Legal Medicine最新文献

The impact of postmortem damage on 3D-3D superimposition in the pair-matching of skeletal remains: A cautionary note

IF 1.3 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-03-02 DOI: 10.1016/j.legalmed.2025.102605

Andrea Palamenghi , Annalisa Cappella , Riccardo Solazzo , Debora Mazzarelli , Eugenio Cosentini , Danilo De Angelis , Chiarella Sforza , Daniele Gibelli , Cristina Cattaneo

The influence of incompleteness and fragmentation of skeletal remains on novel methods for pair-matching is still unaddressed. For this study 154 innominate bones from 77 male individuals were selected. The bones presented different rates of preservation, which was systematically assessed, including three classes. The models were acquired with a stereophotogrammetric device and edited to isolate the iliac region. For each class, the left model was mirrored and superimposed on the right one, and the point-to-point distance of each superimposition was recorded in terms of Root-Mean-Square (RMS) value. Seventy-seven superimpositions between true-matches and 30 superimpositions between mismatches (10 for each class of preservation) were performed. Statistical differences between RMS values of the three classes were investigated with a two-way analysis of variance (ANOVA) test (p < 0.05).

ANOVA revealed significant main effects for both “Type of superimposition” (match or mismatch), and “Class of preservation”, both with a p-value < 0.001. Significant differences between matches and mismatches within each level of “Class of preservation” were found (p < 0.001), with matches having significantly lower RMS values compared to mismatches. Overall, the results showed the interaction between the Type of superimposition and Class of preservation, where the preservation state significantly affects the RMS outcome of the superimposition.

For the first time, this test systematically demonstrated that the RMS distance values of bones affected by postmortem damage differ according to the extent of the damage. Medium to considerable damage intensively affect the performance of the 3D-3D pair-matching, leaving this issue unresolved for future studies.

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引用次数: 0

Alteration of bronchiolar club cells and pneumocytes as markers of fatal pulmonary toxicity from systemic agents: Considerations on a group of autopsy samples

IF 1.3 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-02-25 DOI: 10.1016/j.legalmed.2025.102602

Alberto Amadasi , Lorenzo Franceschetti , Graziano Domenico Luigi Crudele , Greta Pogliani , Guendalina Gentile , Riccardo Zoja

Introduction

Club cells and pneumocytes may undergo qualitative and quantitative modifications when lungs are damaged and the modifications of these cells when the body is involved in systemic toxicity, thus when lung is not the target organ, may be an interesting challenge. Therefore, crucial information may be provided by the investigation of the feasibility of possible markers of lung damage in case of intoxication by different substances.

Methods

For this reason, the study aimed at assessing the histological changes of club cells and type I-II pneumocytes in 85 cases of acute poisoning by exogenous substances, whilst controls were 50 cases of death related to non-toxic causes. A total of 405 histological thin sections were analyzed after staining with hematoxylin-eosin, Masson’s trichrome and Periodic acid–Schiff (PAS).

Results

The results showed a numerical variation of club cells and type I and type II pneumocytes depending on the toxic agent examined.

Conclusion

It is therefore possible to ascribe to this kind of bronchiolar cells a detoxifying effect, capable of detecting lung injuries in an early stage and which may represent a marker (although not specific for the substance) even when lungs are not directly involved among a systemic toxic mechanism.

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引用次数: 0

Forensic age progression application in a morphological study of an Italian family: A case report

IF 1.3 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-02-24 DOI: 10.1016/j.legalmed.2025.102601

Laura Donato , Douglas H. Ubelaker , Valentina Bugelli , Jessika Camatti , Michele Treglia , Anna Laura Santunione , Luigi Tonino Marsella , Rossana Cecchi

Processing a photo aimed at the aging of the person depicted is a delicate process. The technique performed in these cases, i.e. age progression, takes into consideration the physiognomic elements of the face and its variations over time.

This study aims to deepen knowledge regarding the morphological similarities of the physiognomic traits found in two generations of an Italian family. Age progression is carried out on the two daughters to compare the result with their current appearance.

Twelve photos were studied, depicting the members of an Italian family in close-up. Three photos of each member of the family were analysed, consisting of the father, mother, and two sisters (L. and E.). Facial features, such as shape of the face, eyes, eyebrows, nose and mouth were evaluated at age 1, 7 and 30. In addition, age progression technique was applied.

Through the analysis of the images, facial features are studied to find similarities, and the problems encountered in studying the photos are discussed. Furthermore, the age progressions are obtained, and they do not show 100% accuracy. This study represents an analysis of age progression technique and explains how the provision of photographic documentation of family members can be important.

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引用次数: 0

Comprehensive study of various vitamin concentrations in the human postmortem blood with an autopsy case report of beriberi 人体死后血液中各种维生素浓度的综合研究，以及一例脚气病尸检报告。

IF 1.3 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.legalmed.2024.102559

Tadashi Hosoya , Kazuki Harada , Jun Kanetake

Using human cardiac blood from forensic autopsy cases, comprehensive measurements of albumin, vitamins A, B1, B6, B12, C, D, folate, and PIVKA-Ⅱ were performed. Of 128 cases, 83 were male, with an average age of 61.8 years and average postmortem interval of 44 h. The average concentrations of vitamins were 29.8 μg/dL for vitamin A, 32.2 μg/dL for vitamin B1, 278 ng/mL for vitamin B6 (pyridoxamine), 152 ng/mL for vitamin B6 (pyridoxal), 57.2 ng/mL for vitamin B6 (pyridoxal), 17.9 ng/mL for folate, 1188 pg/mL for vitamin B12, 23.5 μg/mL for vitamin C, 15.0 ng/mL for vitamin D, and 1.03 μg/mL for PIVKA-Ⅱ. An autopsy case of a Japanese middle-aged male with beriberi was also presented, where severe edema and effusion of the cavity and a high NT-proBNP serum value were observed; however, cardiac pathology showed no specific abnormal features. In the present case, the blood vitamin B1 concentration was within the standard clinical range. This study revealed that bloodborne water-soluble vitamin levels shows higher to clinical standard value at postmortem, whereas fat-soluble vitamin levels may stay in the standard range or lower. Our findings suggest that postmortem water-soluble vitamin concentrations within the clinical standard may reflect low antemortem vitamin concentrations.

使用法医尸检病例的人心脏血液，进行了白蛋白、维生素A、B1、B6、B12、C、D、叶酸和PIVKA-Ⅱ的综合测量。的128例中,有83是男性,平均年龄61.8岁,平均死亡时间44 h。维生素的平均浓度分别为29.8μg / dL维生素A, 32.2μg / dL维生素B1、278 ng / mL为维生素B6(吡哆胺),152 ng / mL为维生素B6(吡哆醛),57.2 ng / mL为维生素B6(吡哆醛),17.9 ng / mL的叶酸、维生素B12 1188 pg / mL,维生素C 23.5μg / mL, 15.0 ng / mL为维生素D和1.03μg / mL PIVKA -Ⅱ。一个日本中年男性脚气病的尸检病例也被提出，其中严重的水肿和积液腔和高NT-proBNP血清值观察到；然而，心脏病理未显示特异性异常特征。本例患者血液中维生素B1浓度均在临床标准范围内。本研究表明，死后血源性水溶性维生素含量高于临床标准值，而脂溶性维生素含量可能维持在标准范围内或更低。我们的研究结果表明，在临床标准范围内的死后水溶性维生素浓度可能反映出死前维生素浓度较低。

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引用次数: 0

Effective diagnosis of cervical fracture using postmortem computed tomography and autopsy findings 利用死后计算机断层扫描和尸检结果有效诊断颈椎骨折。

IF 1.3 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.legalmed.2024.102555

Yoriko Shinba , Yuki Abe , Takanori Kohyama , Masahide Mitsuma , Hiromi Yamashita , Takehiko Murase , Kazuya Ikematsu

A common forensic problem is cervical fractures, which sometimes need to be diagnosed only by physical examination of the body, without imaging or autopsy. Despite reports from clinical practice describing the association between cervical fractures and head injury, we could not find any analysis of autopsy cases. In addition, discussion of the cervical fracture diagnosis by postmortem computed tomography (PMCT) appears limited. This study aimed to examine autopsy and PMCT findings and explore valid methods for the diagnosis. We analyzed autopsy cases of cervical fractures during the 7 years before (2004–2010) and after (2014–2020) the PMCT introduction in our department. In 2014–2020, 67 autopsy cases with cervical fractures were recorded, of which 61 (91 %) were related to blunt injury to the head. Those with cervical fractures had a significantly higher incidence of blunt injury to the head (p < 0.001), particularly “forehead” and “face” injury, which accounted for > 50 % of cases. Of the external forces on the neck, “extension” accounted for 82.1 %. The cervical fracture-positive rate in all autopsy cases increased significantly from 11 (4.0 %) in 2004–2010 to 67 (8.2 %) in 2014–2020 (p = 0.021). From December 2015 to December 2020, when “cervical retroflexion” imaging was actively performed in PMCT, the cervical fracture diagnosis rate increased significantly from 57.1 % in the cervical normal position to 81.0 % with the addition of “cervical retroflexion” position (p = 0.021). Blunt head injury and PMCT in the “cervical retroflexion” position may be useful in the diagnosis of cervical fractures.

一个常见的法医问题是颈椎骨折，有时只需要通过身体检查来诊断，而不需要成像或尸检。尽管来自临床实践的报告描述了颈椎骨折和头部损伤之间的联系，但我们无法找到任何尸检病例的分析。此外，通过死后计算机断层扫描（PMCT）诊断颈椎骨折的讨论似乎有限。本研究旨在检验尸检和PMCT的结果，并探讨有效的诊断方法。我们分析了在我科引入PMCT之前（2004-2010）和之后（2014-2020）7年间颈椎骨折的尸检病例。2014-2020年共记录了67例颈椎骨折尸检病例，其中61例（91%）与头部钝性损伤有关。颈椎骨折的患者发生头部钝性损伤的几率明显更高（50%）。颈部外力中，“伸”力占82.1%。所有尸检病例的颈椎骨折阳性率从2004-2010年的11例（4.0%）显著上升至2014-2020年的67例（8.2%）（p = 0.021）。2015年12月至2020年12月，在PMCT中积极进行“颈椎后屈”显像时，颈椎骨折诊断率从颈椎正常位的57.1%显著增加到“颈椎后屈”位的81.0% （p = 0.021）。钝性头部损伤和“颈椎后屈”位的PMCT可能对颈椎骨折的诊断有用。

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引用次数: 0

Letter to the Editor regarding the Article “Complex suicides involving the use of firearms and hanging: A retrospective study and review of the literature” 致编辑关于文章“涉及使用枪支和上吊的复杂自杀：文献的回顾性研究和回顾”的信。

IF 1.3 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.legalmed.2024.102563

Andrea Gentilomo , Stefano Tambuzzi , Guendalina Gentile , Riccardo Zoja

引用次数: 0

Age estimation by radiomics analysis of mandibular condylar cone beam computed tomography images 下颌髁突锥束计算机断层图像放射组学分析的年龄估计。

IF 1.3 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.legalmed.2024.102560

Aytaç Üzel, Alican Kuran, Oğuz Baysal, Umut Seki, Enver Alper Sinanoglu

Objectives

The aim of this study was to estimate the legal age using the parameters obtained from radiomic analysis of the mandibular condyle in cone beam computed tomography (CBCT) images.

Material and Methods

The study group consisted of 300 mandibular condyles, which were categorized into six groups based on the age of the patients: 8–11 years, 12–14 years, 15–17 years, 18–20 years, 21–23 years, and over 24 years. Each patient’s condyle was segmented individually using the 3D Slicer program. Radiomic features were extracted from the segmented images using the SlicerRadiomics plugin. Subsequently, three distinct models were developed with reference to three specific subgroups of the 12–14 age group, 15–17 age group, 18–20 age group and the efficacy of radiomic features in predicting the age of the patient was evaluated.

Results

The ROC analysis of the three radiomics scores (RS) yielded AUC values of 0.927, 0.860, and 0.769 for RS_12-14, RS_15-17, and RS_18-20, respectively. The RS_12-14 model exhibited the highest sensitivity and specificity values among the models, with 88% and 84.4%, respectively.

Conclusion

Among the radiomic features extracted from the mandibular condyle in CBCT images, the most significant features, identified based on developed models and their respective coefficients, can be applied to estimate patients’ ages. Future studies hold substantial potential for advancing this method, particularly in automating both the segmentation process and the derivation of formulae for age estimation. The use of radiomic features for age prediction presents a promising alternative method for developing fully automated systems in clinical practice.

目的：本研究的目的是利用锥形束计算机断层扫描（CBCT）图像中对下颌髁的放射学分析获得的参数来估计合法年龄。材料与方法：研究对象为300个髁突，按患者年龄分为6组：8-11岁、12-14岁、15-17岁、18-20岁、21-23岁、24岁以上。每个患者的髁分别使用3D切片程序进行分割。使用SlicerRadiomics插件从分割后的图像中提取放射组特征。随后，针对12-14岁、15-17岁、18-20岁三个特定的亚组，建立了三种不同的模型，并评估了放射学特征预测患者年龄的有效性。结果：RS12-14、RS15-17和RS18-20的3个放射组学评分（RS）的ROC分析得出的AUC值分别为0.927、0.860和0.769。RS12-14模型的敏感性和特异性值最高，分别为88%和84.4%。结论：在CBCT图像中提取的下颌髁放射学特征中，基于所建立的模型及其相应系数识别出的最显著特征可用于估计患者的年龄。未来的研究有很大的潜力来推进这种方法，特别是在自动化分割过程和年龄估计公式的推导方面。使用放射学特征进行年龄预测为临床实践中开发全自动系统提供了一种有前途的替代方法。

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引用次数: 0

Suicide by sodium nitrite: Autopsy case report 亚硝酸钠自杀：尸检病例报告。

IF 1.3 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.legalmed.2025.102572

Dragan Ječmenica, Snežana Pavlekić, Vladimir Živković, Aleksandra Repić, Suzana Marković, Veljko Milošević

Introduction

Suicide by sodium nitrite poisoning (SNP) is not common. In the last decade, an increase in the number of suicides caused by SNP was observed.

Case report

A 47-year-old female was found dead in her apartment. Four cups with a yellowish liquid and a scale for precise measurement were found at the scene. Also, an empty plastic bag labeled “Sodium Nitrite NaNO₂”. In the external examination, general signs of asphyxia were noticed. Bluish and slightly brownish hypostasis, which was prominent on the face and thighs, was present. The blood and all tissues were somewhat darker in appearance than usual. Toxicological analysis showed high levels of nitrites, nitrates, methemoglobin, and metoclopramide in blood and stomach content. It was concluded that this was a suicide by SNP.

Discussion

Autopsy signs of SNP are nonspecific. The grayish-brown color of the hypostasis is a characteristic sign of SNP but is very subjective and may be missed. Sodium nitrite cannot be legally purchased for domestic use in Serbia. Even though sodium nitrite commerce is strictly regulated, the victim was able to illegally obtain it and use it in combination with the antiemetic drug metoclopramide, which shows the knowledge that exceeds the common knowledge regarding this substance and is an example of suicide committed by intellectuals.

Conclusion

Cases of the fatal SNP may present a significant challenge in forensic practice due to their rarity and nonspecific presentation. Without any information about the circumstances of the case, it is often unrecognizable.

亚硝酸钠中毒（SNP）自杀并不常见。在过去十年中，SNP导致的自杀人数有所增加。病例报告：一名47岁女性被发现死于自己的公寓。在现场发现了四个装有黄色液体的杯子和一个精确测量的秤。还有一个空塑料袋，上面写着“亚硝酸钠纳米2”。外检发现窒息的一般征象。面部和大腿有明显的浅蓝色和微褐色的汗液。血液和所有组织的颜色都比平时暗一些。毒理学分析显示，血液和胃内容物中亚硝酸盐、硝酸盐、高铁血红蛋白和甲氧氯普胺含量很高。结论是这是苏格兰民族党自杀。讨论：SNP的尸检征象是非特异性的。腺质呈灰褐色是SNP的特征性征象，但这是非常主观的，可能会被忽略。在塞尔维亚，不能合法购买亚硝酸钠供家庭使用。虽然亚硝酸钠的交易受到严格的管制，但受害者可以非法获得亚硝酸钠，并与止吐药甲氧氯普胺一起使用，这表明他们对亚硝酸钠的了解超出了普通人的范围，是知识分子自杀的典型。结论：致命SNP病例由于其罕见和非特异性表现，可能在法医实践中提出重大挑战。由于没有关于案件情况的任何信息，它往往是无法辨认的。

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引用次数: 0

Driving under the influence of drugs – The failed quest of finding medical signs indicative to driving impairment 在药物影响下驾驶——未能找到表明驾驶障碍的医学迹象。

IF 1.3 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.legalmed.2025.102567

Varjas Péter Nagy , Viktor Soma Poór , Mónika Kuzma , Mátyás Mayer , Dénes Tóth , Veronika Heckmann , Gábor Simon

Motor vehicle accidents (MVA) are the leading cause of death in childhood and young adult age. One of the most important factors behind MVA is driving under the influence of alcohol (DUIA) and drugs (DUID). The importance of DUID is rising together with the increasing drug abuse. The legal approaches to DUID are based on impairment, impairment per se or zero tolerance. In case of impairment, the negative effect of the substance on the driving abilities has to be proven by a forensic expert, which can be challenging. This study compares the medical signs registered during blood sampling with the concentrations of substances detected by toxicological examination to find medical signs indicative of impairment. Statistical analysis did not find a correlation between substance concentration and measured parameters (pupil diameter, blood pressure and pulse rate). No connection was found between substance concentrations and the appearance of medical signs. The results indicate that pupil dilation, heart rate, and blood pressure could not be used as indicators of possible driving impairment by drugs, and no medical sign could reliably indicate the driving impairment by substances other than ethanol.

机动车事故是儿童和青年死亡的主要原因。MVA背后最重要的因素之一是在酒精（DUIA）和药物（DUID）的影响下驾驶。随着药物滥用的增加，DUID的重要性也在上升。对DUID的法律处理方法是基于减值、减值本身或零容忍。在损害的情况下，物质对驾驶能力的负面影响必须由法医专家证明，这可能是具有挑战性的。本研究将血液采样中记录的医学体征与毒理学检查中检测到的物质浓度进行比较，以寻找表明损害的医学体征。统计分析未发现物质浓度与测量参数（瞳孔直径、血压和脉搏率）之间存在相关性。没有发现物质浓度与医学症状之间的联系。结果表明，瞳孔扩张、心率和血压不能作为可能的药物驾驶损害的指标，并且没有医学体征可以可靠地指示除乙醇以外的物质的驾驶损害。

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引用次数: 0

Let’s “game” it!: Dangerous games, a new health challenge 让我们“游戏”它！危险的游戏，新的健康挑战。

IF 1.3 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.legalmed.2024.102562

Laetitia Afonso , Mélanie Voyer , Michel Sapanet , Ghina Harika-Germaneau , Alexia Delbreil

In the past several years, children and adolescents have increasingly been enticed into playing dangerous and challenging games, particularly through social networks. Epidemiological data regarding this phenomenon are particularly difficult to come by, as is information regarding the somatic and psychological consequences of these activities, which can end up having fatal outcomes. We here report the case of a suspicion of child abuse that turned out to be due to participation in a challenge game known as “The Deodorant Challenge” by a 10-year-old child who presented with burn-like lesions. Collaboration with the police and assessment of the psychopathological profile of the child allowed the self-inflicted nature of the injuries to be identified, thereby allowing intrafamilial abuse to be ruled out as the cause of the injuries.

在过去的几年里，儿童和青少年越来越多地被引诱去玩危险和具有挑战性的游戏，特别是通过社交网络。关于这一现象的流行病学数据尤其难以获得，关于这些活动的身体和心理后果的信息也是如此，这些活动最终可能造成致命的后果。我们在此报告一起涉嫌虐待儿童的案件，结果是由于一个10岁的孩子参加了一个名为“除臭剂挑战”的挑战游戏，他出现了烧伤样的病变。与警察的合作以及对儿童的精神病理特征的评估，使得可以确定伤害的性质是自己造成的，从而可以排除家庭内部虐待是造成伤害的原因。

引用次数: 0