Legal MedicinePub Date : 2024-09-23DOI: 10.1016/j.legalmed.2024.102530
L. Geoffray , L. Tuchtan , M-D. Piercecchi-Marti , C. Delteil
{"title":"Post-mortem transmission risk of infectious disease: A systematic review","authors":"L. Geoffray , L. Tuchtan , M-D. Piercecchi-Marti , C. Delteil","doi":"10.1016/j.legalmed.2024.102530","DOIUrl":"10.1016/j.legalmed.2024.102530","url":null,"abstract":"<div><h3>Introduction</h3><div>Autopsies may expose to infectious risks. The objective of this study is to assess the risk of <em>post-mortem</em> transmission of HIV, HBV, HCV, <em>Mycobacterium tuberculosis</em> (MBT), SARS-CoV2 and prion in the workplace and to estimate the duration of their infectiousness.</div></div><div><h3>Material and method</h3><div>the PRISMA 2020 guideline was used. Pubmed, Web of Science, Google Scholar and Sciencedirect databases were assessed until February 28, 2023. We searched for articles in any language and any date of publication. Studies involving animals, transmission between two living people or transmission outside the workplace were excluded. Risk of bias was assessed using the appropriate assessment tools for each type of study. A descriptive analysis was performed.</div></div><div><h3>Results</h3><div>A total of 46 studies were included. Cases of <em>post-mortem</em> transmission were certain for HIV (n = 1) and MBT (n = 18). The longest <em>post-mortem</em> interval for positive diagnostic tests was 17 days for HIV, 60 for HBV, 7 for HCV, 36 for MBT and 17 for SARS-CoV2. The longest <em>post-mortem</em> interval for positive cultures was 21 h for HIV, 6 days for HBV, 36 days for MBT, 17 days for SARS-CoV2. The methodology of the studies was heterogeneous, some of them associated with a high risk of bias.</div></div><div><h3>Conclusion</h3><div>There is a lack of consistent data in the literature concerning the infectivity of cadavers, except for MBT. Legislation appears to be based on minimizing contact between the biological agent and the professional. In the absence of recent robust scientific data, workers should systematically follow the best practice recommendations.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"71 ","pages":"Article 102530"},"PeriodicalIF":1.3,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Legal MedicinePub Date : 2024-09-14DOI: 10.1016/j.legalmed.2024.102529
Sang-Seob Lee , Akiko Kumagai
{"title":"Comparison of the accuracy and bias of Demirjian’s method for East Asian children and development of Japanese population-specific age estimation formulae","authors":"Sang-Seob Lee , Akiko Kumagai","doi":"10.1016/j.legalmed.2024.102529","DOIUrl":"10.1016/j.legalmed.2024.102529","url":null,"abstract":"<div><p>Despite the increased global mobility owing to the development of the international community, there remains a need for population-specific methods to estimate children’s ages. Therefore, this study aimed to substantiate the necessity for a Japanese-specific age estimation method by contrasting the formerly reported age estimation accuracy and bias using Demirjian’s method for Chinese, Taiwanese, South Korean, and Japanese children. We analyzed 1,558 panoramic radiographs from Japanese children (777 boys and 781 girls), assessed the maturity of seven left permanent teeth using Demirjian’s criteria, and calculated the estimated age using Demirjian’s method. The accuracy of the estimated ages was compared with previous reports of children from other East Asian countries which used the same age estimation method. Chinese, Taiwanese, and South Korean boys and girls were all reported to be older than their chronological ages, with the Eastern and Northern Chinese regions being the only exceptions. The same was true for Japanese children: the estimated ages of both sexes tended to be higher than their chronological age. However, there were significant variations in the values, indicating the differences in tooth growth and development between East Asian countries and sexes. Therefore, new regression equations specific to the Japanese population were formulated, and their accuracy was evaluated as the final result of this study.</p></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"71 ","pages":"Article 102529"},"PeriodicalIF":1.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142240531","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}
Legal MedicinePub Date : 2024-09-12DOI: 10.1016/j.legalmed.2024.102526
André Salgado , Daniel Wdowicz , Fábio Fernandes , Mariusz Ptak , Ricardo Alves de Sousa
{"title":"Assessing head injury risks in electric scooter accidents: A multi-body simulation study with insights into sex differences","authors":"André Salgado , Daniel Wdowicz , Fábio Fernandes , Mariusz Ptak , Ricardo Alves de Sousa","doi":"10.1016/j.legalmed.2024.102526","DOIUrl":"10.1016/j.legalmed.2024.102526","url":null,"abstract":"<div><p>E-scooters have become increasingly popular for short-distance travel in urban areas, but this rise in usage also brings about an increased risk of accidents. Studies have shown that approximately 40% of electric scooter accident victims admitted to hospitals suffer head injuries. Therefore, it is crucial to implement safety measures and improve safety systems and equipment to mitigate these risks. One approach to gaining insights into the injuries users face is through simulations using the multi-body method. This method allows for the reconstruction of accidents by modeling and analyzing the dynamic behavior of interconnected bodies. This study aims to assess the impacts on the user’s head and the injuries they may sustain in electric scooter accidents using numerical methods. Initially, a reference scenario was established based on a YouTube video, with the assumption that the user was an average-height man. Simulations were conducted for various percentiles, including both males and females. Different velocities were simulated to determine the threshold velocity at which survival becomes practically impossible. Two scenarios were considered: one where the car braked for 0.333 s and another where the distance between the start the braking task and the collision was kept constant. The location of the first head impact on the vehicle was also examined. Injury assessment was conducted using two criteria: Head Injury Criterion (HIC) and Brain Injury Criterion (BrIC). The study found that smaller individuals are more vulnerable to severe injuries, and higher car velocities correlate with more severe user injuries. Furthermore, the location of the first impact varies between genders, with women more likely to experience impacts in the lower part of the windshield, while men tend to experience impacts in the central zone. This study highlights the importance of considering user characteristics and accident dynamics in assessing injury risks associated with e-scooters.</p></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"71 ","pages":"Article 102526"},"PeriodicalIF":1.3,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1344622324001366/pdfft?md5=8a66206314c6d1558a66b7fb8935ccf5&pid=1-s2.0-S1344622324001366-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142240530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Legal MedicinePub Date : 2024-09-06DOI: 10.1016/j.legalmed.2024.102528
Juho-Antti Junno , Mikael Brix , Eveliina Lammentausta , Timo Liimatainen , Alina Junno , Juha Kiljunen , Jaakko Niinimäki , Petteri Oura
{"title":"Expanding bullets and ballistic gelatin – A restricted expansion experiment","authors":"Juho-Antti Junno , Mikael Brix , Eveliina Lammentausta , Timo Liimatainen , Alina Junno , Juha Kiljunen , Jaakko Niinimäki , Petteri Oura","doi":"10.1016/j.legalmed.2024.102528","DOIUrl":"10.1016/j.legalmed.2024.102528","url":null,"abstract":"<div><p>Ballistic gelatin has gained a status as standard method for terminal ballistic testing and experimenting. Variation considering the recipe and manufacturing of the blocks exists. The golden standard has been a cuboid gelatin block, dimensions varying according to the type and kinetic energy of the ammunition.</p><p>Powerful ammunition requires larger gelatin blocks, making their handling and manufacturing difficult. This is the case especially with powerful, expanding hunting ammunition that leave most of their kinetic energy within the gelatin block. High speed cameras reveal that blocks tend to expand or swell significantly and even travel upon impact, potentially affecting to some basic values of terminal ballistics such as cavitation and energy transfer.</p><p>In this study, we wanted to experiment new method to study terminal ballistics of high power, expanding ammunition by using cylinder shaped gelatin blocks. Secondly, we used a plastic tube around the gelatin cylinder to restrict the expansion/swelling. Thirdly we attached our gelatin target to a sturdy platform to restrict the movement of the cylinder and potentially improve the energy transfer of the bullet into the gelatin.</p><p>To conduct our study we compared our experimental setting with a traditional, cuboid gelatin block. After the test firing the blocks underwent computed tomography scanning with clinical equipment. Three-dimensional reconstructions of gelatin cavitation and bullet fragment deposition were created.</p><p>Our results clearly demonstrate that the restricted expansion of the block also clearly restricts the cavitation inside the gelatin. We believe that the method can be further developed, and it allows better potential for ballistic testing of heavy ammunition. In addition, it may aid in terminal ballistic reconstruction of forensic cases with gunshot trauma in anatomical structures fully enclosed by connective tissue such as brain and structures of the thorax.</p></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"71 ","pages":"Article 102528"},"PeriodicalIF":1.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S134462232400138X/pdfft?md5=898a4c4f324e2fc35c46a4a6f9649af4&pid=1-s2.0-S134462232400138X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fatal acute lemborexant Poisoning: An autopsy case report","authors":"Gentaro Yamasaki , Yasuhiro Ueno , Motonori Takahashi , Takeshi Kondo","doi":"10.1016/j.legalmed.2024.102527","DOIUrl":"10.1016/j.legalmed.2024.102527","url":null,"abstract":"<div><p>A 50-year-old male was found dead in a park. Postmortem analysis using liquid chromatography-tandem mass spectrometry revealed lemborexant concentrations of 1.651 μg/mL in blood from the right heart, 0.236 μg/mL in the urine, and 58.642 μg/mL in the stomach contents. Based on the autopsy findings and postmortem analyses, the cause of death was identified as acute lemborexant poisoning due to an overdose. Although lemborexant is generally considered safe, its excessive ingestion can be fatal. Since no lethal concentration of lemborexant has been reported, the blood levels in this case can serve as a reference. Despite its widespread clinical use, lemborexant is not detected by the rapid urine drug screening tests currently available in Japanese investigative agencies. Forensic pathologists must be vigilant in order not to overlook acute lemborexant poisoning.</p></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"71 ","pages":"Article 102527"},"PeriodicalIF":1.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157612","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}
Legal MedicinePub Date : 2024-09-03DOI: 10.1016/j.legalmed.2024.102525
Sima Beigoli , Ali Asghar Hajizadeh , Mohammad Ehsan Taghavizadeh Yazdi , Hossin Zarei , Farzaneh Vafaee , Mohammad Hossein Boskabady
{"title":"The brain and systemic oxidative stress and memory changes induced by inhaled paraquat in rat improved by Crocus sativus","authors":"Sima Beigoli , Ali Asghar Hajizadeh , Mohammad Ehsan Taghavizadeh Yazdi , Hossin Zarei , Farzaneh Vafaee , Mohammad Hossein Boskabady","doi":"10.1016/j.legalmed.2024.102525","DOIUrl":"10.1016/j.legalmed.2024.102525","url":null,"abstract":"<div><p>The present study aimed to investigate the effect of <em>Crocus sativus</em> (Cs) on paraquat (PQ)-induced learning and memory deficits as well as brain and lung oxidative stress and systemic inflammation, and oxidative stress in rats.</p><p>Rats were exposed to saline (Ctrl) or PQ (PQ groups) aerosols. PQ groups were treated with 0.03 mg/kg/day dexamethasone (Dexa), 20 and 80 mg/kg/day Cs-L and Cs-H, 5 mg/kg/day pioglitazone (Pio), and Cs-L+Pio for 16 days during PQ exposure period. Learning and memory abilities were assessed by Morris water maze (MWM) and passive avoidance tests.</p><p>PQ group showed increased numbers of total and differential WBCs in blood, and increased malondialdehyde (MDA), in the serum, brain, and lung but reduced thiol, catalase (CAT), and superoxide dismutase (SOD) levels compared to the control group (for all, p < 0.001). The escape latency and traveled distance were increased in the PQ group. However, the time spent in the target quadrant in the MWM test and the latency to enter the dark room were reduced after receiving an electrical shock (p < 0.05 to P<0.001). In all treated groups, measured values were improved compared to PQ group (p < 0.05 to p < 0.001). The combination of Cs-L+Pio showed more pronounced effects compared to either treatment alone (p < 0.05 to p < 0.001).</p><p>These findings suggest that Cs has neuroprotective properties and may be beneficial in the treatment of neurodegenerative diseases induced by noxious agents such as PQ.</p></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"71 ","pages":"Article 102525"},"PeriodicalIF":1.3,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146692","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}
Legal MedicinePub Date : 2024-09-01DOI: 10.1016/j.legalmed.2024.102524
Jie Zhang , Rongshuai Wang , Guoqiang Qu , Jinghong Ma , Yunyun Wang , Dongchen Zhang , Xiaowei Zhou , Liang Liu
{"title":"Acute fatal chromium toxicity: A case report of electroplating water ingestion","authors":"Jie Zhang , Rongshuai Wang , Guoqiang Qu , Jinghong Ma , Yunyun Wang , Dongchen Zhang , Xiaowei Zhou , Liang Liu","doi":"10.1016/j.legalmed.2024.102524","DOIUrl":"10.1016/j.legalmed.2024.102524","url":null,"abstract":"<div><div>Heavy metals, including chromium, are extensively employed in industrial processes, leading to human poisoning and environmental contamination. Chronic exposure to chromium commonly occurs through skin contact and inhalation of airborne particles. The bioaccumulation of chromium can result in toxicity and harm to various biological systems. However, it is quite rare to come across reports of acute fatal cases resulting from oral ingestion of chromium.</div><div>Here we report a case of the accidental ingestion of electroplating water containing chromium by the female worker resulted in multiple organ failure and ultimately died. The initial symptoms of nausea and abdominal pain are consistent with chromium toxicity. The sequential impairment of various organ systems, starting with the kidneys and progressing damage to the liver, digestive system, cardiovascular system, and immune system, indicates the widespread toxic effects of chromium on the body. Interestingly, the yellow-green changes observed in multiple organs during the autopsy and it have not been previously documented in the literature. The histopathological examination further confirmed the extensive damage. Toxicological analysis substantiated the presence of chromium in various body fluids and organs, both qualitatively and quantitatively. This confirms the absorption and distribution of chromium throughout the body following oral ingestion. These findings highlight the acute and severe toxic effects of orally ingested chromium, leading to fatal consequences in this case.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"71 ","pages":"Article 102524"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407111","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}
Legal MedicinePub Date : 2024-08-30DOI: 10.1016/j.legalmed.2024.102523
Emina Dervišević , Džan Ahmed Jesenković , Ema Avdić , Aida Bešić , Nedim Šuta , Aida Selmanagić
{"title":"The forensic significance of core temperature in identifying primary and secondary hypothermia as a cause of death: A pilot study on Wistar rats","authors":"Emina Dervišević , Džan Ahmed Jesenković , Ema Avdić , Aida Bešić , Nedim Šuta , Aida Selmanagić","doi":"10.1016/j.legalmed.2024.102523","DOIUrl":"10.1016/j.legalmed.2024.102523","url":null,"abstract":"<div><h3>Introduction</h3><p>Hypothermia is defined as a body core temperature below 35 °C and can be caused by internal or external stress. Primary hypothermia is caused by excessive exposure to low environmental temperature without any medical conditions prior to that. Secondary hypothermia is caused by alteration in thermoregulation by disease, trauma, surgery, drugs, or infections. The aim of the research is to investigate core temperature values in rats subjected to specific water temperatures at five different time points. It focuses on distinguishing between primary and secondary hypothermia in these rats.</p></div><div><h3>Methods</h3><p>The total 21 Wistar rats were divided into three experimental groups as: Control group rats exposed only to hypothermic condition (n = 7); Alcohol + hypothermia (n = 7); and Benzodiazepines + hypothermia (n = 7). The temperature spots analyzed in the study were: normal core temperature, core temperature during injection of 0,3 ketamine, temperature of immersion and the temperature at the onset of hypothermia and temperature at the time of death.</p></div><div><h3>Results</h3><p>In our study the comparative analysis of body temperatures at various time points following submersion in water revealed significant differences among the study groups treated with either alcohol or benzodiazepines and the control group. Notable differences were observed in baseline temperature, post-anesthesia induction temperature, and immediate post-submersion temperature. Specifically, significant differences were discovered among the alcohol and benzodiazepine groups (p < 0.001) and ranging from the alcohol and control groups (p < 0.001). The analysis of survival times following induced hypothermia revealed a statistically significant difference among the three experimental groups (p = 0.04), though subsequent post-hoc comparisons did not demonstrate significant differences in mean survival times.</p></div><div><h3>Conclusion</h3><p>There is a difference in survival time between primary and secondary hypothermia groups, depending on consumption and intoxication with alcohol or benzodiazepines. The analysis of survival times following induced hypothermia showed a statistically significant difference among the groups.</p></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"71 ","pages":"Article 102523"},"PeriodicalIF":1.3,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142097962","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}
{"title":"Fatal pregabalin poisoning in Japan: A case report","authors":"Kaori Shintani-Ishida, Masataka Kawamoto, Hiroki Kondo, Tomonori Onoe, Hiroshi Ikegaya","doi":"10.1016/j.legalmed.2024.102522","DOIUrl":"10.1016/j.legalmed.2024.102522","url":null,"abstract":"<div><p>Pregabalin is a new drug used for treating neuropathic pain, epilepsy, and anxiety disorders. Since 2010, the number of pregabalin prescriptions has dramatically increased in many countries. Although pregabalin has been considered to have a low potential for abuse and toxicity, fatal cases associated with pregabalin misuse or abuse have been increasing with an increased number of prescriptions. In addition, these fatalities are likely under-reported because pregabalin is commonly not part of postmortem routine drug screens. By contrast, pregabalin-related death has not yet been reported in Japan. We encountered a fatal case of pregabalin overdose. The patient has visited hospitals for benzodiazepine dependence, insomnia and anxiety disorder and has been prescribed pregabalin, flunitrazepam, and zolpidem. One day, his home caregivers, who were his constant companions to the hospitals, found him dead. Comprehensive drug screening performed in the police crime laboratory detected 7-aminoflunitrazepam and zolpidem, but not pregabalin in the cardiac blood. By contrast, we could find all drugs, including pregabalin, in our autopsy because pregabalin was a part of our routine drug screening. The pregabalin concentration was fatal at 18.5 μg/mL in the femoral blood, whereas 7-aminoflunitrazepam (0.1 μg/mL) and zolpidem (0.2 μg/mL) were lower than the fatal levels. We concluded that pregabalin played a primary role in the cause of death but not independently. This report addresses Japanese clinicians and forensic toxicologists to the risk of pregabalin poisoning, and pregabalin should be added in postmortem routine drug screening.</p></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"71 ","pages":"Article 102522"},"PeriodicalIF":1.3,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142077536","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}
{"title":"“Shock kidney-like Appearance”: Objective evaluation of renal color changes in hemorrhagic shock deaths","authors":"Shogo Shimbashi , Motoo Yoshimiya , Akiko Tashiro , Sakon Noriki , Hideki Hyodoh","doi":"10.1016/j.legalmed.2024.102521","DOIUrl":"10.1016/j.legalmed.2024.102521","url":null,"abstract":"<div><p>Severe bleeding due to various traumatic injuries can cause hemorrhagic shock, which is difficult to diagnose using forensic medicine. Therefore, we defined the difference in color between the renal cortex and medulla observed in hemorrhagic shock deaths as “shock kidney-like appearance (SKLA)” and digitally analyzed the color difference with a digital camera and color analysis software. The aim of this study was to develop and evaluate a method for objectively determining SKLA and improve the accuracy of forensic diagnosis. We examined the kidneys of 122 cases (83 males and 39 females; average age, 64.8 years) autopsied at our facility. Using Image J, we analyzed the color of the cortex and medulla from photographs of bisected kidneys. We defined the color difference between the cortex and medulla in the L*a*b* color space as cortical-medullary color difference and performed a comparative analysis between the hemorrhage and control groups. Significant differences were observed in ΔL* and Δa* values between the two groups (p < 0.05 and p < 0.001, respectively). Analysis of Δa* values showed that the cortex was less reddish than the medulla in the hemorrhage group. The cutoff value for determining SKLA was set at Δa* = −1.33 (sensitivity, 0.79; specificity, 0.81; AUC, 0.859). Traditional evaluations of color rely on subjective assessments, which raise issues of reliability and reproducibility. This study successfully overcame the limitations of subjective evaluation by objectively assessing cortical-medullary color difference in the kidneys. Our results represent an important step towards improving the objectivity of color evaluations.</p></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"71 ","pages":"Article 102521"},"PeriodicalIF":1.3,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1344622324001317/pdfft?md5=18a4678876178b794d597bea1379b1d3&pid=1-s2.0-S1344622324001317-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142077535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}