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Atypical suicide by single incising cut to the throat without hesitation marks: Case report and review of the literature 无犹豫痕迹的单刀割喉非典型自杀:病例报告和文献综述
IF 1.5 4区 医学 Q2 Nursing Pub Date : 2024-06-05 DOI: 10.1016/j.legalmed.2024.102468
V. Cirielli , G. Cecchetto , M. Narayanasamy , A. Eccher , S. Gobbo , M. Brunelli , N. Pigaiani

Several studies have been performed to recognize the main features in homicide and suicide sharp wound-related death, revealing that a single cutting wound to the neck is an infrequent event in suicide cases, and several hesitation marks near the fatal injury are usually present.

We report a case of an atypical self-inflicted cutthroat injury without tentative marks involving a 79-year-old female. The weapon used, a kitchen knife, was found at the crime scene. The wound had clean margins, and no other incisions were found. Scene circumstances, namely the absence of signs of a break-in, the victim found on the bed, the knife located near the body, the vital wound in an accessible site, and the absence of defense injuries, collectively support a likely suicide.

A literature review was also performed to compare forensic data of the case presented with the other 6 cases reported regarding atypical suicide characterized by a single incising cut to the throat without hesitation marks.

Given the few cases reported and the lack of gross descriptions and histopathological data available in the literature, additional knowledge of such a case may help forensic pathologists in the identification of suicidal events when a single neck injury is observed. In this frame, suicide by a unique single incising cut to the throat without hesitation marks near the lethal injury may be observed as an atypical presentation, and the crime scene investigation, together with additional background information of the deceased, aid in the identification of the manner of the death.

我们报告了一例非典型的自残割喉伤,死者是一名 79 岁的女性,她的颈部没有明显的刀痕。使用的凶器是一把菜刀,是在犯罪现场发现的。伤口边缘干净,没有发现其他切口。现场情况,即没有破门而入的迹象、受害者被发现躺在床上、刀子位于尸体附近、重要伤口位于可触及的部位以及没有防卫伤,共同支持了自杀的可能性。我们还进行了文献综述,将本案例的法医数据与其他 6 起非典型自杀案件的报告数据进行了比较,这些非典型自杀案件的特点是喉部被单刀切开,没有犹豫痕迹。鉴于报告的病例较少,且文献中缺乏大体描述和组织病理学数据,对此类病例的更多了解可能有助于法医病理学家在观察到单一颈部损伤时识别自杀事件。在这种情况下,在致命伤附近观察到独特的单一割喉自杀,且无犹豫痕迹,可能是一种非典型表现,犯罪现场调查以及死者的其他背景信息有助于确定死亡方式。
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引用次数: 0
Unexpected death in alcohol addiction requires extensive post-mortem assessment 酒精成瘾者意外死亡需要进行广泛的尸检评估
IF 1.3 4区 医学 Q2 Nursing Pub Date : 2024-06-05 DOI: 10.1016/j.legalmed.2024.102467
Josef Finsterer
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引用次数: 0
Importance of repeated computed tomography on pediatric traumatic acute posterior fossa subdural hematoma: A case study 重复计算机断层扫描对小儿外伤性急性后窝硬膜下血肿的重要性:病例研究
IF 1.5 4区 医学 Q2 Nursing Pub Date : 2024-06-04 DOI: 10.1016/j.legalmed.2024.102466
Shuheng Wen , Yohsuke Makino , Motoki Inaji , Nobutaka Arai , Kana Unuma

Traumatic acute posterior fossa subdural hematoma (PFSDH) is a rare and potentially fatal condition in which the progressed hematoma compresses the brainstem or causes secondary hydrocephalus. Hence, vigilant monitoring of clinical and radiological findings is crucial to detect the typical sudden deterioration, which can occur in the early stages. However, managing pediatric PFSDHs poses additional challenges due to risks associated with radiation exposure from repeat computed tomography (CT) examinations, potentially impeding crucial diagnostic insights. Here, we present a rare pediatric case of fatal acute traumatic PFSDH. Despite undergoing a timely initial CT scan that indicated the presence of PFSDH, the patient experienced sudden deterioration 15 h later and eventually died. No follow-up CT examinations were conducted during this critical period. This case underscores the challenges in managing pediatric PFSDHs, particularly concerning the benefits of repeated CT examinations in initially stable patients.

外伤性急性后窝硬膜下血肿(PFSDH)是一种罕见且可能致命的疾病,血肿进展会压迫脑干或导致继发性脑积水。因此,对临床和放射学检查结果进行警惕性监测对于发现早期典型的突然恶化至关重要。然而,由于重复计算机断层扫描(CT)检查带来的辐射风险,小儿 PFSDH 的治疗面临更多挑战,可能会阻碍重要的诊断见解。在此,我们介绍了一例罕见的儿科致命性急性创伤性 PFSDH 病例。尽管患者及时接受了首次 CT 扫描,结果显示存在 PFSDH,但 15 小时后病情突然恶化,最终死亡。在这一关键时期没有进行后续 CT 检查。该病例凸显了处理小儿 PFSDH 所面临的挑战,尤其是在最初病情稳定的患者中重复 CT 检查的益处。
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引用次数: 0
Traumatic axonal injury: Clinic, forensic and biomechanics perspectives 创伤性轴索损伤:临床、法医和生物力学视角
IF 1.5 4区 医学 Q2 Nursing Pub Date : 2024-06-02 DOI: 10.1016/j.legalmed.2024.102465
Clémence Delteil , Thais Manlius , Nicolas Bailly , Yves Godio-Raboutet , Marie-Dominique Piercecchi-Marti , Lucile Tuchtan , Jean-Francois Hak , Lionel Velly , Pierre Simeone , Lionel Thollon

Identification of Traumatic axonal injury (TAI) is critical in clinical practice, particularly in terms of long-term prognosis, but also for medico-legal issues, to verify whether the death or the after-effects were attributable to trauma. Multidisciplinary approaches are an undeniable asset when it comes to solving these problems. The aim of this work is therefore to list the different techniques needed to identify axonal lesions and to understand the lesion mechanisms involved in their formation. Imaging can be used to assess the consequences of trauma, to identify indirect signs of TAI, to explain the patient’s initial symptoms and even to assess the patient’s prognosis. Three-dimensional reconstructions of the skull can highlight fractures suggestive of trauma. Microscopic and immunohistochemical techniques are currently considered as the most reliable tools for the early identification of TAI following trauma. Finite element models use mechanical equations to predict biomechanical parameters, such as tissue stresses and strains in the brain, when subjected to external forces, such as violent impacts to the head. These parameters, which are difficult to measure experimentally, are then used to predict the risk of injury. The integration of imaging data with finite element models allows researchers to create realistic and personalized computational models by incorporating actual geometry and properties obtained from imaging techniques. The personalization of these models makes their forensic approach particularly interesting.

创伤性轴索损伤(TAI)的鉴定在临床实践中至关重要,特别是在长期预后方面,同时也涉及到医学法律问题,需要核实死亡或后遗症是否归因于创伤。在解决这些问题时,多学科方法是一种不可否认的资产。因此,这项工作的目的是列出识别轴索病变所需的不同技术,并了解其形成的病变机制。影像学可用于评估创伤的后果、识别 TAI 的间接征象、解释病人的初期症状,甚至评估病人的预后。颅骨的三维重建可以突出显示骨折提示的外伤。显微镜和免疫组化技术目前被认为是早期识别外伤后颅内损伤的最可靠工具。有限元模型使用机械方程来预测生物力学参数,如大脑在受到外力(如头部受到猛烈撞击)时的组织应力和应变。这些参数难以通过实验测量,因此可用于预测受伤风险。通过将成像数据与有限元模型相结合,研究人员可以结合从成像技术中获得的实际几何形状和属性,创建逼真的个性化计算模型。这些模型的个性化使其法医方法特别有趣。
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引用次数: 0
Suicidal decapitation by hanging: A systematic review of the literature and comparison with case reports 上吊斩首自杀:文献系统回顾及与病例报告的比较
IF 1.5 4区 医学 Q2 Nursing Pub Date : 2024-06-01 DOI: 10.1016/j.legalmed.2024.102464
Luca Tomassini , Cristiana Gambelunghe , Piergiorgio Fedeli , Roberto Scendoni , Anna Claudia Caruso , Eleonora Mezzetti , Anna Maria Manta , Massimo Lancia

Introduction

Suicidal hanging resulting in decapitation is rarely documented. This discussion involves a case of a 35-year-old man found decapitated in his residence's garden. A systematic literature review on hanging-induced decapitation was conducted to comprehensively investigate and compare the case to existing literature. The study aims to identify frequently described post-mortem findings in cases of suicidal hanging leading to decapitation.

Case report

A 35-year-old man was found decapitated in his garden, with a jute strap and chimney debris nearby. The cervical region was completely severed along the dorsoventral and craniocaudal plane, exposing internal structures. A ligature mark was present, along with Amussat’s sign and Simon’s bleeding.

Methods

The systematic review of the literature followed PRISMA standards, analyzing 3622 publications from Google Scholar, PubMed, and Scopus databases up to 2023. Inclusion criteria comprised cases of complete or incomplete decapitation resulting from hanging, available in full-text and written in English.

Results

16 articles on hanging-induced decapitation met the selection criteria; 22 cases were analyzed. Studies, mostly from Europe, showed a mean victim age of 44.3, all male. Fall height ranged from 1 m to 18 m, with various suspension media. Most cases displayed complete decapitation, primarily between cervical vertebrae C1 and C3. Some cases noted collateral findings.

Conclusions

Complete crime scene investigation and thorough post-mortem examination are crucial for reconstructing events, especially with confounding elements. Precise evidence collection and literature comparison are essential to understand the case and substantiate the forensic pathologist's hypothesis in court.

导言:自杀性上吊导致斩首的案例很少见。本讨论涉及一例在自家花园发现的斩首的 35 岁男子。为了全面调查该病例并将其与现有文献进行比较,我们对有关上吊导致斩首的文献进行了系统回顾。病例报告一名 35 岁的男子被发现在自家花园中被斩首,附近有一根黄麻带和烟囱碎片。颈部沿背腹面和颅尾面被完全切断,露出内部结构。方法系统性文献综述遵循 PRISMA 标准,分析了截至 2023 年谷歌学术、PubMed 和 Scopus 数据库中的 3622 篇文献。纳入标准包括绞刑导致的完全或不完全斩首病例,以全文形式提供,用英语撰写。研究结果显示,受害者平均年龄为 44.3 岁,均为男性。坠落高度从 1 米到 18 米不等,悬挂介质多种多样。大多数病例显示完全断头,主要发生在颈椎 C1 和 C3 之间。结论完整的犯罪现场调查和彻底的尸检对于重建事件至关重要,尤其是在存在干扰因素的情况下。精确的证据收集和文献对比对于理解案件和在法庭上证实法医病理学家的假设至关重要。
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引用次数: 0
Construction of 13-locus X-STR multiplex PCR system that reinforces Argus X-12 kit discrimination capacity: Application to the Malay population 构建可增强 Argus X-12 试剂盒鉴别能力的 13 个位点 X-STR 多重 PCR 系统:在马来人口中的应用。
IF 1.5 4区 医学 Q2 Nursing Pub Date : 2024-05-27 DOI: 10.1016/j.legalmed.2024.102463
Kiyoshi Minaguchi , Michinaga Samejima , Phrabhakaran Nambiar , Yu Kaneko , Eriko Ochiai , Yu Kakimoto , Motoki Osawa

Closely linked groups of markers on the X chromosome are very useful for testing complex kinship relationships involving X-STR transmission. The Argus X-12 kit, a unique commercially available kit, can obtain haplotypes of 4 linkage groups (LGs) consisting of 3 markers. Although many population data have been reported for forensic purposes, differences in discrimination ability exist between LG1 and LG2, 3, and 4 in East Asian populations, and the data of this kit would become more useful if the discrimination ability of the latter groups were increased. Therefore, for matches found using this kit for some linkage group data, then to increase the identification ability, we additionally introduced 13 X-STR loci and established a method allowing comparison using data from 25 loci. The 13X-STRs add two locus data to each of LG2, 3, and 4, and also add two closely linked group (CLG) data between LG2 and 3 and LG3 and 4 in one multiplex PCR. Assessment of this method for a Malay population for which data by Argus X-12 had already been reported showed that the frequencies of distinct haplotypes in LG2, 3, and 4 were increased by 33.0–42.6 %, and frequencies of unique haplotypes increased by 45.4–59.2 %. The respective haplotype diversity values of the additional 3-locus and 4-locus CLGs were 0.9838 and 0.9939, which helps to improve discriminatory power and to predict recombination locations on the X chromosome. Although we have been testing these loci with Japanese subjects, this system would also be useful for the Malay population.

X 染色体上紧密相连的标记群对于检测涉及 X-STR 传播的复杂亲缘关系非常有用。Argus X-12 试剂盒是一种独特的市售试剂盒,可获得由 3 个标记组成的 4 个连锁群(LG)的单倍型。虽然已有许多用于法医目的的人群数据报告,但在东亚人群中,LG1 与 LG2、3 和 4 的分辨能力存在差异,如果提高后几组的分辨能力,该试剂盒的数据将更加有用。因此,对于使用本试剂盒找到的某些连接组数据的匹配结果,为了提高识别能力,我们额外引入了 13 个 X-STR 位点,并建立了一种可以使用 25 个位点数据进行比较的方法。13 个 X-STR 位点为 LG2、3 和 4 各增加了两个位点数据,还在一次多重 PCR 中为 LG2 和 3 以及 LG3 和 4 之间增加了两个密切相关群(CLG)数据。该方法对一个马来种群的评估显示,LG2、3 和 4 中不同单倍型的频率增加了 33.0-42.6%,独特单倍型的频率增加了 45.4-59.2%。新增的 3 个基因座和 4 个基因座 CLG 的单倍型多样性值分别为 0.9838 和 0.9939,这有助于提高鉴别力和预测 X 染色体上的重组位置。虽然我们是在日本受试者中测试这些位点,但这一系统对马来人群也很有用。
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引用次数: 0
The relevance of taurodontism in forensic dental age estimation 牙槽骨在法医牙科年龄估计中的相关性
IF 1.5 4区 医学 Q2 Nursing Pub Date : 2024-05-27 DOI: 10.1016/j.legalmed.2024.102462
Maximilian Timme , Chané Smit , Liam Robinson , Herman Bernitz , Yu-Cheng Guo , Andreas Schmeling

Taurodontism is a dental morphological anomaly characterized by enlarged pulp cavities repositioned towards the apical region of the tooth, coupled with shortened root structures. Molars are commonly affected by this alteration. Certain populations exhibit up to 48% prevalences for this dental alteration, underscoring its significance in dental age estimation (DAE). In the field of DAE, an individual’s chronological age is inferred from specific dental features, frequently employed within the forensic context.

The effect of taurodontism on the features of DAE is an unanswered issue. The influence of taurodontism on eruption, mineralization, radiographic visibility of root canals, and radiographic visibility of the periodontal ligament space in mandibular third molars- some of the established criteria for DAE as examples-is currently not systematically examined.

Some common staging scales for the dental features of DAE cannot technically be applied to taurodontic teeth.

Additionally, given the association of taurodontism with syndromes affecting tooth development, caution is warranted in age assessment procedures.

Notably, taurodontic teeth may serve as indicators of syndromes influencing skeletal development, further emphasizing the relevance of taurodontism in forensic age assessment.

Presumably taurodontic teeth were included in reference data to some extent due to their partially high prevalence in the past, whereby the influence of taurodontism has been statistically absorbed within the overall spread of the features. Future studies should compare the temporal course of these tooth characteristics in affected and unaffected teeth.

Subsequent initiatives should focus on raising awareness among forensic dentists regarding taurodontism, necessitating in-depth exploration of the subject.

牙髓腔扩大症是一种牙齿形态异常,其特点是牙髓腔扩大,位置向牙根尖方向移动,同时牙根结构缩短。这种改变通常影响到磨牙。在某些人群中,这种牙齿畸形的发生率高达 48%,突出了其在牙龄估计(DAE)中的重要性。在牙龄推算领域,个人的法定年龄是通过特定的牙齿特征推断出来的,在法医鉴定中经常使用。牙槽骨发育不全对下颌第三磨牙的萌出、矿化、根管的影像学可见度和牙周韧带间隙的影像学可见度的影响--这些都是DAE的既定标准--目前尚未得到系统的研究。值得注意的是,牙槽骨可能是影响骨骼发育的综合征的指标,这进一步强调了牙槽骨在法医年龄评估中的相关性。牙槽骨被纳入参考数据在一定程度上可能是由于其在过去的部分高流行率,即牙槽骨的影响已在统计上被吸收到特征的整体分布中。今后的研究应比较受影响牙齿和未受影响牙齿的这些牙齿特征的时间进程。随后的举措应侧重于提高法医牙科医生对牙槽骨的认识,这就需要对该主题进行深入探讨。
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引用次数: 0
Investigating the pathogenesis of vitreous in postmortem COVID patients via untargeted metabolomics based bioinformatics model 通过基于非靶向代谢组学的bıoınformatıcs模型研究尸检COVID患者玻璃体的发病机制
IF 1.5 4区 医学 Q2 Nursing Pub Date : 2024-05-16 DOI: 10.1016/j.legalmed.2024.102461
Elif Kesmen , Ahmet Nezih Kök , Orhan Ateş , Onur Şenol

SARS-CoV-2 virus has become a worldwide pandemic causing millions of death. This severe disaster lead to a immense panic and stress all over the world. Several studies were dedicated to understand its mechanism, pathogenesis and spreading characteristics. By this way, scientists try to develop different therapy and diagnose strategies. For these reasons, several metabolomics, proteomics and genomics studies were also carried out to improve knowledge in this newly identified virus. In this study, we are aimed to explain the pathogenesis of SARS-CoV-2 exposure on postmortem COVID (+) patients via untargeted metabolomics analysis. To carry out this study, a Data Independent Acquisition SWATH method is optimized and performed. Vitreous samples were analyzed in both MS1 and MS2 ESI(+) mode. An orthogonal Partial Least Square Discriminant Analysis were performed for classification. It was observed that lipid metabolism, several amino acids and oxidative stress biomarkers were strongly affected due to high inflammation and possible cytokine storm.

SARS-CoV-2 病毒已成为导致数百万人死亡的全球性流行病。这场严重的灾难在全世界引发了巨大的恐慌和压力。多项研究致力于了解其机制、发病机理和传播特点。通过这种方式,科学家们试图开发出不同的治疗和诊断策略。为此,科学家们还开展了多项代谢组学、蛋白质组学和基因组学研究,以增进对这种新发现病毒的了解。本研究旨在通过非靶向代谢组学分析,解释 COVID(+)患者死后接触 SARS-CoV-2 的发病机制。为了开展这项研究,我们优化并实施了数据独立采集 SWATH 方法。玻璃体样本在 MS1 和 MS2 ESI(+) 模式下进行分析。采用正交偏最小平方判别分析进行分类。结果表明,由于高度炎症和可能的细胞因子风暴,脂质代谢、几种氨基酸和氧化应激生物标志物受到强烈影响。
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引用次数: 0
N-acetylcysteine alleviates arsenic trioxide-induced reductions in hepatic catalase gene expression both in vitro and in vivo N- 乙酰半胱氨酸可减轻三氧化二砷诱导的肝脏过氧化氢酶基因表达的体外和体内减少
IF 1.5 4区 医学 Q2 Nursing Pub Date : 2024-05-11 DOI: 10.1016/j.legalmed.2024.102458
Shutaro Nagano , Kana Unuma , Toshihiko Aki , Koichi Uemura

Arsenic trioxide (ATO), one of the oldest and most frequently used poisons, is well-known in forensic science for inducing hepatotoxicity. The regulation of peroxisomal antioxidative enzyme catalase (CAT) involves intricate mechanisms at both transcriptional and post-transcriptional levels. However, the molecular mechanisms underlying the regulation of CAT gene expression in hepatic cells remain elusive. Furthermore, the regulation of CAT gene expression evident in animals administered with ATO in vivo is not well-explored, although several studies have revealed ATO-induced reductions in CAT enzymatic activity in rat livers. In this study, we revealed ATO-dependent reductions in CAT gene expression in both rat liver and Huh-7 human hepatoma cells. Our results indicate that the decline in CAT enzymatic activity can be attributed, at least in part, to the downregulation of its gene expression. The ATO-induced reduction in CAT expression was concurrent with the reduction in peroxisome proliferator-activated receptor-gamma (PPARγ) coactivator (PGC)-1α and inactivation of PPARγ, both considered as positive regulators of CAT gene expression. Moreover, antioxidant N-acetylcysteine (NAC) demonstrated the capability to alleviate the downregulation of CAT gene expression both in vivo and in vitro. Additionally, NAC played a role in alleviating ATO-induced hepatotoxicity, potentially by mitigating the transcriptional downregulation of the CAT gene. Altogether, these results indicate that ATO exerts toxicity by inhibiting the antioxidant defense mechanism, which may be useful for forensic diagnosis of arsenic poisoning and clinical treatment of mitigating ATO-induced hepatotoxicity.

三氧化二砷(ATO)是最古老、最常用的毒药之一,在法医学中以诱发肝中毒而闻名。过氧物酶体抗氧化酶过氧化氢酶(CAT)的调控涉及转录和转录后水平的复杂机制。然而,肝细胞中 CAT 基因表达调控的分子机制仍然难以捉摸。此外,虽然有几项研究显示 ATO 会降低大鼠肝脏中 CAT 酶的活性,但在体内使用 ATO 的动物中,CAT 基因表达的明显调控机制还没有得到很好的探讨。在本研究中,我们揭示了大鼠肝脏和 Huh-7 人类肝癌细胞中 CAT 基因表达的 ATO 依赖性降低。我们的研究结果表明,CAT 酶活性的下降至少部分归因于其基因表达的下调。ATO 诱导的 CAT 表达减少与过氧化物酶体增殖激活受体-γ(PPARγ)辅激活剂(PGC)-1α 的减少和 PPARγ 的失活同时发生,而这两者都被认为是 CAT 基因表达的正向调节因子。此外,抗氧化剂 N-乙酰半胱氨酸(NAC)在体内和体外都显示出缓解 CAT 基因表达下调的能力。此外,NAC 在减轻 ATO 引起的肝毒性方面也发挥了作用,这可能是通过减轻 CAT 基因的转录下调实现的。总之,这些结果表明 ATO 通过抑制抗氧化防御机制而产生毒性,这可能有助于砷中毒的法医诊断和减轻 ATO 引起的肝毒性的临床治疗。
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引用次数: 0
Boar hunt or Manhunt? fatality during a wild boar hunting expedition. Need for a multidisciplinary forensic approach 野猪狩猎还是追捕?采用多学科法医方法的必要性
IF 1.5 4区 医学 Q2 Nursing Pub Date : 2024-05-11 DOI: 10.1016/j.legalmed.2024.102459
Naomi Iacoponi , Valentina Bugelli , Rosario Fico , Claudia Giaconi , Rita Lorenzini , Paride Minervini , Marco Di Paolo

Hunting is commonly regarded as a prevalent leisure activity in many Western countries. Moreover, hunting-related shooting injuries and fatalities are an important issue in the forensic world. However, there is limited research investigating the necessity of a multidisciplinary approach to provide a thorough analysis of these deaths. Being able to distinguish between homicide and accidental death is crucial in hunting-related incidents. In cases of hunting incidents, it also becomes essential to identify the shooter among the participants of the hunting expedition. The authors report a case of death occurred during a wild boar hunting expedition. The autopsy revealed a penetrating gunshot wound that tore the internal iliac artery and caused massive blood loss. A careful and detailed examination of the events leading up to the hunter's death revealed that the bullet first hit a wild boar and then, due to the deflection of the bullet on the animal's humerus, the victim. These deductions represent the culmination of an exhaustive forensic investigation led by experts in multiple scientific and forensic disciplines.

在许多西方国家,狩猎通常被视为一种普遍的休闲活动。此外,与狩猎相关的枪击伤亡事故也是法医学领域的一个重要问题。然而,对采用多学科方法对这些死亡进行彻底分析的必要性进行调查的研究却很有限。在与狩猎有关的事件中,能够区分他杀和意外死亡至关重要。在狩猎事件中,确定狩猎参与者中的枪手也变得至关重要。作者报告了一起在野猪狩猎过程中发生的死亡案例。尸检结果显示,枪伤为穿透性枪伤,撕裂了髂内动脉,造成大量失血。对导致该猎人死亡的事件进行认真细致的检查后发现,子弹首先击中了一头野猪,然后由于子弹在野猪肱骨上的偏转,击中了受害者。这些推断是由多个科学和法医学科的专家领导的详尽法医调查的最终结果。
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引用次数: 0
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