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Factors influencing the incidence of cervical spine/cord injury and severe injury caused by falls. 影响跌倒致颈椎/脊髓损伤及严重损伤发生率的因素。

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-01-22 DOI: 10.1016/j.legalmed.2026.102791

Masaki Inoue, Takahiro Tomioka, Takato Murai, Marin Takaso, Mami Nakamura, Kazuki Takaoka, Masahito Hitosugi

Falls are major causes of trauma in older people, often resulting in cervical spine/cord injury, and may even be fatal. We aimed to identify factors associated with cervical spine/cord injury and severe injury caused by falls to aid forensic evaluation. We retrospectively analyzed data for 83 individuals who fell between 2011 and 2023 at Shiga University of Medical Science. The characteristics of the victim, cause of death, presence of cervical spine/cord injury, injury severity, part of the body making contact with the impact surface, properties of the impact surface, and fall height were evaluated. Injury severity was assessed using the Abbreviated Injury Severity score and Injury Severity Score (ISS). Severe injury with ISS ≥ 16 occurred in 39.8% of victims and cervical spine/cord injury in 21.7%. Logistic regression analyses revealed that body mass (odds ratio [OR] 1.063, 95% confidence interval [CI] 1.003-1.126) and the part of the body making contact with the impact surface (chest/abdomen vs. head/face, OR 0.074, CI 0.007-0.723) significantly influenced the incidence of cervical spine/cord injury, and fall height >3 m was significantly associated with severe injury (OR 11.473, CI 2.163-60.868). These findings demonstrate that the severity of injury depends on the fall height, whereas cervical spine/cord injury is influenced by body mass and the part of the body making contact with the impact surface. Therefore, the collection of scene information, including the fall height, and body mass and posture are critical for postmortem examinations. Autopsy should be considered when cervical spine/cord injury is suspected.

跌倒是老年人外伤的主要原因，经常导致颈椎/脊髓损伤，甚至可能致命。我们的目的是确定与颈椎/脊髓损伤和跌倒引起的严重损伤相关的因素，以帮助法医评估。我们回顾性分析了2011年至2023年在滋贺医科大学（Shiga Medical Science University）住院的83名患者的数据。评估了受害者的特征、死亡原因、有无颈椎/脊髓损伤、损伤严重程度、与撞击面接触的身体部位、撞击面性质和坠落高度。使用简略损伤严重程度评分和损伤严重程度评分（ISS）评估损伤严重程度。ISS≥16的严重损伤发生率为39.8%，颈椎/脊髓损伤发生率为21.7%。Logistic回归分析显示，身体质量（优势比[OR] 1.063, 95%可信区间[CI] 1.003-1.126）和身体与撞击面接触部位（胸/腹vs头/脸，OR 0.074, CI 0.007-0.723）显著影响颈椎/脊髓损伤的发生率，跌落高度bbbb3 m与严重损伤显著相关（OR 11.473, CI 2.163-60.868）。这些研究结果表明，损伤的严重程度取决于坠落高度，而颈椎/脊髓损伤受身体质量和与撞击面接触的身体部位的影响。因此，收集现场信息，包括坠落高度、体重和姿势，对尸检至关重要。当怀疑颈椎/脊髓损伤时，应考虑尸检。

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引用次数: 0

A novel ACTA2 variant in sudden fatal familial thoracic aortic dissection: literature review and genotype-phenotype expansion. 猝死致死性家族性胸主动脉夹层中一种新的ACTA2变异：文献回顾和基因型-表型扩展。

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-01-21 DOI: 10.1016/j.legalmed.2026.102790

Lin Lihua, Duan Yijie, Huang Jing, Hou Jiaqi, Chai Qianqian, Pan Meichen, Du Jianghua, Liu Qian

Thoracic aortic dissection (TAD) is a life-threatening emergency frequently linked to underlying genetic variants, particularly in familial cases. Molecular autopsy has become increasingly valuable in forensic practice for identifying occult heritable disorders when routine autopsy alone cannot fully clarify the cause of death. Here, we report a 17-year-old male who died suddenly due to pericardial tamponade caused by ruptured TAD. Gene testing identified a novel ACTA2 variant, c.155_162delinsGCACA. This indel leads to two amino acid substitutions (p.K52_D53delinsST) and a deletion (p.S54del), involving evolutionarily conserved residues. Histological examination showed aortic medial degeneration, characterized by elastic fiber rupture and disorganized arrangement of smooth muscle cells. Family screening confirmed the variant was inherited from his mother, with his elder sister also carrying it; both the mother and sister exhibited abnormal aortic calcification and congenital heart disease. Our systematic review revealed that pathogenic ACTA2 variants frequently involve multiple organ systems. This multisystem pattern enhances the forensic value of genetic testing by providing additional phenotypic clues that help determine the underlying cause of sudden death when routine autopsy findings are insufficient. By identifying this novel variant, our study expands the ACTA2 variants spectrum relevant to forensic molecular autopsy and reinforces the importance of incorporating postmortem genetic testing into death investigations, particularly in unexplained fatal aortic events.

胸主动脉夹层（TAD）是一种危及生命的紧急情况，通常与潜在的遗传变异有关，特别是在家族病例中。当常规尸检不能完全阐明死亡原因时，分子尸检在法医鉴定隐匿的遗传性疾病方面变得越来越有价值。我们在此报告一位17岁男性，因TAD破裂导致心包填塞而猝死。基因测试鉴定出一种新的ACTA2变异，c.155_162delinsGCACA。该indel导致两个氨基酸替换（p.K52_D53delinsST）和一个缺失（p.S54del），涉及进化上保守的残基。组织学检查显示主动脉内侧变性，以弹性纤维断裂和平滑肌细胞排列紊乱为特征。家庭筛查证实，这种变异遗传自他的母亲，他的姐姐也携带这种变异；母亲和妹妹都表现出异常的主动脉钙化和先天性心脏病。我们的系统综述显示致病性ACTA2变异经常涉及多个器官系统。这种多系统模式通过提供额外的表型线索来提高基因检测的法医价值，这些线索有助于在常规尸检结果不足的情况下确定猝死的潜在原因。通过鉴定这一新的变异，我们的研究扩展了与法医分子尸检相关的ACTA2变异谱，并加强了将死后基因检测纳入死亡调查的重要性，特别是在无法解释的致命主动脉事件中。

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引用次数: 0

Histiocytic myocarditis: A rare and complex cause of cardiogenic shock 组织细胞性心肌炎：心源性休克的一种罕见而复杂的病因

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-01-21 DOI: 10.1016/j.legalmed.2026.102795

Tommaso D’Anna , Beatrice Belmonte , Elisabetta Orlando , Eleonora Formisano , Ginevra Malta , Antonina Argo , Stefania Zerbo , Ada Maria Florena , Emiliano Maresi

Introduction

Histiocytic Myocardial Inflammatory Disease (HMID) is a rare and under-recognized form of myocarditis, characterized by predominant histiocytic infiltration within the myocardial tissue. Unlike more common lymphocytic and eosinophilic forms, HMID remains diagnostically challenging, particularly in children. Here we present a pediatric case, outlining the clinical course and the difficulties encountered, and highlighting the histopathological and immunohistochemical features essential for establishing the diagnosis.

Case description

A 4-year-old girl accompanied by her parents, who showed up at the hospital with persistent fever, abdominal pain, and vomiting. A cardiac evaluation revealed a mild pericardial effusion with preserved systolic function. Doctors treated her with corticosteroids and broad-spectrum antibiotics, but her condition rapidly deteriorated, resulting in cardiogenic shock and death from cardiac arrest. We performed a forensic autopsy that included histopathological examination and immunohistochemical analysis of the cardiac muscle (in particular in the right ventricle). The CD68 positivity highlighted the presence of a diffuse infiltrate of hystiocites. CD3, CD4, CD8, and CD20 staining showed only scarce lymphocyte representation. The child’s history gave no hint of autoimmune or inflammatory disease, underscoring the abrupt and unexpected nature of her illness.

Discussion

HMID is rare but can mimic common myocarditis, complicating diagnosis. Its fulminant course requires early recognition and confirmation by histopathology and immunohistochemistry. This case shows the importance of recognizing HMID in pediatric cardiogenic shock or sudden cardiac death of unclear cause.

组织细胞性心肌炎症病（HMID）是一种罕见且未被充分认识的心肌炎，其特征是心肌组织内主要的组织细胞浸润。与更常见的淋巴细胞型和嗜酸性粒细胞型不同，HMID的诊断仍然具有挑战性，特别是在儿童中。在这里，我们提出一个儿科病例，概述临床过程和遇到的困难，并强调组织病理学和免疫组织化学特征是建立诊断所必需的。病例描述：一名4岁女童在父母陪同下，因持续发热、腹痛和呕吐来到医院。心脏检查显示轻度心包积液，并保留了收缩功能。医生用皮质类固醇和广谱抗生素治疗她，但她的病情迅速恶化，导致心源性休克和心脏骤停死亡。我们进行了法医尸检，包括组织病理学检查和心肌（特别是右心室）的免疫组织化学分析。CD68阳性提示存在弥漫性囊性浸润。CD3、CD4、CD8和CD20染色仅显示少量淋巴细胞。孩子的病史没有显示出自身免疫性疾病或炎症性疾病的迹象，强调了她的疾病的突发性和出乎意料的性质。hmid是罕见的，但可以模拟普通心肌炎，使诊断复杂化。其暴发性病程需要通过组织病理学和免疫组织化学早期识别和确认。本病例显示在小儿心源性休克或原因不明的心源性猝死中识别HMID的重要性。

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引用次数: 0

Suicidal death due to the toxicity of the organophosphorus pesticide ethoprophos 由于有机磷农药乙氧丙磷的毒性导致的自杀死亡

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-01-21 DOI: 10.1016/j.legalmed.2026.102792

Amvrosios Orfanidis, Kleio-Evangelia Fragkouli, Dimitra Florou, Vassiliki A. Boumba

The current case report concerns the first reported fatality due to ethoprophos toxicity after intentional ingestion of the toxicant, to the best of authors’ knowledge, documented with autopsy findings and toxicological data, including the identification and quantification of ethoprophos in blood by LC-MS/MS. The deceased was a 60-year-old man, who was found dead in his vehicle by his family. Initially the death was considered as sudden, and the decedent was subjected to postmortem investigation. Upon autopsy, no external injuries were observed, nor macroscopic lesions or signs of underlying disease were noticed. Internal examination revealed cerebral and pulmonary edema and partially digested gastric contents with multiple black granules attached to his gastric mucosa. Peripheral blood, urine, and gastric contents, with the black granules, were collected for toxicology analysis. The GC–MS screening analysis of the granules revealed that their active component was ethoprophos. To determine this pesticide in blood, an analytical protocol based on LC-MS/MS analysis was developed that allowed the identification of trace amounts of ethoprophos in blood. The toxicological results indicated that ethoprophos was the only toxic substance that could have contributed to the death, and the manner of death was reported as suicide. In the present case, death was attributed to the intake of ethoprophos, and the manner of death was reported as suicide.

据作者所知，目前的病例报告涉及首次报告的因故意摄入该毒物而导致的乙丙磷毒性死亡，并记录了尸检结果和毒理学数据，包括通过LC-MS/MS对血液中乙丙磷的鉴定和定量。死者是一名60岁的男子，被家人发现死在自己的车里。最初认为死亡是突然的，对死者进行了尸检。尸检时，没有观察到外伤，也没有发现宏观病变或潜在疾病的迹象。内部检查显示脑水肿和肺水肿，胃内容物部分消化，胃粘膜有多个黑色颗粒附着。采集带有黑色颗粒的外周血、尿和胃内容物进行毒理学分析。GC-MS筛选分析表明，颗粒的有效成分为乙硫磷。为了确定血液中的农药，建立了一种基于LC-MS/MS分析的分析方案，可以鉴定血液中痕量的乙氧丙磷。毒理学结果表明，乙氧丙磷是唯一可能导致死亡的有毒物质，据报告，死亡方式为自杀。在本案中，死亡原因是摄入了乙氧丙磷，据报告死亡方式为自杀。

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引用次数: 0

Retrospective analysis of suicide cases in the province of Ferrara 费拉拉省自杀案例的回顾性分析

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-01-21 DOI: 10.1016/j.legalmed.2026.102793

Luca Diani , Giada Rovito , Irene Pradelle , Matilde Ruju , Rosa Maria Gaudio , Margherita Neri

Introduction

In 2016, the Postgraduate School of Forensic Medicine of the University of Ferrara presented a paper at the Annual Congress of the AAFS that analyzed some characteristics of suicides in the territory of the Province of Ferrara between 1996 and July 2016. This presentation is intended to stand as an ideal follow-up to that work.

Since 2017, the number of suicides in Italy has been progressively decreasing and peaked in 2021 (0.40 per 10,000 inhabitants). In Emilia-Romagna, available data confirm a steady decline in the number of suicides since 2001.

Materials and methods

Records collecting necrosectorial activity of the Institute were retrospectively analyzed. During the period between August 2016 and April 2025, about 1000 autopsies were performed, 153 of which involved suicide cases. For each of these autopsies, factors regarding the people who committed suicide, as well as the suicide method and the type of activity carried out by the Institute pathologists were examined.

Results and discussion

Among deaths by suicide, 77% are male (118 vs 35), with percentages not dissimilar to those between 1996 and 2016.

The most frequently used suicide method is confirmed to be hanging (49%), followed by the use of firearms (15.6%) and precipitation (9.8%).

Suicide cases come to the attention of the Institute overwhelmingly at the request of the Judicial Authority (87.2%) with judicial autopsy performed in 60% of cases.

Thus, the data collected show that suicide trends have not changed over the past nine years and are in line with national data.

2016年，费拉拉大学法医学研究生院在AAFS年会上发表了一篇论文，分析了1996年至2016年7月费拉拉省境内自杀事件的一些特征。这次演讲的目的是作为这项工作的理想后续。自2017年以来，意大利的自杀人数一直在逐步减少，并在2021年达到峰值（每万居民0.40人）。在艾米利亚-罗马涅，现有数据证实，自2001年以来，自杀人数稳步下降。材料和方法回顾性分析该所收集的坏死部门活动记录。在2016年8月至2025年4月期间，进行了约1000例尸检，其中153例涉及自杀案件。对于每一次尸检，都检查了有关自杀者的因素，以及研究所病理学家进行的自杀方法和活动类型。在自杀死亡人数中，77%为男性（118比35），这一比例与1996年至2016年的比例没有什么不同。最常使用的自杀方式是上吊（49%），其次是使用枪械（15.6%）和自杀（9.8%）。研究所注意到的自杀案件绝大多数是应司法当局的要求（87.2%），其中60%的案件进行了司法尸检。因此，收集的数据表明，自杀趋势在过去九年中没有改变，并且与国家数据一致。

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引用次数: 0

Shot or buckshot? The evidentiary value of ballistic and forensic medical expertise in a case of homicide and personal injury 霰弹还是铅弹？在杀人案和人身伤害案中，弹道和法医专业知识的证据价值。

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-01-20 DOI: 10.1016/j.legalmed.2026.102794

Eleonora Micaela Ertola , Euprepio Caprino , Tommaso Berloco , Gianpiero D’Antonio , Marco Albore , Cataldo Raffino , Giorgio Bolino

This case highlights the crucial role of forensic sciences in reconstructing the dynamics of a firearms-related case involving two victims. G.D. died at the scene after being struck by three shots from a 12-gauge firearm loaded with 11/0 buckshot, causing massive bilateral hemothorax and aortic laceration. Autopsy revealed multiple pellet wounds consistent with this ammunition. C.D. was hospitalized with multiple injuries, including three entry wounds to each shoulder and grazing wounds to the left temporal region and right thoracic wall. Examination of seized evidence—cartridge cases, an unexploded cartridge, wads, and pellets—confirmed that all injuries were compatible with the same weapon and ammunition type. Ballistic analysis demonstrated that all cartridge cases were fired from a single firearm. G.D.’s injuries corresponded to shots from 3 to 7 m, while C.D. was struck by two shots from 10 to 12 m. Initial hypotheses suggesting the use of different weapons (birdshot and buckshot) were not supported; metallic fragments in C.D.’s temporal region were identified as fragments from a single buckshot pellet. Shooting distances were estimated based on pellet spread and wound patterns and confirmed through experimental test-firing.

In conclusion, the investigation confirmed that both the fatal injuries of G.D. and the non-fatal wounds of C.D. resulted from a single 12-gauge firearm using 11/0 buckshot. This case underscores the importance of a combined medico-legal and ballistic approach for accurately evaluating firearm injuries and reconstructing shooting events.

这一案件突出了法医学在重建涉及两名受害者的与枪支有关的案件的动态过程中的关键作用。动力局被一把装有11/0铅弹的12口径手枪击中三枪当场死亡，造成双侧大量胸血和主动脉撕裂。尸检显示多处弹丸伤与这种弹药相符。C.D.因多处受伤住院，包括每个肩膀的三处射入伤以及左颞区和右胸壁的擦伤伤。检查了缴获的证据——弹壳、未爆炸的弹壳、弹团和弹丸——确认所有伤害都是由同一种武器和弹药造成的。弹道分析表明所有的弹壳都是由一支枪射出的。国民生产总值s的伤口对应于3到7米的子弹，而C.D.则被10到12米的子弹击中。最初关于使用不同武器（鸟枪和铅弹）的假设不被支持；cd中的金属碎片的颞区被鉴定为一枚铅弹的碎片。根据弹丸的扩散和伤口形态估算射击距离，并通过试验射击进行确认。总之，调查证实了动力局的致命伤和C.D.的非致命伤都是由一把12口径的霰弹造成的。这一案件强调了医学-法律和弹道相结合的方法对于准确评估火器伤害和重建射击事件的重要性。

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引用次数: 0

Three cases of drug-related death during treatment for stimulant-induced psychosis 兴奋剂性精神病治疗期间药物相关性死亡3例

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-01-20 DOI: 10.1016/j.legalmed.2026.102789

Tadashi Nishio, Yoko Toukairin, Tomoaki Hoshi, Tomomi Arai, Makoto Nogami

Long-term use of stimulant drugs can cause schizophrenia-like psychotic symptoms including hallucinations and delusions in the syndrome known as stimulant-induced psychosis. Therefore, treatment for stimulant-induced psychosis follows the approach for schizophrenia and primarily involves the use of antipsychotic drugs that antagonize dopamine release. However, multiple studies suggest that pharmacotherapy and psychosocial therapy for stimulant-induced psychosis have limited therapeutic efficacy, leading to poor long-term prognosis characterized by recurrence and chronicity of psychiatric symptoms, social isolation, and an extremely high risk of suicide. Here we report three forensic autopsy cases of patients with stimulant-induced psychosis whose cause of death was considered to be due to overdose of prescription medications. All three patients had received treatment with antipsychotic drugs during their lifetimes, but they had poor medication adherence and had discontinued treatment. Two deaths were directly due to drug overdose (Case 1, chlorpromazine and quetiapine poisoning; Case 2, zotepine and tramadol poisoning). In the third case, the direct cause of death was hanging, but markedly elevated blood concentrations of quetiapine and trazodone suggested that drug intoxication may have contributed to death. Elucidating the pathophysiology of stimulant-induced psychosis and selecting and developing effective treatments are essential, and long-term mental health care and social support to prevent isolation are crucial for preventing unfortunate deaths.

长期使用兴奋剂药物会导致类似精神分裂症的精神病症状，包括被称为兴奋剂诱发精神病的幻觉和妄想。因此，兴奋剂性精神病的治疗遵循精神分裂症的治疗方法，主要包括使用抗精神病药物来对抗多巴胺的释放。然而，多项研究表明，药物治疗和社会心理治疗对兴奋剂性精神病的治疗效果有限，导致长期预后差，其特点是精神症状复发和慢性，社会孤立，自杀风险极高。在这里，我们报告三例法医尸检患者的兴奋剂诱发精神病，其死因被认为是由于过量的处方药。这三名患者一生中都接受过抗精神病药物的治疗，但他们的药物依从性很差，并停止了治疗。2例直接死于药物过量（病例1，氯丙嗪和喹硫平中毒；病例2，佐替平和曲马多中毒）。在第三个案例中，死亡的直接原因是上吊，但血液中喹硫平和曲唑酮浓度明显升高表明，药物中毒可能是导致死亡的原因之一。阐明兴奋剂诱发精神病的病理生理学以及选择和开发有效的治疗方法至关重要，长期精神卫生保健和防止孤立的社会支持对于防止不幸死亡至关重要。

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引用次数: 0

Forensic implications of early postmortem changes in skeletal, cardiac, and smooth muscles following acute colchicine intoxication in rats 大鼠急性秋水仙碱中毒后早期死后骨骼、心脏和平滑肌变化的法医意义

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-01-12 DOI: 10.1016/j.legalmed.2026.102780

Dina Y. Hegab , Nabela I. El-Sharkawy , Gihan G. Moustafa , Taghred M. Saber , Mohamed M.M. Metwally , Yasmina M. Abd-Elhakim

Acute colchicine (CHC) poisoning can be fatal due to its narrow therapeutic index, involvement of multiple organ systems, and the lack of a specific antidote. This study investigated early postmortem biochemical, histopathological, and immunohistochemical changes in skeletal, smooth, and cardiac muscles within 24 h of death following acute CHC intoxication in rats. Sixty male Sprague Dawley rats were divided into control and CHC-intoxicated groups (n = 30 each). Controls received saline and were euthanized humanely; CHC rats received a single oral lethal dose (4.9 mg/kg b.wt) and died naturally within 8–10 h. Samples from the gastrocnemius muscle, intestine, and heart were collected at 0, 3, 6, 12, and 24 h postmortem. Tissue homogenates were analyzed for pH, CRP, Na⁺, K⁺, Ca⁺⁺, LDH, ATP, glycogen, and lactic acid. Immunohistochemistry assessed cytochrome c oxidase (CcO) and Na⁺, K⁺-ATPase (NKA) expression. CHC intoxication significantly altered most biochemical markers in a time-dependent manner. pH, Na⁺, ATP, and glycogen decreased, while CRP, LDH, Ca⁺⁺, K⁺, and lactic acid increased. CRP rose in the gastrocnemius and intestine but remained unchanged in the heart. CcO and NKA staining did not differ significantly between groups, though both declined with increasing postmortem interval (PMI). Several markers showed significant CHC-PMI interactions across tissues. Conclusively, acute CHC intoxication induced time-dependent biochemical changes in vital muscle tissues within 24 h PM. These findings underscore the forensic significance of understanding both toxicant-specific effects and PMI-related dynamics, enhancing the interpretation of muscle-based markers in suspected CHC poisoning cases.

急性秋水仙碱（CHC）中毒可能是致命的，因为它的治疗指数窄，累及多器官系统，缺乏特异性的解毒剂。本研究研究了急性CHC中毒大鼠死后24小时内骨骼、平滑肌和心肌的早期死后生化、组织病理学和免疫组织化学变化。将60只雄性Sprague Dawley大鼠分为对照组和chc中毒组，各30只。对照组接受生理盐水并人道安乐死；CHC大鼠接受单次口服致死剂量（4.9 mg/kg b.wt），在8-10小时内自然死亡。在死后0、3、6、12和24小时采集腓肠肌、肠道和心脏样本。组织匀浆分析pH、CRP、Na+、K+、Ca++、LDH、ATP、糖原和乳酸。免疫组化检测细胞色素c氧化酶（CcO）和Na+， K+- atp酶（NKA）的表达。CHC中毒以时间依赖性的方式显著改变了大多数生化标志物。pH、Na+、ATP和糖原降低，而CRP、LDH、Ca++、K+和乳酸升高。CRP在腓肠肌和肠道中升高，但在心脏中保持不变。CcO和NKA染色在各组间无显著差异，但两者均随死后时间（PMI）的增加而下降。一些标记物在组织中显示出显著的CHC-PMI相互作用。最后，急性CHC中毒在24小时PM内引起重要肌肉组织的时间依赖性生化变化。这些发现强调了了解毒物特异性效应和pmi相关动力学的法医意义，增强了对疑似CHC中毒病例中肌肉标志物的解释。

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引用次数: 0

Postmortem computed tomography lung imaging findings in cases of fatal hypothermia with infusion administered for cardiopulmonary resuscitation 致命低温输注心肺复苏病例的死后计算机断层扫描肺成像结果

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-01-11 DOI: 10.1016/j.legalmed.2026.102781

Akiko Takeuchi , Shigeki Jin , Takayuki Kiuchi , Ryo Uozumi , Tomoko Matoba , Yuta Hara , Keiko Takahashi , Chihiro Misaki , Aya Kikawa , Ayako Eguchi , Manabu Murakami , Hideki Hyodoh , Kotaro Matoba

Objective

The aim of this study was to investigate and evaluate the changes in postmortem lung computed tomography (CT) imaging findings following cardiopulmonary resuscitation (CPR) using infusion in cases of fatal hypothermia.

Materials and Methods

Between January 2020 and December 2024, among 65 cases of fatal hypothermia deaths subjected to postmortem CT imaging and forensic autopsy at our institution, 29 cases with a postmortem interval of less than 48 h were selected. 11 subjects who received intravenous resuscitation before death was declared comprised Group I and 18 subjects who did not receive infusion comprised Group II. In the postmortem chest CT scans of these cases, chest cavity excluding the mediastinum (CC) and aerated lung volume (ALV) were measured. Furthermore, the ratio of ALV to CC (%ALV = ALV/CC × 100) was calculated.

Results

The ALV in Groups I and II was 1018 ± 333.4 and 2573 ± 168.0 mL, respectively, with a significant difference between the groups (p = 0.0011). The %ALV was significantly lower in Group I (34.6 % ± 8.88 %) than in Group II (81.3 % ± 1.39 %) (p < 0.0001). A strong negative correlation was observed between infusion volume and %ALV in all cases, with a correlation coefficient of −0.7743 (p < 0.0001).

Conclusion

Our findings suggest that, in cases of fatal hypothermia, the %ALV in postmortem lung CT decreases when resuscitation with a large volume of infusion is administered as part of resuscitation after cardiopulmonary arrest.

目的本研究的目的是调查和评估致命性低体温患者在心肺复苏（CPR）输注后死后肺部计算机断层扫描（CT）成像的变化。材料与方法2020年1月至2024年12月，选取我院65例经死后CT成像及法医尸检的致死性低温死亡病例，其中29例死后间隔小于48 h。死亡前接受静脉复苏的11例为第一组，未接受静脉输液的18例为第二组。在这些病例的死后胸部CT扫描中，测量了除纵隔外的胸腔（CC）和通气肺体积（ALV）。计算ALV与CC的比值（%ALV = ALV/CC × 100）。结果I、II组ALV分别为1018±333.4、2573±168.0 mL，两组间差异有统计学意义（p = 0.0011）。I组ALV（34.6%±8.88%）明显低于II组（81.3%±1.39%）（p < 0.0001）。在所有病例中，输注量与%ALV呈强负相关，相关系数为- 0.7743 （p < 0.0001）。结论在致死性低体温的病例中，在心肺骤停后进行大量输液复苏时，死后肺部CT显示的%ALV降低。

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引用次数: 0

Mucoid extracellular matrix accumulation as a histopathological marker of aortic fragility: Two autopsy cases and a literature review 黏液细胞外基质堆积作为主动脉易碎性的组织病理学标志：两个尸检病例和文献综述。

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-01-10 DOI: 10.1016/j.legalmed.2026.102779

Marida Imbriani , Damiano Marchesini , Gianluca N. Piras , Monica La Greca , Anna Claudia Caruso , Anna Maria Manta , Benedetta Baldari

Medial degeneration of the aortic wall represents a critical substrate for the development of acute aortic syndromes, particularly dissection, in both clinically healthy individuals and those with known cardiovascular disease or syndromic features. Among these alterations, Mucoid Extracellular Matrix Accumulation (MEMA) has emerged as a key histopathological marker of aortic fragility, with implications not only for clinical practice but also for forensic investigations of sudden and unexpected deaths. This study presents two autopsy case reports of 41-year-old and 44-year-old individuals who died from acute aortic dissection with no prior evidence of cardiovascular disease or other macroscopic findings that could explain the death. Detailed histopathological examination revealed mucoid extracellular matrix accumulation and associated medial changes; in one case, acute cocaine intoxication was identified as a plausible hemodynamic trigger acting upon an intrinsically vulnerable aortic wall. Furthermore, a narrative review on MEMA and its role in medial layer alteration was conducted, allowing comparison of our findings with existing literature.

These cases highlight the forensic significance of identifying medial degenerative lesions in sudden aortic deaths. Comprehensive autopsy and histopathological assessment (hematoxylin-eosin staining) allow the recognition of MEMA and other medial alterations even in individuals without history of cardiovascular disease, support differentiation between intrinsic structural vulnerability and potential external precipitants, and contribute to a more accurate reconstruction of the mechanisms underlying unexpected aortic fatalities. Systematic evaluation of the aortic wall also improves differentiation between intrinsic aortic pathology and external triggers, contributing to scientific understanding and to forensic accuracy, and may support medico-legal evaluations of potential medical malpractice in appropriate contexts.

在临床健康个体和已知心血管疾病或综合征特征的个体中，主动脉壁内侧退变是急性主动脉综合征（特别是夹层）发展的关键基础。在这些改变中，黏液细胞外基质积累（Mucoid Extracellular Matrix Accumulation， MEMA）已成为主动脉易损的关键组织病理学标志物，不仅对临床实践有重要意义，而且对突发和意外死亡的法医调查也有重要意义。本研究报告了两例41岁和44岁的人死于急性主动脉夹层的尸检病例，没有心血管疾病的证据或其他宏观发现可以解释死亡。详细的组织病理学检查显示黏液细胞外基质积累和相关的内侧改变；在一个病例中，急性可卡因中毒被确定为一种可能的血流动力学触发因素，作用于本质上脆弱的主动脉壁。此外，我们对MEMA及其在中间层改变中的作用进行了叙述性回顾，并将我们的发现与现有文献进行了比较。这些病例强调了鉴定主动脉猝死中内侧退行性病变的法医学意义。全面的尸检和组织病理学评估（苏木精-伊红染色）允许识别MEMA和其他内侧改变，甚至在没有心血管疾病史的个体中，支持区分内在结构脆弱性和潜在的外部沉淀因素，并有助于更准确地重建意外主动脉死亡的机制。对主动脉壁的系统评估也有助于区分主动脉内部病理和外部诱因，有助于科学理解和法医准确性，并可能支持在适当情况下对潜在医疗事故的医学-法律评估。

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引用次数: 0