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Dephosphorylation of connexin 43 ratio in forensic autopsy cases of sudden cardiac death without coronary artery involvement: a marker of early ischemic injury in cardiomyocytes 不累及冠状动脉的心源性猝死法医尸检病例中连接蛋白43比率的去磷酸化：心肌细胞早期缺血性损伤的标志

IF 1.3 4区医学

Legal Medicine Pub Date : 2025-06-25 DOI: 10.1016/j.legalmed.2025.102664

Toshiaki Takeichi, Atsushi Yamada, Masaki Yoshida, Satoshi Takashino, Kyoka Kiryu, Osamu Kitamura

{"title":"Dephosphorylation of connexin 43 ratio in forensic autopsy cases of sudden cardiac death without coronary artery involvement: a marker of early ischemic injury in cardiomyocytes","authors":"Toshiaki Takeichi, Atsushi Yamada, Masaki Yoshida, Satoshi Takashino, Kyoka Kiryu, Osamu Kitamura","doi":"10.1016/j.legalmed.2025.102664","DOIUrl":"10.1016/j.legalmed.2025.102664","url":null,"abstract":"<div><div>Lethal arrhythmia is a common cause of sudden cardiac death. However, no identifiable histological abnormalities were found. This study aimed to clarify whether ischemia-induced changes in myocardial cells caused by a sudden decrease in coronary blood flow are observed in cases of sudden cardiac death without coronary artery involvement.</div><div>The autopsy cases included sudden cardiac death without coronary artery involvement, acute coronary syndrome, or other sudden deaths. We performed double fluorescent immunostaining for connexin 43 (Cx43) and its dephosphorylated form (npCx43) and calculated the npCx43 rate. Additionally, immunohistochemical analysis was performed on the complement system activation in cardiomyocytes using an anti-C5b-9 antibody, and mRNA expression of hypoxia-inducible factor-1 (HIF-1) was assessed.</div><div>The results showed a significant increase in npCx43 rate, whereas C5b-9 or HIF-1 mRNA expression did not significantly change. These findings suggest that the npCx43 expression rate may be a useful indicator of rapid ischemic changes induced in the myocardium of patients who die of sudden cardiac death without coronary artery involvement.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"76 ","pages":"Article 102664"},"PeriodicalIF":1.3,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501209","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}

引用次数: 0

A useful data presentation tool: Ternary plots in forensic medicine 一个有用的数据展示工具：法医学中的三元图

IF 1.3 4区医学

Legal Medicine Pub Date : 2025-06-24 DOI: 10.1016/j.legalmed.2025.102652

S. Potente, F. Ramsthaler, J.M. Federspiel

引用次数: 0

Drug-perpetrated Munchausen by proxy syndrome: When we dare and why we dare to care 毒品犯孟乔森代理综合症：我们何时敢于关心，为什么敢于关心

IF 1.3 4区医学

Legal Medicine Pub Date : 2025-06-22 DOI: 10.1016/j.legalmed.2025.102659

Pascale Basilicata, Angela Simonelli, Mariagrazia Marisei, Angela Silvestre, Rossella Guadagni, Maria Pieri

{"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}

引用次数: 0

Forensic application of micro-radiological analysis and 3D-printed vertebrae in a stab wound homicide case 显微放射学分析和3d打印椎骨在刺伤杀人案中的法医应用

IF 1.3 4区医学

Legal Medicine Pub Date : 2025-06-22 DOI: 10.1016/j.legalmed.2025.102661

Oriana Cuman , Federico Toselli , Guido Viel , Paolo Fais , Maria Sech , Chiara Giraudo , Francesco Bertelli , Vladimiro Vida , Giovanni Cecchetto

{"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}

引用次数: 0

An autopsy case of fatal lacosamide overdose 拉科沙胺过量致死的尸检案例

IF 1.3 4区医学

Legal Medicine Pub Date : 2025-06-21 DOI: 10.1016/j.legalmed.2025.102658

Yukie Yamasaki , Fumio Moriya , Kaori Taniguchi , Masanobu Miura , Kei Yoshitome , Chie Kobayashi , Satoru Miyaishi

{"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}

引用次数: 0

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 2007-2022年波兰波兹南大都市区及周边省份社会人口背景下上吊自杀中Amussat、Martin和Simon症状的流行及分析

IF 1.3 4区医学

Legal Medicine Pub Date : 2025-06-12 DOI: 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

{"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 arteryand 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}

引用次数: 0

Pattern, characterization and outcomes of blunt and penetrating cardiothoracic injuries. A medico-legal comparative study 钝性和穿透性心胸损伤的模式、特征和结果。医学与法律的比较研究

IF 1.3 4区医学

Legal Medicine Pub Date : 2025-06-08 DOI: 10.1016/j.legalmed.2025.102654

Heba Ibrahim Lashin , Nadia Ezzat Helal , Mai Mohammed Mahran , Asmaa Fady Sharif

{"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}

引用次数: 0

Necessity for further exploration of both endogenous and exogenous DNases 进一步探索内源性和外源性dna酶的必要性

IF 1.3 4区医学

Legal Medicine Pub Date : 2025-06-06 DOI: 10.1016/j.legalmed.2025.102653

Sultana Razia , Haruo Takeshita , Ken Inoue , Reiko Iida , Misuzu Ueki , Toshihiro Yasuda

{"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}

引用次数: 0

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 给药14天后，大鼠心肌心肌线粒体内和收缩带附近calpain-1和- 2表达增加：一项初步研究

IF 1.3 4区医学

Legal Medicine Pub Date : 2025-06-03 DOI: 10.1016/j.legalmed.2025.102651

Shuheng Wen, Toshihiko Aki, Kana Unuma

引用次数: 0

Determination of multiple psychostimulants and antipsychotics in postmortem dried blood spot samples by liquid chromatography–tandem mass spectrometry 液相色谱-串联质谱法测定死后干血斑样品中多种精神兴奋剂和抗精神病药物

IF 1.3 4区医学

Legal Medicine Pub Date : 2025-06-03 DOI: 10.1016/j.legalmed.2025.102650

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

{"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}

引用次数: 0