chromatin-based scaffold, NETs provide a structural foundation that enhances platelet adhesion. Furthermore, they significantly contribute to the perpetuation of a self-amplifying cycle of venous endothelial cell injury, thereby exacerbating thrombogenesis. While extant research has predominantly concentrated on the role of NETs in the initiation of DVT, there remains a paucity of investigation into the temporal dynamics of NETs content across the sequential stages of thrombus development, including formation, elongation, organization, and recanalization. The present study elucidates the forensic application of NETs for temporal assessment of thrombus age in cases of sudden death resulting from pulmonary embolism secondary to deep vein thrombosis. This was accomplished through the establishment of a time-gradient DVT model in a rat model system. Utilizing myeloperoxidase (MPO) antibody, a well-established marker of neutrophil activation, in conjunction with CitH3 histone antibody, a specific marker for neutrophil extracellular traps, we performed dual immunofluorescence co-localization studies. These investigations confirmed the integral involvement of NETs in the thrombotic process. Complementary Western blot analyses demonstrated temporal variations in NETs content within the thrombotic mass. The CitH3 levels exhibited no significant elevation during the initial 3-6 h post-ligation period, followed by a gradual increase after 24 h, reaching maximal expression on day 3. Subsequently, a progressive decline was observed, culminating in complete resolution by day 21. Quantitative analysis of positive cell counts (×1000, across five representative fields) at sequential time points revealed distinct temporal patterns. During the initial 3-hour to 1-day post-ligation period, MPO-positive cells demonstrated a significantly more rapid increase compared to CitH3-positive cells. By day 3, MPO levels commenced a decline, ultimately falling below CitH3 levels. Subsequent analysis of the CitH3/MPO ratio yielded significant forensic implications. Our findings demonstrate that a CitH3/MPO ratio approximating 1.0 corresponds to a thrombus formation time within 5 days. The degree of ratio variation among multiple samples serves as a temporal indicator: minimal variation (approaching 1.0) suggests a shorter thrombus formation interval, while ratios exceeding 2.0 or demonstrating substantial variation are indicative of thrombus formation times surpassing 7 days.

A diagnosis of atherosclerotic cardiovascular disease is critical importance in forensic medicine, particularly because severe atherosclerosis is known to be associated with a high risk of sudden death. In South Korea, the assessment of coronary atherosclerosis during autopsy largely depends on the forensic pathologist's visual measurements, which may limit diagnostic accuracy. The objective of this study was to develop a deep learning algorithm for rapid and precise assessment of coronary atherosclerosis and to identify factors influencing the model's prediction of atherosclerosis severity. A total of 3,717 digital photographs were retrospectively extracted from a database of 1,920 forensic autopsies, with one image each selected for the left anterior descending coronary artery and the right coronary artery. The deep learning algorithm developed in this study demonstrated a high level of agreement (0.988, 95% CI: 0.985-0.990) and absolute agreement (0.986, 95% CI: 0.978-0.991) between predicted and ground truth atherosclerosis values on the test set. The model demonstrated strong overall performance on the test set, achieving a weighted F1-score of 0.904. However, the class-wise F1-scores were 0.957 for mild, 0.785 for moderate, and 0.876 for severe grades, indicating that performance was lowest for the moderate grade. Additionally, decomposition, stent implantation, and thrombi did not have a statistically significant impact on coronary atherosclerosis assessment except for calcification. Although enhancing model performance for moderate grades remains a challenge, this study's findings demonstrate the potential of artificial intelligence as a practical tool for assessing coronary atherosclerosis in autopsy photographs.

Age estimation is crucial in forensic sciences for victim identification, migration studies, and bioarchaeology. In subadults, it is based on maturational changes, while in adults, it relies on degenerative processes, reducing accuracy. Traditional methods, such as anthropological and dental approaches, are widely used, but recent advances in biochemical and molecular biology (BMB) have introduced epigenetic and biochemical analyses. Given the variability in biological aging, it is essential to evaluate and compare these methods for more precise and reproducible results. This article is a scoping review analyzing the accuracy of anthropological, dental, and BMB methods for estimating age in living individuals, cadavers, and adult skeletal remains. A scoping review following PRISMA-ScR guidelines was conducted in PubMed, Scopus, and WOS, covering studies from 2015 to 2024. Articles applying regression models for age estimation and reporting error metrics were included, while reviews and studies without precision data were excluded. Anthropological methods analyze degenerative changes in bone structures, such as the pubic symphysis and acetabulum, with error margins of 4-25 years. Forensic dentistry uses pulp-to-tooth ratios and secondary dentin deposition, yielding mean errors of 2.5-12.5 years. BMB methods, such as DNA methylation, telomere shortening, and aspartic acid racemization, offer accuracies of ± 3 to ± 10 years but require specialized equipment. Artificial intelligence enhances reproducibility, although standardization challenges remain. Age estimation in adults, particularly those over 40, remains challenging. Validating traditional methods, integrating AI, and applying multivariate molecular models can improve accuracy. A multidisciplinary approach is essential for forensic applications.

Sudden cardiac death due to an isolated right ventricular thromboembolism is an uncommon cause of death. In the reported case, a healthy, asymptomatic young male with no past medical history outside of obesity and his age was found unresponsive by a family member who suspected him to be sleeping. Examination of the heart at autopsy revealed a large serpiginous, organized and obstructive blood clot compromising most of the right ventricle with no other cardiac abnormalities and without any evidence of a pulmonary embolism. The patient was found to not have any history of substance abuse, genetic predispositions, kidney disease, or COVID-19 infection which has all been linked to ventricular thrombi.

This is a case report of a postmortem dismemberment (removal of the head) of a 44-year-old man (the perpetrator was 39-years-old) who died of natural causes (massive pneumonia). The case was neither a defensive nor an offensive mutilation but could be properly termed a "communication" dismemberment. The assumption that a victim of dismemberment is always a victim of homicide is not true in this case. To our knowledge, this is one of the very rare cases in which a perpetrator who has nothing to do with the death dismembered a body. Gerchow's question about whether there has ever been a case in which someone who had nothing to do with the death dismembered a body can be answered with a "yes."

Estimating the postmortem interval (PMI) is a crucial aspect of forensic death-related investigations. However, determining the time of death remains one of the biggest challenges in forensic medicine. This study aims to assess the potential of protein analysis as a vital tool and histopathological examination to evaluate the PMI. Fifty male rats were randomly distributed into five groups of 10. These rats were kept at room temperature (22 °C) with a relative humidity of 15% during the period between the time of death and organ removal. The kidneys and Livers were extracted at 0-, 24-, 48-, 72-, and 96-hour intervals. The β-catenin immunohistochemical analysis showed no immunoreactivity in either organ at 0 h, which increased to severe immunoreactivity at 96 h after death. Additionally, flow cytometry demonstrated a decline in liver and kidney Bcl-2 expression at 96 h, at 17.5% and 12.8%, respectively, as the postmortem period increased. Moreover, a histopathological examination of the Liver and kidney showed progressively greater degradation over time as the PMI increased, resulting in the loss of normal Liver and kidney architecture at 96 h. These findings suggest the potential use of specific proteins' autolytic alterations as definite diagnostic parameters for the PMI. Autolytic processes have a delayed onset and show a significant increase in progression rate at each time interval. Different organs suffer different rates of autolysis in correlation to their structure and enzymatic content. Further studies are required to evaluate the definite roles of β-catenin and Bcl-2 expression as predictive tools for future applications in humans based on extensive experimental studies.

The wave of migration that is observed worldwide, and especially the one in the Mediterranean region is contributing significantly to the contemporary humanitarian crisis. Shipwrecks are one of the most characteristic ways in which the migratory wave leads to mass casualties. Forensic practitioners nowadays are called upon to establish the cause of death, but also to identify victims of mass disasters, whose features may be significantly altered due to the extreme conditions in which they are found. On November 1st, 2022, a shipwreck of a boat full of immigrants, transiting from Turkey to Italy occurred at the southern region of Karystos, a coastal city located in Evoia island, Greece. The management of this case by our Department, involving multiple fatalities, including all relevant aspects (identification procedures, post-mortem examination) is presented. A brief review of the relevant literature is also included, with the aim of drawing conclusions on how a forensic department's workload might be affected by relevant incidents. Classical tools of conventional disaster victim identification protocols (e.g. fingerprint collection, dental examination, DNA profiling, etc.), may prove to be non-efficient as is such cases ante-mortem data are very difficult to obtain. International collaboration (Police, Diplomatic Corps) is a critical factor to increase the speed and the efficiency of the whole identification procedure. In the future, planning of a new protocol, adapted to Migrant-related cases, that will include more ante-mortem data (e.g. photographic material, social network or mobile phone data), may prove to help in such cases. It should be stressed that adoption of a universal identification protocol, along with training of all relevant personnel, are crucial steps to achieve increased readiness and handling-speed for future cases.