Pub Date : 2025-06-24DOI: 10.1016/j.legalmed.2025.102652
S. Potente, F. Ramsthaler, J.M. Federspiel
Ternary plots are triangle shaped diagrams which display the proportions of three given categories in an information dense format. This short communication aims at demonstrating ternary plots as a method of data presentation in forensic medicine. In addition, a practical example is given and discussed. They are generally underutilized in medicine and forensic medicine in particular. This method paper describes how to read and design ternary plots. Template files are provided. Example diagrams for “manner of death in custody” are demonstrated and discussed.
{"title":"A useful data presentation tool: Ternary plots in forensic medicine","authors":"S. Potente, F. Ramsthaler, J.M. Federspiel","doi":"10.1016/j.legalmed.2025.102652","DOIUrl":"10.1016/j.legalmed.2025.102652","url":null,"abstract":"<div><div>Ternary plots are triangle shaped diagrams which display the proportions of three given categories in an information dense format. This short communication aims at demonstrating ternary plots as a method of data presentation in forensic medicine. In addition, a practical example is given and discussed. They are generally underutilized in medicine and forensic medicine in particular. This method paper describes how to read and design ternary plots. Template files are provided. Example diagrams for “manner of death in custody” are demonstrated and discussed.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"76 ","pages":"Article 102652"},"PeriodicalIF":1.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144471021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The term Munchausen syndrome by proxy (MSP) refers to a situation in which one or both parents by procuring or inventing symptoms or illness that their children do not have. As a consequence children can be exposed to continual medical examinations, tests and analyses, including surgery that can severely injure or, in extreme cases, provoke death. Usually, the victim is a young child, and the perpetrator is the mother, usually the person child is almost exclusively entrusted, placing her in the best position to simulate illness. Difficulty in making a diagnosis is motivated by the low prevalence of cases, unspecific nature of the symptoms, difficulty of reconducting the overcure back to a criminal case and tracing it back to the care giver.
Objective
Starting from a case series, a diagnostic algorithm useful for prompt MSP identification has been developed.
Participants and setting
A detailed examination of four cases is given, all with a common feature: drug administration to perpetrate MSP.
Methods
Biological fluids have been sampled and analyzed for drugs to which symptomatology could be traced.
Results
In all presented cases a late MSP diagnosis was possible on the base of results from toxicological analyses. Although analytical results are often diagnostic, a delay in sample collection, related to improper diagnostic algorithm, is frequent. Only an integrated approach, based on collaboration among multiple professionals, among which the role of the medico-legal expert and toxicologist stands out, can ensure the achievement of a rapid diagnosis and the protection of the victim.
{"title":"Drug-perpetrated Munchausen by proxy syndrome: When we dare and why we dare to care","authors":"Pascale Basilicata, Angela Simonelli, Mariagrazia Marisei, Angela Silvestre, Rossella Guadagni, Maria Pieri","doi":"10.1016/j.legalmed.2025.102659","DOIUrl":"10.1016/j.legalmed.2025.102659","url":null,"abstract":"<div><h3>Background</h3><div>The term Munchausen syndrome by proxy (MSP) refers to a situation in which one or both parents by procuring or inventing symptoms or illness that their children do not have. As a consequence children can be exposed to continual medical examinations, tests and analyses, including surgery that can severely injure or, in extreme cases, provoke death. Usually, the victim is a young child, and the perpetrator is the mother, usually the person child is almost exclusively entrusted, placing her in the best position to simulate illness. Difficulty in making a diagnosis is motivated by the low prevalence of cases, unspecific nature of the symptoms, difficulty of reconducting the overcure back to a criminal case and tracing it back to the care giver.</div></div><div><h3>Objective</h3><div>Starting from a case series, a diagnostic algorithm useful for prompt MSP identification has been developed.</div></div><div><h3>Participants and setting</h3><div>A detailed examination of four cases is given, all with a common feature: drug administration to perpetrate MSP.</div></div><div><h3>Methods</h3><div>Biological fluids have been sampled and analyzed for drugs to which symptomatology could be traced.</div></div><div><h3>Results</h3><div>In all presented cases a late MSP diagnosis was possible on the base of results from toxicological analyses. Although analytical results are often diagnostic, a delay in sample collection, related to improper diagnostic algorithm, is frequent. Only an integrated approach, based on collaboration among multiple professionals, among which the role of the medico-legal expert and toxicologist stands out, can ensure the achievement of a rapid diagnosis and the protection of the victim.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"76 ","pages":"Article 102659"},"PeriodicalIF":1.3,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-22DOI: 10.1016/j.legalmed.2025.102661
Oriana Cuman , Federico Toselli , Guido Viel , Paolo Fais , Maria Sech , Chiara Giraudo , Francesco Bertelli , Vladimiro Vida , Giovanni Cecchetto
Stab injuries involving the vertebral region are rare and pose significant challenges during forensic autopsy due to the complexity of the surrounding anatomical structures. Radiological techniques, such as post-mortem computed tomography (PMCT) or micro-CT, have shown great potential for detecting and detailing sharp bone lesions. We herein present a fatal case of homicidal stab wound involving the left vertebral artery and the homolateral surface of the axis. PMCT identified a fracture of the left lateral mass of the axis (C2), and micro-CT revealed a cortical discontinuity of the left transverse process of C2, nearly separating the transverse process from the body of the axis. Based on micro-CT data, a 3D model of the first three cervical vertebrae was printed in a clear material on a Formlabs Form 3L printer, and a fit-matching analysis was conducted with two potential weapons. The billhook seized by the Police demonstrated a precise fit with the fracture pattern when its handle was positioned posteriorly, and the tip penetrated laterally in a left-to-right trajectory.
In conclusion, to the best of our knowledge, this is the first report of vertebral stab wound analysis using a combined micro-CT and 3D printing approach.
Although 3D printing is not yet a fully validated forensic method, and further research is needed for identifying any potential errors occurring during production, segmentation, stereolithography data generation, and post-processing, this report highlights the high potentiality of micro-radiology and 3D printing as promising tools for the morphometric analysis of vertebral injuries.
由于周围解剖结构的复杂性，涉及椎体区域的刺伤是罕见的，并且在法医尸检中构成了重大挑战。放射学技术，如死后计算机断层扫描（PMCT）或微ct，在检测和详细描述尖锐骨病变方面显示出巨大的潜力。我们在此提出一个致命的情况下，杀人刺伤涉及左椎动脉和轴的同外侧表面。PMCT发现左侧椎轴侧块（C2）骨折，micro-CT显示左侧C2横突皮质不连续，几乎将横突与椎体分离。基于micro-CT数据，在Formlabs Form 3L打印机上以透明材料打印出前三节颈椎的三维模型，并与两种潜在武器进行拟合匹配分析。警方检获的鹰嘴钩，其柄位在后，刀尖沿从左至右的轨迹横向插入，与骨折模式吻合。综上所述，据我们所知，这是首个使用显微ct和3D打印相结合的方法分析椎体刺伤的报告。虽然3D打印还不是一种完全有效的法医方法，并且需要进一步研究以确定在生产、分割、立体光刻数据生成和后处理过程中发生的任何潜在错误，但该报告强调了微放射学和3D打印作为椎体损伤形态测量分析的有前途的工具的巨大潜力。
{"title":"Forensic application of micro-radiological analysis and 3D-printed vertebrae in a stab wound homicide case","authors":"Oriana Cuman , Federico Toselli , Guido Viel , Paolo Fais , Maria Sech , Chiara Giraudo , Francesco Bertelli , Vladimiro Vida , Giovanni Cecchetto","doi":"10.1016/j.legalmed.2025.102661","DOIUrl":"10.1016/j.legalmed.2025.102661","url":null,"abstract":"<div><div>Stab injuries involving the vertebral region are rare and pose significant challenges during forensic autopsy due to the complexity of the surrounding anatomical structures. Radiological techniques, such as post-mortem computed tomography (PMCT) or micro-CT, have shown great potential for detecting and detailing sharp bone lesions. We herein present a fatal case of homicidal stab wound involving the left vertebral artery and the homolateral surface of the axis. PMCT identified a fracture of the left lateral mass of the axis (C2), and micro-CT revealed a cortical discontinuity of the left transverse process of C2, nearly separating the transverse process from the body of the axis. Based on micro-CT data, a 3D model of the first three cervical vertebrae was printed in a clear material on a Formlabs Form 3L printer, and a fit-matching analysis was conducted with two potential weapons. The billhook seized by the Police demonstrated a precise fit with the fracture pattern when its handle was positioned posteriorly, and the tip penetrated laterally in a left-to-right trajectory.</div><div>In conclusion, to the best of our knowledge, this is the first report of vertebral stab wound analysis using a combined micro-CT and 3D printing approach.</div><div>Although 3D printing is not yet a fully validated forensic method, and further research is needed for identifying any potential errors occurring during production, segmentation, stereolithography data generation, and post-processing, this report highlights the high potentiality of micro-radiology and 3D printing as promising tools for the morphometric analysis of vertebral injuries.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"76 ","pages":"Article 102661"},"PeriodicalIF":1.3,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lacosamide is a third-generation antiepileptic drug that selectively promotes the slow inactivation of sodium channels. Herein, we report a case of fatal lacosamide poisoning following an autopsy. A female in her fifties was found dead in her living room. She had been diagnosed with epilepsy and had been prescribed lacosamide, carbamazepine, lamotrigine, and perampanel. At the scene, empty blister packs containing a total of 4950 mg of lacosamide were found in her bag. Additionally, two tablets of a commercially available sleeping medication containing diphenhydramine were missing. A medicolegal autopsy was conducted two days later. The stomach contained 120 mL of a slightly viscid fluid, which appeared powdery and suspended. Qualitative analysis using gas chromatography–mass spectrometry detected lacosamide, carbamazepine, and lamotrigine, while perampanel and diphenhydramine were not found. The blood lacosamide concentration was 70.1–86.8 µg/mL. These values were higher than the current reference range of lacosamide and comparable to or higher than those of previous fatal cases. Carbamazepine and lamotrigine levels were within or below the therapeutic range. Based on these findings, we determined that the cause of her death was lacosamide poisoning.
{"title":"An autopsy case of fatal lacosamide overdose","authors":"Yukie Yamasaki , Fumio Moriya , Kaori Taniguchi , Masanobu Miura , Kei Yoshitome , Chie Kobayashi , Satoru Miyaishi","doi":"10.1016/j.legalmed.2025.102658","DOIUrl":"10.1016/j.legalmed.2025.102658","url":null,"abstract":"<div><div>Lacosamide is a third-generation antiepileptic drug that selectively promotes the slow inactivation of sodium channels. Herein, we report a case of fatal lacosamide poisoning following an autopsy. A female in her fifties was found dead in her living room. She had been diagnosed with epilepsy and had been prescribed lacosamide, carbamazepine, lamotrigine, and perampanel. At the scene, empty blister packs containing a total of 4950 mg of lacosamide were found in her bag. Additionally, two tablets of a commercially available sleeping medication containing diphenhydramine were missing. A medicolegal autopsy was conducted two days later. The stomach contained 120 mL of a slightly viscid fluid, which appeared powdery and suspended. Qualitative analysis using gas chromatography–mass spectrometry detected lacosamide, carbamazepine, and lamotrigine, while perampanel and diphenhydramine were not found. The blood lacosamide concentration was 70.1–86.8 µg/mL. These values were higher than the current reference range of lacosamide and comparable to or higher than those of previous fatal cases. Carbamazepine and lamotrigine levels were within or below the therapeutic range. Based on these findings, we determined that the cause of her death was lacosamide poisoning.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"76 ","pages":"Article 102658"},"PeriodicalIF":1.3,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-12DOI: 10.1016/j.legalmed.2025.102656
Piotr Adamski , Marta Golik , Piotr Kawalec , Maria Krzemińska , Julia Malinowska , Sandra Przybysz , Jan Radomski , Szymon Rzepczyk, Klaudia Dolińska-Kaczmarek, Paweł Świderski, Czesław Żaba, Bartosz Burchardt
Hanging is the most common method of suicide worldwide and is characterized by a high mortality rate. The purpose of this study is to determine the incidence of Martin’s, Amussat’s, and Simon’s signs in hanging cases and to investigate the epidemiology of suicide by hanging. Amussat’s sign is a transverse laceration of the intimal layer of carotid arteries, Martin’s sign is definied as a hematoma in the adventitia of the carotid artery and Simon’s sign is a haemorrhage into the anterior surface of the intervertebral discs of the lumbar region. Study analyzed 6072 autopsy protocols performed between 2007 and 2022 in the Department of Forensic Medicine of Poznan University of Medical Sciences, of which 367 were cases of suicide by hanging, that meet the inclusion criteria. The analysis took into account: age, gender, place of death, month and year of death, and presence of typical post-mortem signs of hanging. In this study, there was no clear trend in mortality due to suicides by hanging. Men more often committed suicide by hanging than women (84,7%). The average age is 44 years. The results suggest that in more than half of the deaths resulting from suicide hangings, the postmortem examination did not reveal any of the three symptoms studied, and Simon’s sign is the most common. Simon’s symptom occurred more frequently among younger people and men. Moreover, Simon’s sign was more often identified in cases revealed in the public space in summer.
{"title":"Prevalence and analysis of Amussat’s, Martin’s and Simon’s signs in suicide by hanging in socio-demographic context in the Poznan metropolitan area and surrounding provinces in Poland in 2007–2022","authors":"Piotr Adamski , Marta Golik , Piotr Kawalec , Maria Krzemińska , Julia Malinowska , Sandra Przybysz , Jan Radomski , Szymon Rzepczyk, Klaudia Dolińska-Kaczmarek, Paweł Świderski, Czesław Żaba, Bartosz Burchardt","doi":"10.1016/j.legalmed.2025.102656","DOIUrl":"10.1016/j.legalmed.2025.102656","url":null,"abstract":"<div><div>Hanging is the most common method of suicide worldwide and is characterized by a high mortality rate. The purpose of this study is to determine the incidence of Martin’s, Amussat’s, and Simon’s signs in hanging cases and to investigate the epidemiology of suicide by hanging. Amussat’s sign is a transverse laceration of the intimal layer of carotid arteries, Martin’s sign is definied as a hematoma in the adventitia of the carotid artery<!--> <!-->and Simon’s sign is a haemorrhage into the anterior surface of the intervertebral discs of the lumbar region. Study analyzed 6072 autopsy protocols performed between 2007 and 2022 in the Department of Forensic Medicine of Poznan University of Medical Sciences, of which 367 were cases of suicide by hanging, that meet the inclusion criteria. The analysis took into account: age, gender, place of death, month and year of death, and presence of typical post-mortem signs of hanging. In this study, there was no clear trend in mortality due to suicides by hanging. Men more often committed suicide by hanging than women (84,7%). The average age is 44 years. The results suggest that in more than half of the deaths resulting from suicide hangings, the postmortem examination did not reveal any of the three symptoms studied, and Simon’s sign is the most common. Simon’s symptom occurred more frequently among younger people and men. Moreover, Simon’s sign was more often identified in cases revealed in the public space in summer.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"76 ","pages":"Article 102656"},"PeriodicalIF":1.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144308137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-08DOI: 10.1016/j.legalmed.2025.102654
Heba Ibrahim Lashin , Nadia Ezzat Helal , Mai Mohammed Mahran , Asmaa Fady Sharif
Cardiothoracic injuries are crucial aspect of traumatology, resulting in significant morbidities and mortalities. Little is understood about the interrelationship between mechanism of trauma, and the associated outcomes. This work aimed to investigate the association between the mechanism of trauma and the induced pattern of injuries, as well as their association with adverse outcomes, namely mortality and the need for mechanical ventilation (MV). The current study is a prospective cohort study involving 229 patients diagnosed with acute cardiothoracic injuries. This work reveals an overall mortality of 22.3%, while 42.4% needed MV. Exsanguination was the leading cause of death, followed by respiratory failure. Cardiac, great vessels, and other mediastinal injuries, as well as diaphragmatic injuries, were significantly higher in penetrating trauma. Though blunt trauma was primarily unintentional, they are graver and more lethal than penetrating ones, denoted by significantly higher injury severity score, need for MV (49.6% vs. 32.3%), and mortality (28.6% vs. 13.5%). Cardiac injuries significantly predicted death and MV (P < 0.05). Other significant mutual predictors of mortality and MV were blunt trauma, diaphragmatic injuries, hemothorax and hemopericardium, facial and intracranial injuries (subdural hemorrhage), and clavicular fractures. Two proposed models explained 74.6% and 60.5% of variances in probability of mortality and MV, respectively. Those models demonstrated high accuracy, above 89.21%. The proven association between the mechanism of trauma and pattern of injuries, as well as the need for MV and death, warrants precise interpretation and rapid response in various settings to improve outcomes for patients affected with cardiothoracic trauma.
{"title":"Pattern, characterization and outcomes of blunt and penetrating cardiothoracic injuries. A medico-legal comparative study","authors":"Heba Ibrahim Lashin , Nadia Ezzat Helal , Mai Mohammed Mahran , Asmaa Fady Sharif","doi":"10.1016/j.legalmed.2025.102654","DOIUrl":"10.1016/j.legalmed.2025.102654","url":null,"abstract":"<div><div>Cardiothoracic injuries are crucial aspect of traumatology, resulting in significant morbidities and mortalities. Little is understood about the interrelationship between mechanism of trauma, and the associated outcomes. This work aimed to investigate the association between the mechanism of trauma and the induced pattern of injuries, as well as their association with adverse outcomes, namely mortality and the need for mechanical ventilation (MV). The current study is a prospective cohort study involving 229 patients diagnosed with acute cardiothoracic injuries. This work reveals an overall mortality of 22.3%, while 42.4% needed MV. Exsanguination was the leading cause of death, followed by respiratory failure. Cardiac, great vessels, and other mediastinal injuries, as well as diaphragmatic injuries, were significantly higher in penetrating trauma. Though blunt trauma was primarily unintentional, they are graver and more lethal than penetrating ones, denoted by significantly higher injury severity score, need for MV (49.6% vs. 32.3%), and mortality (28.6% vs. 13.5%). Cardiac injuries significantly predicted death and MV (<em>P</em> < 0.05). Other significant mutual predictors of mortality and MV were blunt trauma, diaphragmatic injuries, hemothorax and hemopericardium, facial and intracranial injuries (subdural hemorrhage), and clavicular fractures. Two proposed models explained 74.6% and 60.5% of variances in probability of mortality and MV, respectively. Those models demonstrated high accuracy, above 89.21%. The proven association between the mechanism of trauma and pattern of injuries, as well as the need for MV and death, warrants precise interpretation and rapid response in various settings to improve outcomes for patients affected with cardiothoracic trauma.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"76 ","pages":"Article 102654"},"PeriodicalIF":1.3,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144240517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deoxyribonucleases (DNases) are essential enzymes involved in DNA metabolism, playing critical roles in replication, repair, recombination, and the degradation of apoptotic DNA. They are primarily classified into two families: DNase I and DNase II, each exhibiting distinct catalytic properties and tissue-specific functions. Dysregulated DNase activity is implicated in various diseases. This review synthesizes current knowledge on the biochemical properties, gene structures, tissue distributions, and clinical significance of DNases. It explores their roles in disease mechanisms, the impact of genetic polymorphisms on enzyme activity, and their potential as biomarkers for early disease detection. While considerable progress has been made in elucidating the physiological functions of endogenous DNases, increasing attention is being directed toward the therapeutic applications of exogenous DNases. Beyond their established role in cystic fibrosis treatment, DNases show promise in addressing conditions such as cancer, acute kidney injury, sepsis, traumatic brain injury, and diabetic wound healing by modulating inflammation and clearing extracellular DNA. By providing a comprehensive overview of DNase families, this review highlights their functional diversity and clinical relevance, paving the way for future research, therapeutic advancements, and novel approaches to disease management. Therefore, this article contributes valuable insights not only to the field of legal medicine but also to broader areas of basic and clinical medical sciences.
{"title":"Necessity for further exploration of both endogenous and exogenous DNases","authors":"Sultana Razia , Haruo Takeshita , Ken Inoue , Reiko Iida , Misuzu Ueki , Toshihiro Yasuda","doi":"10.1016/j.legalmed.2025.102653","DOIUrl":"10.1016/j.legalmed.2025.102653","url":null,"abstract":"<div><div>Deoxyribonucleases (DNases) are essential enzymes involved in DNA metabolism, playing critical roles in replication, repair, recombination, and the degradation of apoptotic DNA. They are primarily classified into two families: DNase I and DNase II, each exhibiting distinct catalytic properties and tissue-specific functions. Dysregulated DNase activity is implicated in various diseases. This review synthesizes current knowledge on the biochemical properties, gene structures, tissue distributions, and clinical significance of DNases. It explores their roles in disease mechanisms, the impact of genetic polymorphisms on enzyme activity, and their potential as biomarkers for early disease detection. While considerable progress has been made in elucidating the physiological functions of endogenous DNases, increasing attention is being directed toward the therapeutic applications of exogenous DNases. Beyond their established role in cystic fibrosis treatment, DNases show promise in addressing conditions such as cancer, acute kidney injury, sepsis, traumatic brain injury, and diabetic wound healing by modulating inflammation and clearing extracellular DNA. By providing a comprehensive overview of DNase families, this review highlights their functional diversity and clinical relevance, paving the way for future research, therapeutic advancements, and novel approaches to disease management. Therefore, this article contributes valuable insights not only to the field of legal medicine but also to broader areas of basic and clinical medical sciences.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"76 ","pages":"Article 102653"},"PeriodicalIF":1.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-03DOI: 10.1016/j.legalmed.2025.102651
Shuheng Wen, Toshihiko Aki, Kana Unuma
Calpains are calcium-dependent proteases implicated in cardiac pathologies that induce mitochondrial dysfunction and intercalated disc disruption. However, their role in cocaine-induced cardiotoxicity remains unclear. This study investigates the effects of subchronic cocaine exposure on cardiac calpain-1 and −2 in vivo. Calpain-1 and −2 expressions specifically increased in the mitochondria and adjacent to contraction bands in the myocardium of rats receiving 14-day cocaine administration (20 mg/kg/day via the tail vein), accompanied by decreased expression of ATP5A1, a subunit of a major component of the mitochondrial respiratory chain, suggesting calpain-related mitochondrial dysfunction. These findings provide preliminary evidence for the calpain involvement in cocaine-induced cardiotoxicity and offer potential insights for characteristic findings at autopsy of cocaine intoxication.
{"title":"Increased expression of calpain-1 and −2 within cardiac mitochondria and adjacent to the contraction bands in rat myocardium after 14-day cocaine administration: A preliminary study","authors":"Shuheng Wen, Toshihiko Aki, Kana Unuma","doi":"10.1016/j.legalmed.2025.102651","DOIUrl":"10.1016/j.legalmed.2025.102651","url":null,"abstract":"<div><div>Calpains are calcium-dependent proteases implicated in cardiac pathologies that induce mitochondrial dysfunction and intercalated disc disruption. However, their role in cocaine-induced cardiotoxicity remains unclear. This study investigates the effects of subchronic cocaine exposure on cardiac calpain-1 and −2 <em>in vivo</em>. Calpain-1 and −2 expressions specifically increased in the mitochondria and adjacent to contraction bands in the myocardium of rats receiving 14-day cocaine administration (20 mg/kg/day via the tail vein), accompanied by decreased expression of ATP5A1, a subunit of a major component of the mitochondrial respiratory chain, suggesting calpain-related mitochondrial dysfunction. These findings provide preliminary evidence for the calpain involvement in cocaine-induced cardiotoxicity and offer potential insights for characteristic findings at autopsy of cocaine intoxication.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"76 ","pages":"Article 102651"},"PeriodicalIF":1.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144221401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
When dealing with psychostimulant and antipsychotic poisoning deaths in forensic practice, detection and accurate quantification of the causative drug are essential for a definitive diagnosis. If post-mortem changes have resulted in the presence of various adulterants in the blood, commercially available simple screening kits may produce false positives. In this study, we focused on applying dried blood spot (DBS) samples to develop a simple and accurate method for forensic toxicological analysis of drugs of interest in poisoning deaths.
To test our novel analytical method we used liquid chromatography coupled with electrospray ionization−tandem mass spectrometry to quantify two psychostimulants (amphetamine, methamphetamine) and eight antipsychotics (chlorpromazine, haloperidol, levomepromazine, aripiprazole, clozapine, quetiapine, risperidone, and paliperidone) in cadaveric DBS samples. The linearities of the calibration curves were good in the concentration range of 0.05–1.0 μg/mL. The method allowed for repeatable and accurate quantification of the 10 target drugs with intra- and inter-assay coefficients of variation of below 10.6 % and 12.4 %, respectively. In addition, the concentrations of all drugs stored at −80 °C in DBSs remained almost stable for at least 2 weeks. Comparison with our general practice method (known as QuEChERS) showed good positive correlations of the quantifiable concentrations of all drugs. In addition, for all drugs, the concentrations obtained by the DBS method were almost well coincident with those obtained by the QuEChERS method.
{"title":"Determination of multiple psychostimulants and antipsychotics in postmortem dried blood spot samples by liquid chromatography–tandem mass spectrometry","authors":"Tadashi Nishio, Yoko Toukairin, Tomoaki Hoshi, Tomomi Arai, Makoto Nogami","doi":"10.1016/j.legalmed.2025.102650","DOIUrl":"10.1016/j.legalmed.2025.102650","url":null,"abstract":"<div><div>When dealing with psychostimulant and antipsychotic poisoning deaths in forensic practice, detection and accurate quantification of the causative drug are essential for a definitive diagnosis. If post-mortem changes have resulted in the presence of various adulterants in the blood, commercially available simple screening kits may produce false positives. In this study, we focused on applying dried blood spot (DBS) samples to develop a simple and accurate method for forensic toxicological analysis of drugs of interest in poisoning deaths.</div><div>To test our novel analytical method we used liquid chromatography coupled with electrospray ionization−tandem mass spectrometry to quantify two psychostimulants (amphetamine, methamphetamine) and eight antipsychotics (chlorpromazine, haloperidol, levomepromazine, aripiprazole, clozapine, quetiapine, risperidone, and paliperidone) in cadaveric DBS samples. The linearities of the calibration curves were good in the concentration range of 0.05–1.0 μg/mL. The method allowed for repeatable and accurate quantification of the 10 target drugs with intra- and inter-assay coefficients of variation of below 10.6 % and 12.4 %, respectively. In addition, the concentrations of all drugs stored at −80 °C in DBSs remained almost stable for at least 2 weeks. Comparison with our general practice method (known as QuEChERS) showed good positive correlations of the quantifiable concentrations of all drugs. In addition, for all drugs, the concentrations obtained by the DBS method were almost well coincident with those obtained by the QuEChERS method.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"76 ","pages":"Article 102650"},"PeriodicalIF":1.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144221400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-02DOI: 10.1016/j.legalmed.2025.102648
Gülay Açar , Demet Aydoğdu
We aimed to introduce a new approach to sex determination using 3D models of skull triangles including mastoid (MT), bimastoid (BMT), occipital (OCT) and facial (FT) triangles to explore how to achieve better accuracy, and also to assess the influence of skeletal malocclusion parameters (ANB, SNA), cephalic index (CI), and Welcher basal angle (WBA). The study was conducted on152 3D computed tomography scans, in which the dimensions of skull triangles, ANB, SNA, WBA, cranial length (CL) and breadth (CB) were measured. All parameters except the angular measurements were higher in males than in females. Univariate discriminant function analysis (DFA) yielded an average accuracies ranging from 54.6% to 79.6%. Multivariate DFA increased the percentage of correct predictions of gender to vary from 79.6 to 89.5%. Receiver operator characteristic curve (ROC) analysis showed that the area under ROC curve value to vary from 0.458 to 0.870. There was a general tendency for a decrease in all triangle dimensions except FT with increasing CI. In some cases, skeletal malocclusion, CI, and WBA influenced the area of triangles. In general, dolichocephalic individuals with larger WBA had lower RMT and LMT areas, whereas dolichocephalic and mesocephalic individuals with Class III had higher BMT and OCT areas. In FT, brachycephalic subjects with Class III had the lowest and Class I had the highest area value. Our results suggest that the MT, BMT, FT, and CL can be used effectively for sex determination and skeletal malocclusion, CI, and WBA had some influence in dimensions of skull triangles.
{"title":"Investigating sexual dimorphism of the mastoid, bimastoid, occipital, and facial triangles in different craniofacial skeletal patterns using three dimensional models generated from CT scans","authors":"Gülay Açar , Demet Aydoğdu","doi":"10.1016/j.legalmed.2025.102648","DOIUrl":"10.1016/j.legalmed.2025.102648","url":null,"abstract":"<div><div>We aimed to introduce a new approach to sex determination using 3D models of skull triangles including mastoid (MT), bimastoid (BMT), occipital (OCT) and facial (FT) triangles to explore how to achieve better accuracy, and also to assess the influence of skeletal malocclusion parameters (ANB, SNA), cephalic index (CI), and Welcher basal angle (WBA). The study was conducted on152 3D computed tomography scans, in which the dimensions of skull triangles, ANB, SNA, WBA, cranial length (CL) and breadth (CB) were measured. All parameters except the angular measurements were higher in males than in females. Univariate discriminant function analysis (DFA) yielded an average accuracies ranging from 54.6% to 79.6%. Multivariate DFA increased the percentage of correct predictions of gender to vary from 79.6 to 89.5%. Receiver operator characteristic curve (ROC) analysis showed that the area under ROC curve value to vary from 0.458 to 0.870. There was a general tendency for a decrease in all triangle dimensions except FT with increasing CI. In some cases, skeletal malocclusion, CI, and WBA influenced the area of triangles. In general, dolichocephalic individuals with larger WBA had lower RMT and LMT areas, whereas dolichocephalic and mesocephalic individuals with Class III had higher BMT and OCT areas. In FT, brachycephalic subjects with Class III had the lowest and Class I had the highest area value. Our results suggest that the MT, BMT, FT, and CL can be used effectively for sex determination and skeletal malocclusion, CI, and WBA had some influence in dimensions of skull triangles.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"76 ","pages":"Article 102648"},"PeriodicalIF":1.3,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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