Antipsychotics are a category of psychotropic medications that often require long-term or even lifelong administration, and they are also routinely screened in forensic examinations. Clinically, the use of antipsychotics can usually cause observed signs, such as QT interval prolongation, supraventricular tachycardia and conduction block. A relatively high proportion of deaths among individuals taking these medications present as negative autopsies, making cause of death determination in cases involving antipsychotics particularly unique and challenging. At present, due to the lack of effective detection indicators and standardized forensic protocols for such negative autopsy cases, forensic scientists often can only provide exclusionary or presumptive cause of death determinations. This situation frequently calls into question the scientific rigor and professional credibility of forensic opinions. To address this issue, this consensus integrates opinions from domestic forensic and related field experts, summarizes the latest evidence from forensic toxicology and molecular identification relevant to such difficult cases, and provides recommendations for case investigation, sampling and laboratory testing of such cases. It aims to offer scientific evidence for cause of death determination in antipsychotics-related deaths with negative autopsy findings, to better integrate evidence from forensic pathology, forensic toxicology, and forensic genetics, and to serve as a reference for conducting related forensic identifications.

To explore the possible mechanisms of changes in neural metabolic cells in the white matter injury sites of the brain in mice with carbon monoxide (CO) poisoning and the abnormal absorption of iron ions in the body caused by intestinal flora and intestinal flora disorders. C57BL/6 mice were placed in a closed jar and given CO to establish a mouse model of CO poisoning. The control group was given the same treatment but not given CO. Samples were taken from the white matter to observe the morphological changes of white matter, the expression of transferrin (TRF) and glutathione peroxidase 4 (GPX4) was analyzed by immunohistochemistry and Western blotting. Meanwhile, feces of mice were collected at 3rd and 7th day after CO exposure, and 16S rRNA sequencing was performed to analyze the changes of intestinal flora in mice caused by CO poisoning. Electron microscopy showed that CO poisoning caused obvious demyelination, with increased expression of TRF and decreased expression of GPX4 in the white matter (P<0.05). CO poisoning led to abnormal distribution of intestinal flora in mice, resulting in abnormal absorption of iron in intestinal tissue. CO poisoning can cause damage to white matter nerve cells in the brain, leading to demyelination. It can also cause abnormal intestinal flora distribution and iron absorption in mice.

As a discipline with a long history, forensic pathology is tasked with determining the cause of death, clarifying the nature and manner of death, and reconstructing the truth of events based on postmortem examinations. It is dedicated to providing scientific, objective, and reliable evidentiary support for judicial proceedings, playing an irreplaceable role in combating crime, protecting human rights, and resolving social conflicts. In the context of rapid advances in new technologies, forensic pathology is facing historic opportunities and challenges as it transitions from traditional morphological diagnosis to multimodal, precision-driven, and intelligent approaches. From the perspective of technological innovation driving disciplinary evolution, this paper comprehensively reviews the current development status of forensic pathology in key technical fields, including microscopic diagnosis, molecular marker detection, imaging technologies, and intelligent biomechanical analysis. Focusing on innovative application areas such as postmortem interval (PMI) estimation, diatom testing in aquatic bodies, forensic diagnosis of anaphylactic shock and sudden cardiac death, molecular identification of traumatic brain injury and asphyxia, crime scene reconstruction of complex injuries, and contributions to emerging infectious diseases, it systematically elaborates on the application value and challenges of new technologies in improving the accuracy of cause of death determination, the objectivity of PMI estimation, and the scientific rigor of injury mechanism analysis. Furthermore, the paper prospects the future of forensic pathology in data-driven development, intelligent decision-making, and deep multidisciplinary integration, with emphasis on the construction of standardized systems, talent cultivation, ethical and legal frameworks, the formation of multimodal intelligent disciplinary paradigms, and the enhancement of societal value.

To analyze the factors contributing to inconsistent opinions on assessments of mental disability degrees caused by traumatic brain injury (TBI). A retrospective analysis was conducted on 50 cases of re-assessment of mental disability caused by TBI at Forensic Medicine Center of Sun Yat-sen University from 2018 to 2019. General demographic information of the assessed individuals, TBI conditions, and initial and re-assessment opinions were collected. Descriptive statistics, Spearman correlation analysis and generalized estimating equations were used to analyze the differences in mental disorder diagnosis and disability degrees between initial and re-assessment. The reasons for inconsistent opinions were analyzed. The inconsistency rate for two mental disability assessment opinions was 70.0% (including only mental disorder diagnosis were inconsistent, only disability degrees were inconsistent and both inconsistent). The responses to questioning, memory, intelligence, emotional activities, volitional behavior activities, and self-awareness during the assessment were correlated with the location of the cerebral malacia foci caused by TBI. There were significant differences between the two assessments in the degree of impairment to some mental symptoms and the living ability. The reasons for the inconsistent opinions on the two assessments may be: (1) depending on different brain imaging information (including changes in brain imaging information in the recent three months, and the location of cerebral malacia foci); (2) examiners have different understandings of the degree of damage caused by mental disorders; (3) examiner's assessment of the degree of impairment in living ability varies.

To investigate the relationship between the narrow band Chirp auditory brainstem response (NB Chirp ABR) response thresholds, 40 Hz auditory event related potential (40 Hz AERP) response thresholds and pure-tone audiometry (PTA) thresholds in normal hearing adults under sound stimulation of different frequencies. A total of 100 ears of 50 normal-hearing adult subjects were selected as the experimental group. PTA, NB Chirp ABR and 40 Hz AERP tests were conducted at the frequencies of 0.5, 1, 2, and 4 kHz. The relationship between the NB Chirp ABR, 40 Hz AERP response thresholds and the PTA thresholds were analyzed using paired samples t-tests, Pearson correlation coefficients, and scatter plots. The mean differences between the response thresholds and the PTA thresholds at each frequency were calculated as the calibration values for our laboratory. Additionally, 22 ears of 11 normal-hearing adult subjects were selected as the validation group to evaluate the accuracy of predicting behavioral hearing thresholds using NB Chirp ABR, 40 Hz AERP, and their combined application, respectively. Mean absolute error (MAE), mean square error (MSE), root mean square error (RMSE), and correlation coefficients were used as evaluation metrics. At the frequencies of 0.5, 1, 2, and 4 kHz, the correlation coefficients between the NB Chirp ABR response threshold and the PTA threshold were 0.601, 0.672, 0.805, 0.931, and the correlation coefficients between the 40 Hz AERP response threshold and the PTA threshold were 0.763, 0.737, 0.643, 0.580, respectively. The combined application of NB Chirp ABR and 40 Hz AERP, using laboratory calibration values established in this study, demonstrated the accuracy of predicting behavioral hearing thresholds with MAE, MSE, RMSE, and the correlation coefficient values of 2.216 dB nHL, 7.509 dB nHL, 2.740 dB nHL and 0.906, respectively. NB Chirp ABR has application value in the assessment of hearing function. When combined with 40 Hz AERP, with 40 Hz AERP used at 0.5 and 1 kHz, and NB Chirp ABR used at 2 and 4 kHz, it can improve the accuracy of auditory function assessment.

To optimize and establish GC-MS, LC-MS, and infrared spectroscopy (IR) methods for analyzing 1-phenyl-2-propanone (P-2-P) and 3,4-methylenedioxyphenyl-2-propanone (MDP-2-P) precursors. Eleven precursor substances of P-2-P and MDP-2-P were analyzed by GC-MS, LC-MS and IR methods, some key analytical parameters, such as solvent and injection temperature, were optimized. Substances such as 3-oxo-2-phenylbutyl methyl ester (MAPA) contain ester bonds in their structures were prone to ester exchange reactions. Therefore, alcohol solvent should be avoided to prevent the esterification. Instead, non-alcohol solvents, such as acetonitrile, were recommended. Substances such as MAPA that may undergo decomposition at the gas phase injection port temperature exceeded 170 ℃. It was recommended to lower the temperature of the injection port to 170 ℃. For substances that did not show peaks during GC-MS analysis, such as 2-methyl-3-phenylglycidic acid sodium salt (BMK sodium glycidylate) and 2-methyl-3-[3,4-(methylenedioxy)phenyl]glycidic acid sodium salt(PMK sodium glycidylate), it was recommended for IR detection. This study established GC-MS, LC-MS and IR methods that can accurately qualitatively analyze eleven P-2-P and MDP-2-P precursors, which can provide technical support for the detection of such substances in related cases.

To explore the method of postmortem submersion interval (PMSI) estimation for bodies from the Jingzhou reach of the Yangtze River, utilizing an aquatic decomposition score. A total of 105 cases of known PMSI bodies recovered from the Jingzhou reach of the Yangtze River were collected from the cases handled by the Jingzhou Branch of Yangtze River Shipping Public Security Bureau from 2018 to 2022. Considering the average monthly temperature, these cases were categorized into summer and winter groups, with the threshold set at 20 ℃. For each case, the total aquatic decomposition score (TADS) was assessed using the aquatic decomposition score table. The relationship between TADS and PMSI was explored using statistical approach, and two regression equations were established respectively through the natural logarithmic transformation of PMSI. Six bodies recovered in 2023 from the Jingzhou reach of the Yangtze River were selected to verify the equations. In both summer and winter groups, PMSI was positively correlated with TADS (R2>0.70). The regression equation of summer group was TADS=5.117+4.825×ln(PMSI), and for the winter group, it was TADS=3.191+3.967×ln(PMSI). The decomposition degree of the bodies can be used to estimate PMSI combined with the feature of water temperature of the Jingzhou reach of the Yangtze River.