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.     

An Unusual Method of Suicidal Ligature Strangulation

This article reports a case of suicidal strangulation by ligature of a 51‐year‐old woman with a psychiatric disorder. She had been suffering from depression with a history of previous suicidal attempt. The deceased accomplished self‐strangulation using two ligatures, with one placed above the other and consisting of a satin fabric and a shoelace. The underlying shoelace ligature was fastened by a secure fixed square knot at the back of the neck. The overlying fabric piece was tied with a half‐knot under the chin and was tightened around the neck manually. A detailed investigation and autopsy examination strongly suggests suicide. The case is of interest due to its rarity and uncommon method of execution.     

手法复位小夹板固定配合接骨续筋汤治疗老年骨质疏松性Colles骨折临床观察

目的 观察手法复位小夹板固定配合接骨续筋汤治疗老年骨质疏松性Colles骨折的临床疗效。方法 将68例老年骨质疏松性Colles骨折患者随机分为治疗组和对照组,每组34例。两组患者均接受手法复位小夹板固定治疗,并给予常规治疗,治疗组在此基础上内服接骨续筋汤治疗。观察并记录两组患者治疗前,治疗1、2周后视觉模拟评分（visual analogue scale,VAS）,患侧肿胀情况,治疗4、8周后骨折愈合X线评分,并记录骨折愈合时间;骨折愈合后采用Garland-Werley评分对腕关节的活动功能进行评价;治疗90 d后,对两组患者的临床疗效进行评价。结果 治疗1、2周后,两组VAS评分及患侧肿胀度均较治疗前明显降低（P<0.05）,且治疗组VAS评分和患侧肿胀度均明显低于对照组（P＜0.05）。治疗8周后,两组骨折愈合X线评分均较治疗4周后显著上升（P＜0.05）,且治疗组骨折愈合X线评分明显高于对照组（P＜0.05）。与对照组比较,治疗组骨折愈合时间显著缩短（P＜0.05）,Garland-Werley评分显著降低（P＜0.05）。治疗90 d后,两组临床疗效的差异有统计学意义（P＜0.05）,治疗组临床疗效优于对照组。结论 在手法复位小夹板固定基础上服用接骨续筋汤可提高老年骨质疏松性Colles骨折的疗效,能有效缓解患者骨折后疼痛、肿胀程度,缩短骨折愈合时间,改善腕关节活动功能。