血清差异性表达分子在机械性窒息死因鉴定中的作用

血清是血液的重要组成部分，其成分变化可直接反映机体内环境的变化。在对缺氧性疾病的研究中，有学者提出血清差异性表达分子可作为疾病的诊断标志物。由于缺乏特异性的诊断指标，机械性窒息死亡的精准死因鉴定至今仍是法医病理学鉴定的难点。本文回顾了缺氧相关疾病中的血清差异性表达分子的研究，并讨论了这些分子用于机械性窒息死亡鉴定的可能性，以期为机械性窒息精准死因鉴定研究提供新思路。     

肺组织缺氧时分子变化与机械性窒息死亡死因鉴定研究进展

肺是机体最大的呼吸器官,缺氧时肺组织细胞快速发生损伤性变化,同时激活自救通路,进而引发复杂的生物大分子变化。机械性窒息死亡是由机械性暴力引起的急性呼吸障碍导致的死亡。由于缺乏特异性的尸体内部征象,机械性窒息死亡的精准死因鉴定一直是法医病理鉴定的难点。本文回顾了缺氧条件下肺组织的生物大分子变化,探讨了将这些变化用于机械性窒息死亡精准死因鉴定的可能性,以期为相关研究提供新思路。     

PMCT在机械性窒息方面的研究进展

机械性窒息是公安法医日常检案中最常见的死因之一。如何快速准确的判断死者是否为机械性窒息死亡、以及作案手段是判断案件性质、指引案件侦破方向的重要因素。在法医鉴定过程中,诊断机械性窒息需要结合尸体体表征象、尸体内部征象、组织病理学检验等多方面综合判断。PMCT在骨折的检测、异物的检测和气体的检测方面具有极大的优势,在许多国家和地区已作为常规检验手段。本文综述了国内外近年来使用PMCT研究机械性窒息案例中舌骨骨折、甲状软骨骨折、椎间盘真空现象等多个征象的成果,讨论了PMCT诊断机械性窒息的应用价值与潜力,并对国内PMCT的发展前景进行了展望。     

分子生物学指标用于推断机械性窒息死亡的研究进展

体表损伤轻微或无损伤的机械性窒息死亡是法医学鉴定的难点之一。由于缺少病理形态学特异性变化特征,较难与部分存在缺氧过程的其他致死原因相鉴别。近年来,将具有相关性、特异性分子生物学指标用于推断机械性窒息死亡,已成为研究热点。本文就上述专题中法医学最新研究文献进行复习综述,以期为机械性窒息死亡的研究提供新思路。     

机械性窒息死亡案例中的舌骨骨折研究近况

一、概况 用手扼压颈部,用带子勒颈或直接用钝器压迫颈部均可致机械性窒息性死亡.除了1993年Gonzales发表过此类论文及研究过此类与法律有关的死亡方式外,在法医病理学或人类学中很少有涉及此类的论著.尽管诸多尸体现象可以确证机械性窒息死亡的诊断,但舌骨骨折在法医学实践中却有非常重要的意义.     

法医病理大体形态学改变计算机图谱的研究

损伤是法医鉴定工作的主要内容，也是法医理病学工作的重点，做好损伤鉴定，关系到法医学的工作质量和效率。大体损伤等形态学改变在实际检案中占有重要位置。笔者结合实际法医学鉴定和教学工作的实践需要’‘”’、应用计算机多媒体技术进行了法医病理大体损伤的电子图谱研究，取得了较好的效果。该图谱可作为法医病理学计算机辅助教学的选件，补充机械性损伤课堂教学的材料，并可通过法医学工作”者的自学进修，提高鉴定工作水平。材料与方法从多年法医学鉴定工作实践中积累的案例资料中，选取典型的材料，包括机械性损伤、机械性窒息、法…     

猝死156例分析

猝死，又称急死，是指貌似健康而无明显症状的人，由于潜在性疾病或机能障碍，于开始感到不适后24小时内发生意外的急速的自然死亡(suddenunexpectednaturaldeath，SUND)。猝死的最大特点是意外性，因此，猝死常引起死者家属的怀疑、误解，甚至发生一些纠纷，而要求法医学鉴定。本系自1992年至2001年受理的法医病理学鉴定案例中，猝死者有15例，现对其分析如下。1一般情况1.1猝死发生率在本系进行的法医病理学鉴定案例中，经过尸体剖验、组织学检查、毒物分析等，排除了机械性损伤、机械性窒息、中毒等因素，按照WHO关于猝死的诊断标准，…     

机械性窒息死亡案例中的舌骨骨折研究近况

一、概况用手扼压颈部 ,用带子勒颈或直接用钝器压迫颈部均可致机械性窒息性死亡。除了 1 993年Ｇｏｎｚａｌｅｓ发表过此类论文及研究过此类与法律有关的死亡方式外 ,在法医病理学或人类学中很少有涉及此类的论著。尽管诸多尸体现象可以确证机械性窒息死亡的诊断 ,但舌骨骨折在法医学实践中却有非常重要的意义。二、舌骨骨折在机械性窒息案例中的情况舌骨呈Ｕ形 ,位于颈前喉上方 ,在颈部肌群和舌之间起重要连接作用。舌骨前端向后突出连结茎突 ,随着年龄的增长 ,茎突骨化。舌骨被分成几部分。后面的部分形成舌骨大角 ,与舌骨体相连续 ,舌骨…     

中国特色的法医毒理学

我国法医中毒案件在许多方面具有显著中国的特色。法医了解和认识这些特色,有利于法医毒理病理学的理论研究和法医中毒案件的鉴定。下面仅从几个主要方面简要加以介绍。1我国中毒发生原因和方式的特点在我国,中毒是法医实践中继机械性损伤、机械性窒息之后第3位常见的死因和尸检类型[1]。综合北京、杭州、广州、西安、汕头、湖北省部分地区等公开报告的资料[2-6],在5757例中毒死尸检案例中,自杀中毒最多见,计4151例,占72.10%;其次是意外中毒,1050例,占18.24%;他杀投毒也不少见,505例,占8.77%;此外,原因不明的中毒尸检51例。Litovitz等[8]20…     

常用心脏标志物的生化检测及法医学应用

在法医病理学鉴定工作中,由早期缺血性心肌病变及致死性心律失常引起的心源性猝死常常缺乏典型的病理组织学改变,如何准确、客观地诊断、查明死因是法医病理学亟待解决的问题。近来研究发现的一些心肌特异性指标对心源性猝死的诊断有很好的应用前景。本文介绍几种常见心肌特异性标志物的生化特点、实验室检验方法以及临床和法医学应用前景,以期为心源性猝死的法医病理学鉴定提供依据。     

Forensic medical specificity of death in atypical sexual behavior: asphyxiophilia, autoerotism

The diagnosis of death of autoerotic asphyxia has not been virtually stated by Russian forensic medical expert. All such cases were interpreted as mechanical asphyxia entailing suicide, and "accidental" or "fatal" death. The authors observed, during the recent 5 years, 10 lethal cases in different-type autoerotic practice. Strangulation asphyxia was the death cause in 7 cases. Compression asphyxia, inhaling of glue vapor and electric shock caused death, each in one case. Death of asphyxia seizes to be exceptional; it is rather a regular phenomenon in the present-day life, which needs a proper research from 2 standpoints--etiopathogenesis, and forensic medical diagnosis.     

Diagnostic efficacy of biochemical markers in diagnosis post-mortem of ischaemic heart disease

In forensic medicine, there is a need for more sensitive biochemical markers for the post-mortem diagnosis of acute myocardial infarction. A study of the distribution of biochemical markers in different fluids is of great significance in post-mortem diagnosis, because their distribution depends on the location of tissue damage and release kinetics. The aim of this study is to compare the sensitivities and specificities of creatine kinase-MB (CK-MB), myoglobin and cTnI in serum and pericardial fluid for the post-mortem diagnosis of acute myocardial infarction (AMI). We studied 188 cadavers selected during 1 year from medicolegal autopsies. The groups were as follows: (1) myocardial infarction (n = 52); (2) asphyxia (n = 59); (3) multiple trauma (n = 41); (4) natural deaths excluding myocardial infarction (n = 36). We obtained statistically significant differences in pericardial fluid for all the biochemical markers, the highest levels being obtained in the group of cadavers who had died from myocardial infarction. A common factor is the high negative predictive value found in biochemical markers, which is contrary to the findings obtained in clinical practice, when the percentages of sensitivity are very high.     

Classification of Asphyxia: The Need for Standardization

Abstract: The classification of asphyxia and the definitions of subtypes are far from being uniform, varying widely from one textbook to another and from one paper to the next. Unfortunately, similar research designs can lead to totally different results depending on the definitions used. Closely comparable cases are called differently by equally competent forensic pathologists. This study highlights the discrepancies between authors and tries to draw mainstream definitions, to propose a unified system of classification. It is proposed to classify asphyxia in forensic context in four main categories: suffocation, strangulation, mechanical asphyxia, and drowning. Suffocation subdivides in smothering, choking, and confined spaces/entrapment/vitiated atmosphere. Strangulation includes three separate forms: ligature strangulation, hanging, and manual strangulation. As for mechanical asphyxia, it encompasses positional asphyxia as well as traumatic asphyxia. The rationales behind this proposed unified model are discussed.     

Enzyme-linked immunosorbent assay for determination of plasma thyroglobulin and its application to post-mortem diagnosis of mechanical asphyxia

A high sensitive enzyme-linked immunosorbent assay (ELISA) for determination of plasma thyroglobulin was devised and applied to the postmortem diagnosis of mechanical asphyxia. The sensitivity of the present ELISA was 5 ng/ml. All of the 15 victims who died from causes other than mechanical asphyxia showed plasma thyroglobulin levels lower than 200 ng/ml (99.8 +/- 37.9 ng/ml), while 12 out of 14 victims of mechanical asphyxia showed the levels higher than 200 ng/ml (2100 +/- 3450 ng/ml in 14 victims). Thus, the present ELISA appears to be useful for postmortem diagnosis of mechanical asphyxia.     

Model for the prediction of mechanical asphyxia as the cause of death based on four biological indexes in human cardiac tissue

Determination of mechanical asphyxia as the cause of death has always been difficult for forensic pathologists, particularly when signs of asphyxia are not obvious on the body. Currently, depending on only physical examination of corpses, pathologists must be cautious when making cause-of-death appraisals. In a previous study, four biomarkers—dual-specificity phosphatase 1 (DUSP1), potassium voltage-gated channel subfamily J member 2 (KCNJ2), miR-122, and miR-3185—were screened in human cardiac tissue from cadavers that died from mechanical asphyxia compared with those that died from craniocerebral injury, hemorrhagic shock, or other causes. Expression of the markers correlated with death from mechanical asphyxia regardless of age, environmental temperature, and postmortem interval. However, a single biological index is not an accurate basis for the identification of the cause of death. In this study, receiver operating characteristic curves of the ΔCq values of the four indexes were generated. The diagnostic accuracy of the indexes was judged according to their area under the curve (DUSP1: 0.773, KCNJ2: 0.775, miR-122: 0.667, and miR-3185: 0.801). Finally, a nomogram was generated, and single blind experiment was conducted to verify the cause of death of mechanical asphyxia.     

Obturation, aspiration, and inhalation in case of mechanical asphyxia

This paper aims at updating terminology employed for the characteristic of selected forms of mechanical asphyxia. The medical terms "obturation", "aspiration", and "inhalation" are not infrequently used by forensic medical experts and pathological anatomists engaged in diagnostics of mechanical asphyxia, elucidation of the mechanism of the accompanying injury and causes underlying its fatal outcome. It is argued that the use of these terms for the purpose is sometimes either unjustified or incorrect or both. To begin with, they have different meanings in different situations. Second, the mechanism of death from mechanical asphyxia is variable and associated with specific morphological features that are directly dependent not only on the route by which a foreign body enters the respiratory tract but also on its size, weight, structure, shape, properties, and aggregated state. Third, it is necessary to differentiate between inhalation of a toxicant in case of poisoning and inhalation of a gaseous substance leading to mechanical asphyxia.     

Asphyxial deaths and petechiae: a review

Conjunctival and facial petechiae, although nonspecific findings, are considered hallmarks of asphyxial deaths. Consensus in the literature suggests that their pathogenesis is related to the combined effects of increased cephalic venous pressure and hypoxic damage to endothelial cells. Despite the common knowledge that they are neither predictable findings in all asphyxial deaths nor rare in natural, nonasphyxial deaths, the belief persists that petechiae are corroborative evidence of asphyxia. We suggest that a clear, physiologically based understanding of the pathogenesis of petechiae of the head is critical for their appropriate interpretation. We present a review of the literature and the basis of our conclusion that conjunctival and facial petechiae are the product of purely mechanical vascular phenomena, unrelated to asphyxia or hypoxia.     

虚拟解剖技术的应用研究进展

尸体解剖是法医学传统的、经典的技术手段,但由于需破坏尸体,尸体解剖有时会遭到抵制和排斥。虚拟解剖技术为法医学检验提供了一种非侵入性的检验途径,可客观准确地反映骨折、软组织损伤、创道、器官损伤等,为法医学鉴定实践提供直观有力的证据。本文综合国内外最新文献资料,从虚拟解剖在法医损伤鉴定、机械性窒息、溺死、高低温死亡、疾病诊断及其在法医有限元损伤研究中的应用等方面进行综述,阐述了这一新的法医学研究方向。     

Advances in the diagnosis of wound vitality: a review

The diagnosis of the vital origin of wounds in many cases remains an unsolved problem for the forensic pathologist. Practical experience enables the expert to diagnose the vital or postmortem origin of wounds on the basis of macroscopic examination. In some cases, optic microscopy is used to confirm the diagnosis. In many other cases, additional more sensitive and specific markers of vitality are required. In the past 50 years, comprehensive research on this topic has resulted in a better understanding of the acute inflammatory reaction. The development and application of sensitive and specific markers through research in the areas of histochemistry, enzymology, and biochemistry has provided a partial solution to the problems involved in wound vitality diagnosis. A review of this challenging area of forensic pathology, including an explanation of these methods and markers, is presented in this paper.