Forensic Science, Medicine and Pathology最新文献

We report the death of a 32-year-old woman with a history of tobacco smoking who was found dead in her car after being investigated 18-days prior in hospital following a road traffic accident. Postmortem examination showed no evidence of recent injury. The most significant finding on internal examination was severe single-vessel coronary atherosclerosis. The remainder of the autopsy showed smoking-associated lung changes. Toxicologic studies were negative for common medications, usual street drugs and alcohols, but specialized analytical testing, developed in-house, identified the indazole-based fluorinated synthetic cannabinoid (SC) 4F-MDMB-BICA and its butanoic acid metabolite in blood, vitreous fluid and urine. An unlabeled package of a herbal smoking mixture, located in the personal belongings of the deceased, was found to contain 4F-MDMB-BICA. The potency of 4F-MDMB-BICA is reported to be much higher (up to several 100-fold) than marijuana. Reported fatalities related to SCs suggest that their effects are unpredictable and, due to the limited studies available, no clear threshold for a lethal dose has yet been determined. Adverse central nervous system effects documented for 4F-MDMB-BICA include auditory and visual hallucinations, paranoia, agitation, confusion, and insomnia. Euphoria, irregular heartbeat, chest pain and myocardial infarction in teenagers have also been described. SCs pose a substantial risk for cardiac toxicity, with mechanisms involving CB₁ receptor-mediated oxidative stress, ion channel modulation, and autonomic dysregulation, resulting in a wide range of potentially life-threatening cardiovascular events. Genetic studies were undertaken to rule out a possible cardiomyopathy based on the presence of epsilon waves in a recent hospital electrocardiogram. This revealed a c.5329G > A (p.Ala1777Thr) variant of uncertain significance in the MYH7 gene. Detailed heart examination did not show evidence of an underlying cardiomyopathy. Death in this woman was attributed to 4F-MDMB-BICA toxicity, with coronary atherosclerosis listed as a contributing factor given that SC fatalities are considered primarily cardiac in nature, causing/contributing to acute coronary events, such as coronary vasospasm, thrombosis, arrhythmia, and myocardial ischemia.

"Heated tobacco products" (HTPs), featuring a heating blade placed either in the holder (HH) or within the stick itself (EH), are increasingly being used. The composition and mode of consumption, along with the possible reduction in salivation induced by their use, could affect DNA recovery and STR profiling. The aim of this work was to assess the DNA recovery useful for personal identification from two commercially available types of HTP sticks, compared with traditional cigarettes. Sixteen volunteers each smoked 2 traditional cigarettes, 2 HTP sticks of type HH and 2 HTP sticks of type EH each (n = 96). For each type, one filter paper was analyzed immediately (T0), and another after one month of storage in a controlled environment (T1). DNA amounts ranged from 0.265 to 7.4294 ng/μl for traditional cigarettes and 0.0008 ng/μl to 6.4711 ng/μl for HTP sticks, showing a significant difference (p = 0.0092). DNA recovery from traditional cigarette, but not from HTP sticks, was significantly lower at T1 compared to T0. Ninety-two samples (95.8%) were amplified, yielding 88 full STR profiles (95.6%), 4 partial profiles (4.4%) and 5 mixed profiles (5.4%), while no profiles deemed inconclusive. Mixed profiles likely resulted from persistent DNA transferred prior to the controlled conditions. Heated tobacco sticks may lead to lower DNA recovery than traditional cigarettes, potentially impacting other forensic DNA analyses that require higher DNA yield than STR profiling.

Non-occlusive mesenteric ischemia (NOMI) is an acute form of intestinal ischemia that occurs in the absence of organic stenosis of the mesenteric arteries. Vasoconstrictive agents have been recognized as potential etiological factors. This report describes the first documented Japanese autopsy case of NOMI induced by methamphetamine (MA), a potent sympathomimetic agent. A forensic autopsy was performed on a man in his 60s who died suddenly. Gross and histopathological findings of the small intestine and mesenteric arteries were examined, and post-mortem toxicological analysis was performed to quantify the blood MA concentration. Autopsy revealed a dilated small intestine without mechanical obstruction, accompanied by non-contiguous ischemic necrosis and no signs of organic stenosis in the mesenteric arteries. Histopathological examination of the small intestine showed hemorrhage and necrosis, consistent with a diagnosis of NOMI. The blood concentration of MA was within the toxic range but below the fatal threshold, suggesting a causal relationship between MA use and the onset of NOMI. Given the fatal outcome despite an MA concentration below the reported fatal range, prolonged mucosal exposure from oral ingestion may have locally intensified vasoconstrictive effects, contributing to intestinal ischemia. This case highlights the importance of considering MA-induced NOMI in the differential diagnosis of sudden death among MA users and highlights the risk of fatal ischemic complications even at non-fatal MA concentrations.

As with all traumatic pathologies, determining when a fracture occurred and during which event it occurred is necessary for an accurate medicolegal evaluation. Among the 4,224 cases for which forensic reports were prepared, the report outcome changed in 105 cases (2.5%) when prior medical imaging was included in the medicolegal evaluation. In the initial assessment of the cases (based on emergency department medical records and radiology reports), a bone fracture was recorded in 59.0% of the cases, no bone fracture in 10.5%, and a suspected bone fracture in 30.5%. In the final evaluation-conducted by the forensic medicine outpatient clinic-where current medical images were compared with prior medical images, it was determined that a bone fracture had occurred in the most recent trauma in 17.1% of the cases, that no new fracture attributable to the most recent trauma was present in 79.1%, and that new fractures in addition to old bone fractures were present in 3.8%. We believe that, when analysing current medical images, the search for prior medical imaging and the comparative analysis of obtained prior images with current images should be a routine component of medicolegal evaluation for all forensic cases, regardless of case type.