死后伤软组织出血成因分析

1案例资料 案例1某年6月7日,垃圾场作业工发现运来的垃圾中混有赤祼女尸一具。尸体检验情况：颈部数处新月形或小片状表面剥脱、皮下出血,生活反应明显,右颈部肌肉小片状出血。尸体全身广泛表皮剥脱,生活反应不明显。左右后肋多发骨折,左侧胸壁广泛出血、淤血（图1）,未见血凝块,右侧胸壁肋骨骨折处内侧局部小片状出血,外侧出血不明显（考虑原始左侧卧位）。     

家兔死后体表锐器伤出血现象的研究

目的对家兔死后体表锐器损伤出血现象进行研究,以期能够贴近实际办案需要,找到一个更为实用的鉴别生前锐器伤和死后锐器伤的方法。方法家兔脱毛,制作锐器损伤模型,采用大体观察结合HE染色镜下组织病理学观察。结果死后锐器损伤出血量均较少,随着时间延长出血量减少,出血速度慢。死后30min的锐器损伤在形成过程与生前损伤有所区别,但在死后12h肉眼观察结果与生前损伤难以区别。死后1h以上的锐器损伤与生前损伤不同之处在于创缘不会被血染。结论位于尸体低下位置的死后30min内的锐器创与生前锐器创的区别是出血量相对较少。死后60min-90min的锐器伤出血量少,创缘皮肤不被血染,肌肉的出血较局限,与生前损伤相鉴别较容易。     

生前伤与死后伤皮肤弹力纤维变化研究

采用Ｈａｒｔ氏弹力纤维染色对不同时间的皮肤生前伤和死后伤进行组织学观察研究,结果表明：生前伤和死后伤真皮中的弹力纤维在形态和分布上无任何区别,因此,在法医实践中依据真皮中弹力纤维形态变化区别生前伤与死后伤无诊断价值     

ABC法检测血小板颗粒膜蛋白鉴别生前伤与死后伤

甲抗人血小板α-颗粒膜蛋白140（GMP－140）单克隆抗体，ABC免疫组化方法鉴别生前伤与死后伤．生前皮肤切创和刺创标本创缘上见条状褐色反应带，死后皮肤切创标本创线上未见上述反应带。该法可用于检测短时期发生的生前伤与死后伤。     

生前、死后烧伤的法医学检验

火场中的尸体大多被燃烧,而判断生前还是死后烧伤,对火场命案性质的认定具有重要作用。笔者对152例火场尸体检验资料进行研究和分析,提出鉴定生前死后烧伤时需要注意的问题,供同行参考。1尸检资料性别年龄152例中男80例,女72例,男女比例为1.1∶1;年龄在8～68岁,其中20～40岁者102例占67.11%。死亡原因152例中生前烧死有109例,颅脑损伤死亡21例,大失血死亡6例,扼、勒颈部致窒息及高坠死亡各4例,有机磷中毒、自缢及电击死亡各1例,死因不明5例。损伤检验109例生前烧死的尸体上检见局部皮肤烧伤边缘组织有红肿征象的71例,其中检见有“闭眼反应”…     

3例颅前窝死后骨折的成因探讨

<正>颅前窝的骨折,以往认为有3种形成机制:(1)外力直接作用于眼部造成眶上板骨折;(2)外力直接作用于头部,造成颅骨的整体变形,颅前窝可以造成骨折;(3)外力作用于头部,由于脑组织的冲击振荡,形成颅前窝的骨折。上述方式形成骨折,多见于生前,死后形成颅前窝的骨折较少报道。本文作者曾遇3例,现报道如下,并对其形成机理进行初步探讨。     

GYPA、CD68和TNF-α蛋白鉴别水中晚期尸体生前死后伤的作用研究

目的 探讨血型糖蛋白A(Glycophorin A, GYPA)、CD68和肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)蛋白在水中晚期尸体生前伤和死后伤的表达情况,为在水中晚期生前死后伤鉴定筛选标志物。方法 18只SD大鼠分为对照组（n=6）、生前挫伤浸没组（n=6）和死后挫伤浸没组（n=6）,生前挫伤浸没组采用机械失重技术建立SD大鼠右后肢挫伤模型,死后挫伤浸没组是SD大鼠处死后用机械失重技术建立右后肢挫伤模型,对照组不予致伤处理,所有大鼠均浸没72 h。肉眼观察及HE染色观察生前伤和死后伤的情况;免疫组织化学染色（Immunohistochemistry,IHC）和蛋白质免疫印迹（Western blot）检测GYPA、CD68及TNF-α蛋白在挫伤组织表达情况;随后在实际案例中予以验证。结果 肉眼观察和HE染色均无法较好地鉴别浸没72 h大鼠的生前伤和死后伤。免疫组织化学染色发现生前挫伤浸没组软组织GYPA表达呈阳性,CD68在炎性细胞膜呈阳性表达,TNF-α在胞质表达呈弱阳性,GYPA、CD68和TNF-α蛋白表达均显著高于死后挫伤浸没组和对照...     

大鼠纤维连接蛋白诊断生前伤的实验研究

本实验采用我室自己制备的免抗鼠纤维连接蛋白抗血清作为第一抗体，ＡＢＣ免疫组化技术观察不同损伤时间鼠损伤皮肤Ｆｎ的渗出及分布变化．探讨应用纤维连接蛋白诊断生前伤、死后伤的价值．其结果表明：伤后５分钟，创缘深层出现纤维连接蛋白细网．其渗出量与损伤时间密切相关．死后标本均无纤维连接蛋白渗出．因此．我们认为该方法可为法医学研究生前伤和死后伤的鉴别诊断开辟另一新的途径．     

氯胺酮在家兔死后体内的弥散研究

目的研究氯胺酮在大白兔体内死后弥散过程和再分布机制。方法 48只实验大白兔随机分为8组,采用缺氧处死后以150mg/kg氯胺酮灌胃,尸体仰卧位于室温下放置;在0~96h内分8个时间点各解剖1组,提取体液和脏器组织样品;采用GC/MS法定性结合GC-NPD法定量检测样品中氯胺酮含量,并计算心血/外周血中氯胺酮含量的比值。结果大白兔死后氯胺酮灌胃尸体放置96h内,脑、尿液、玻璃体液、左上/下肢肌肉样本中均未检测到氯胺酮,心血、外周血、心肌、脾、肾、肝、肺、胆汁中氯胺酮含量随死后时间呈动态升高的变化;其中距离胃较近的组织(如脾)较早检测到含量较高的氯胺酮,而距离较远的组织或体液中氯胺酮含量较低且较晚检测到;心血/外周血中氯胺酮含量比值为1.73。结论氯胺酮在家兔体内存在死后再分布,从胃到器官组织、心血顺浓度梯度弥散是主要机制。脑、玻璃体液、尿液、肢体肌肉不受死后弥散的影响,可作为生前服毒与死后染毒氯胺酮的鉴别依据。     

氯氮平在家兔体内死后再分布规律研究

目的阐明死后48h内家兔体内氯氮平再分布规律,为相关法医鉴定工作提供借鉴。方法取家兔15只,随机分为5组,以氯氮平灌胃,分别于死后0、6、12、24、48h取心血、外周静脉血、尿液、肝组织检测氯氮平浓度。结果家兔死亡后心血、外周静脉血、肝脏氯氮平浓度不断升高,尿液氯氮平浓度不断降低;死后早期浓度变化率大于晚期浓度变化率。死后48h心血、外周静脉血、肝脏、尿液氯氮平浓度分别为死后0h各检材氯氮平浓度的418%、193%、154%和29%。结论死亡一段时间后,提取生物检材,检测出的氯氮平浓度并不能准确反映刚死时的实际浓度。     

Use of Cardiac Injury Markers in the Postmortem Diagnosis of Sudden Cardiac Death

In the daily practice of forensic pathology, sudden cardiac death (SCD) is a diagnostic challenge. Our aim was to determine the usefulness of blood biomarkers [creatine kinase CK‐MB, myoglobin, troponins I and T (cTn‐I and T), and lactate dehydrogenase] measured by immunoassay technique, in the postmortem diagnosis of SCD. Two groups were compared, 20 corpses with SCD and 8 controls. Statistical significance was determined by variance analysis procedures, with a post hoc Tukey multiple range test for comparison of means (p < 0.05). SCD cases showed significantly higher levels (p < 0.05) of cTn‐T and cTn‐I compared to the control group. Although only cases within the first 8 h of postmortem interval were included, and the control group consisted mainly of violent death cases, our results suggest that blood troponin levels may be useful to support a diagnosis of SCD.     

Pneumomediastinum and Soft Tissue Emphysema in Pediatric Hanging

Postmortem computed tomography (CT) is increasingly being used as a tool in forensic pathology. The exact value of postmortem imaging in detecting specific conditions has not yet been established, but in specific cases, it can be used as a diagnostic tool demonstrating findings that remain undetected during autopsy, as in this case. Pneumomediastinum and soft tissue emphysema were detected with postmortem CT in a 3‐year‐old girl after hanging. It was not found during autopsy. This radiological finding matches 3 adult cases previously described. It is assumed that in this case, the first reported in a child, hanging was the most likely cause as well. In the adult cases, it was interpreted as a vital sign; the person must have been alive to create a pressure gradient causing rupture of the alveoli. This case demonstrates one of the added values of postmortem imaging, the possibility of demonstrating findings that remain undetected during autopsy.     

大鼠肌肉中微生物ATP含量及其在死亡时间推断中的应用

目的 研究死后大鼠肌肉组织中微生物ATP浓度变化及其与死亡时间(postmortem interval,PMI)的关系. 方法取健康SD大鼠处死,死后不同时间取肌肉组织,用生物发光法检测微生物ATP浓度,对所得数据进行统计学处理.结果 死后肌肉组织中微生物ATP含量随时间延长而增加,于7d达到高峰,随后逐渐降低,并于10d再次略微升高.PMI在0～9d内与肌肉中微生物ATP含量变化拟合最优.以PMI为自变量的三次多项式回归方程为:y=0.020x3-0.166x2-0.666x+13.412(r2=0.989,P<0.01).结论 死后肌肉组织中微生物ATP含量变化可用于PMI推测;本检测方法所需检材量小,不受组织自身降解的影响.     

The Interest of Postmortem Bacteriology in Putrefied Bodies

A 27‐year‐old man was found dead in an advanced decomposition stage at home. On external examination, his body showed petechial hemorrhages of the skin. At autopsy, petechial hemorrhages of the epicardium were found, but no sign of meningitis was detected. Toxicological investigations remained negative. Bacteriological conventional analyses showed no significant result. Neisseria meningitidis serogroup B was finally isolated on cerebrospinal fluid by a specific real‐time polymerase chain reaction. To our knowledge, there are no available data about the postmortem diagnosis of an infectious cause of death in a decomposed corpse. In such situations, the polymicrobial overgrowth usually hampers the interpretation of bacteriological conventional methods and questions their diagnostic value. Such molecular bacteriological approaches appear to constitute an important diagnostic tool for forensic scientists and should be widely processed in case of suspected infectious death or sudden death whatever the postmortem interval.     

头部外伤后伴发病理性蛛网膜下腔出血致猝死11例鉴定分析

头部外伤后伴发病理性蛛网膜下腔出血致猝死１１例鉴定分析肖柏坤，曾建华，孙跃刚（ｌ．江西医学院法医教研室；江西３３０００６２．江西医学院第一附属医院脑外科；江西３３０００６３．南昌市公安局刑事科学技术研究所；江西３３０００６）Ａｎａｌｙｓｉｓｏｆ１１Ｃ...     

Facial Soft Tissue Thickness Database for Craniofacial Reconstruction in Korean Adults

Abstract: One hundred Korean adults (50 men, 50 women) were scanned in the upright position using a cone‐beam CT (CBCT) scanner. The soft tissue (ST) thicknesses were measured at 31 landmarks, 10 midline and 21 bilateral landmark sites, and the means and standard deviations were obtained for male and female subjects. While 18 of 31 landmarks showed sex differences, the majority showed higher values for male subjects with the exception of a few landmark sites corresponding to the zygoma area, which showed smaller values in men than in women. The mandibular area showed greater differences between the right and left sides. Overall, the ST thickness measurements obtained in this study can be used as a database for the forensic craniofacial reconstruction of Korean adult faces.     

Facial Soft Tissue Thickness Among Three Skeletal Classes in Adult Pakistani Subjects

Different facial reconstruction methods rely on the average facial soft tissue thickness values provided in previous studies. Facial soft tissue thickness is influenced by the age, sex, and ethnicity of the individual. The aim of the present study was to determine facial soft tissue thickness of adult Pakistani subjects with different facial morphology. A total of 166 subjects were categorized into three skeletal classes (based on convex, straight, or concave facial profile) employing the classification system used in orthodontics. Facial soft tissue thickness was determined at ten midline points on lateral cephalograms. Significant differences in facial soft tissue thickness were present at glabella, labrale superius, stomion, and labiomentale in males and at labrale superius, labrale inferius, labiomentale, and pogonion in females among different skeletal classes. The current study suggests that the skull morphology-related variations in facial soft tissue thickness should be considered during facial reconstruction to achieve accurate results.     

The Effect of Soft Tissue on Temperature Estimation from Burnt Bone Using Fourier Transform Infrared Spectroscopy

This study investigated the effect of soft tissue and different exposure times on the prediction of burning temperatures of bone when using Fourier transform infrared spectroscopy (FTIR). Ovis aries rib bones were burnt at different temperatures and for varying time intervals. Results of a linear regression analysis indicated that burn temperatures can be predicted with a standard error of ±70°C from defleshed bone spectra. Exposure time does not have a significant impact on prediction accuracy. The presence of soft tissue has a significant impact on heat‐induced changes of the bone matrix in low (<300°C) as well as high temperatures (>800°C), slowing down combustion in the former and accelerating it in the latter (p < 0.05). At medium temperatures, no significant difference was noted. These results provide forensic investigators a new perspective with which to interpret the results of crystallinity measures derived from burnt bone.     

Differentiation of Antemortem and Postmortem Appendicular Fractures Using Magnetic Resonance Imaging Signal Intensity Changes in Bone and Soft Tissues,

Intraosseous T1-weighted (T1W) and short-tau inversion recovery (STIR) magnetic resonance imaging (MRI) signal intensity changes—so-called bone marrow edema—may be able to differentiate antemortem and postmortem fractures in human forensic imaging. The primary objective of this study was to investigate this hypothesis using an animal model. Three juvenile Landrace pigs were anesthetized and underwent MRI of both tibiae and both radii using a 1.5 T magnet. T1W, T2-weighted (T2W), STIR, and T2* sequences were included. Antemortem fractures were induced in both tibiae and postmortem fractures in both radii, and MRI was repeated. Two board-certified radiologists blinded to fracture group jointly evaluated the images for intraosseous and soft tissue signal intensity changes. Sensitivity (Se) and specificity (Sp) in identifying antemortem fractures were calculated based on intraosseous, soft tissue, and combined intraosseous and soft tissue signal intensity changes. Intraosseous and soft tissue signal intensity changes, when present, were hyperintense in all sequences. Intraosseous hyperintensity in T1W and T2W sequences yielded Sp of 100% for antemortem fractures. Regardless of sequence, soft tissue hyperintensity was comparatively more sensitive than intraosseous hyperintensity. Sensitivity for each sequence could be maximized by assessment of soft tissue and intraosseous hyperintense signals together; for the T1W sequence, such assessment optimized diagnostic utility yielding a Se of 100% and Sp of 83%. In summary, MRI—particularly the T1W sequence—can differentiate antemortem and postmortem fractures and may be a useful adjunct to the forensic analyses of fractures.     

A Rare Case of Poisoning with a Volatile Substance: Quantitative Determination of n‐Butane in Postmortem Tissue

Poisoning with volatile substances remains exceptional. Authors report the case of a married couple who were found in a car with a butane gas bottle: the woman was dead and her husband alleged it was an unsuccessful suicide pact. A specific research of volatile substances on postmortem samples with headspace gas chromatography–mass spectrometry following a quantitative determination was performed. The n‐butane concentrations detected were composed of 610 μg/L (cardiac blood), 50 μg/kg (brain), 134 μg/kg (lungs), 285 μg/kg (liver), and 4090 μg/kg (heart) and were compatible with the rare lethal concentrations evoked in the literature. The cause of death was determined to be asphyxiation through n‐butane criminal poisoning. Authors recommendation therefore is to take samples immediately and place them in properly sealed containers and hence analyzing the samples as soon as possible after collecting them or storing them under ?30°C (?22°F) if analyses cannot be performed immediately.