Mechanical Asphyxia Research Articles

MRNA expression patterns in human myocardial tissue, pericardial fluid and blood, and its contribution to the diagnosis of cause of death

Gene expression has become an interesting research area in forensic pathology to investigate the process of death at the molecular level. The aims of this study were to analyze changes in gene expression patterns in relation to the cause of death, and to propose new molecular markers of myocardial ischemia of potential use for the postmortem diagnosis of early ischemic heart damage in cases of sudden cardiac death (SCD). We determined mRNA levels of five proteins related with ischemic myocardial damage and repair – TNNI3, MYL3, TGFB1, MMP9 and VEGFA – in specific sites of the myocardium, blood and pericardial fluid in samples from 30 cadavers with different causes of death (SCD, multiple trauma, mechanical asphyxia, and other natural deaths). TNNI3 expression in blood, and MMP9 expression in pericardial fluid, were significantly higher when the cause of death was mechanical asphyxia, probably because of the more sensitive response of these proteins to acute systemic hypoxia/ischemia. Specifically, among SCD cases, increased MYL3, VEGFA and MMP9 values in the anterior wall of the right ventricle were found when the confirmed cause of death was acute myocardial infarction (AMI). Higher TGFB1 expression was found in the interventricular septum when AMI was not the cause of death, most likely as a reflection of the short duration of ischemia. Molecular biology techniques can provide complementary tools for the forensic diagnosis of early ischemic myocardial damage and AMI, and may make it possible to determine the duration and severity of myocardial ischemia.

A Study of pattern of neck injuries in the victims autopsied at tertiary care medical college and hospital of North Karnataka

Introduction: Death due to neck injuries are invariably encountered in medicolegal work. Injuries to neck causing death can occur in different manner and different circumstances. Objectives: To know about the neck wounds, neck structures (organs) commonly involved, agents, manner and cause of death due to neck injuries. Material and Methods: 208 victims of neck injuries were autopsied at Al-Ameen Medical College Mortuary and District Hospital Mortuary, Bijapur (Karnataka) from June 2011 to May 2014. It was a one year retrospective and two years prospective study. Results: Out of 208 victims of neck injuries autopsied, most vulnerable age group was 21-30 yrs (30.76%) followed by age group 31-40yrs (27.88%). Cervical vertebrae fracture and dislocation was the most common skeletal injury in neck region (18.26%). It was found that Suicide by hanging (40.38%) was the most common manner of death followed by road traffic accidents (31.73%). Major cause of death was mechanical asphyxia (53.84%). Conclusion: Neck injuries constitute a potential factor in increasing the amount of mortality and morbidity. The conclusions evolved from the present study may be useful in medicolegal work and if possible to make suggestions for prevention and safety measures. Keywords: Manner, Agents and Cause of death, Neck organs involved.

Mechanical asphyxia as the cause of children's death in Minsk in 2013-2017

The purpose of the work is to study the structure and circumstances of the death of children from mechanical asphyxia in Minsk during 2013-2017.Material and methods. The material used for the study was documentary data (conclusions of forensic experts, results of forensic and histological and forensic researches), management of forensic medical examinations of the State Committee of Forensic Examination of the Republic of Belarus for the city of Minsk during 2013-2017.Research results. For the period from 2013 to 2017, 21333 forensic medical examinations were conducted in Minsk, out of which 173 cases of autopsy of children and adolescents were registered, and constituted 0.81% of the total number of autopsies. At the same time, the ratio of death from mechanical asphyxia was in 47 cases, which constituted 27.2% of the total number of autopsies of children. In the structure of the death of children from mechanical asphyxia, the leading place belongs to obstructive asphyxia (57.5%), in the second place - strangulated asphyxia (25.5%), in the third place - drowning (14.9%).Conclusions. Prevention of the death of children from mechanical asphyxia in a large industrial city should be complex and conducted taking into account the prevailing types of asphyxia in each age group.

Forensic medical examination of alcohol-attributable mortality in Saint Petersburg

This article presents an analytical material on the relationship of alcohol consumption and mortality in St. Petersburg for the period 2015-2017 years, which is based on the data of the city Bureau of forensic medical examination. The analysis of deaths found that the problem of abuse of alcoholic beverages (including ethanol containing) remains relevant, as indicated by the high (up to 30%) frequency of detection of acute ethanol poisoning in forensic examination of corpses. We found that ethanol poisoning in the structure of poisoning occupy the second place, while drug poisoning (opiates, cannabioids, cocaine) confidently and by a large margin occupy the first place. However, more than 75% of those who died from acute drug poisoning had alcohol in their blood. In cases where the death was violent, alcohol was found in the blood of more than 60% of the victims. High rates of alcohol intoxication were found in cases of death from low temperatures and mechanical asphyxia (hanging). About 25% of the victims of road accidents (pedestrians, drivers, passengers) were intoxicated. Our study showed no dynamics of reducing the frequency of alcohol intoxication and in cases where death occurs from diseases. When comparing certain types of non-violent death, it was found that most often the state of alcoholic intoxication accompanied (was the background) in cases of death from diseases of the digestive system: hemorrhagic pancreatitis, cirrhosis, gastric ulcer and duodenal ulcer, varicose veins of the esophagus (in 24-53% of cases), somewhat less – in diseases of the cardiovascular system (in 25-29% of cases).

Infant mortality at home in Perm Krai. Main causes and prevention

Aim. To assess the most frequent causes of infant mortality at home in Perm Krai, to give the main recommendations for its prevention.
 Materials and methods. Retrospective study of 165 cases of the death of children under 1 year of age in Perm Krai over the period of 2013-2016 was carried out.
 Results. Among the causes of the death of children under 1 year of age at home, the most frequently registered were the following: sudden infant death syndrome (SIDS) – 47.9 %, traumas – 24.8 % and respiratory diseases – 18.8 %. In case of SIDS, the share of premature infants was 16.7 %, more than a half of infants had various signs of morphofunctional immaturity (58.8 %). Mothers’ smoking during pregnancy and after giving birth to a child occurred in 78.6 % of SIDS cases. Half of cases of death at home from traumas in children under age 1 is connected with mechanical asphyxia while sleeping, 33 % – as a result of gastric content aspiration into respiratory tract, 16.7 % – owing to nonobservance of safe conditions of sleep. Infant death in consequence of traumas more often than the other causes of death was accompanied by social risk (75.0 % of cases), regarding SIDS social risk was noted in 66.7 %, acute respiratory diseases – in 50.0 %.
 Conclusions. Prevention of the main causes of death at home among infants under 1 year of age consists in a timely detection of prognostic risk and initiation of standard preventing measures.

Evaluating the effects of causes of death on postmortem interval estimation by ATR-FTIR spectroscopy.

Estimating postmortem interval (PMI) is one of the most challenging tasks in forensic practice due to the effects of many factors. Here, attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy combined with chemometrics was utilized to evaluate the effects of causes of death when estimating PMI and to establish a partial least square (PLS) regression model, which can precisely predict PMI under different causes of death. First, the sensitivities to causes of death (brainstem injury, mechanical asphyxia, and hemorrhage shock) of seven kinds of organs were evaluated based on their degrees of cohesion and separation. Then, the liver was selected as the most sensitive organ to establish a PMI estimation model to compare the predicted deviations from different causes of death. It turns out that the cause of death has no significant effect on estimating PMI. Next, a PLS regression model was built with kidney tissues, which have the lowest sensitivity, and this model showed a satisfactory predictive ability and wide applicability. This study demonstrates the feasibility of using ATR-FTIR spectroscopy in conjunction with chemometrics as a powerful alternative for detecting changes in biochemistry and estimating PMI. A new perspective was also provided for evaluating the effect of causes of death when predicting PMI.

Continuing major inconsistencies in the classification of unexpected infant deaths

The classification of the cause of unexpected infant deaths by both pathologists and researchers may be quite inconsistent. For example, if an infant is found lying face down on soft bedding the death may still be certified as ‘sudden infant death syndrome (SIDS)’, ‘accidental suffocation’, ‘undetermined’, ‘unclassified sudden infant death (USID)’, or ‘sudden unexpected death in infancy (SUDI)’. As the San Diego definition of SIDS does not appear to be rigorously or consistently applied, clarifying ‘mechanical asphyxia not determined with certainty’ may help to more clearly separate SIDS from USID. Including a classification algorithm with the definition may also help to better define unsafe sleep factors and suffocation. This commentary reviews the current situation with regard to classifying these deaths and concludes that the absence of diagnostic pathological markers with conflicting classification systems has led to idiosyncratic certification practices.

An overview of the mechanical asphyxia with the main emphasis on hanging

An overview of the mechanical asphyxia with the main emphasis on hanging

Characteristic Changes and 3D Virtual Measurement of Lung CT Image Parameters in the Drowning Rabbit Model.

To use virtual anatomy technique in the analysis of post-mortem characteristic changes of CT images in the experimental drowning rabbit model and the related parameters in 3D virtual model, so as to explore its application value in the diagnosis of drowning in forensic pathology. A model of drowning rabbits was established, with animal models of hemorrhagic shock and mechanical asphyxia as the controls. CT scan was performed on the experimental animals, and the differences in imaging features between the groups were compared by morphological reading of the tomographic images. CT data were imported into Mimics 14.0 software for 3D modeling. The CT values and lung volumes were calculated by the software, and the differences on CT values and lung volumes brought by different causes of death were analyzed. The CT images of lungs in the drowning group showed characteristic ground-glass opacity （diffuse and uniform density increase）. There were no obvious abnormalities in hemorrhagic shock group, and only a few similar changes were found in the mechanical asphyxia group. Compared with the controls, the CT values and the lung volumes in the drowning group were significantly increased P<0.05. Based on post-mortem lung imaging, the combination of CT value and lung volume changes can effectively reflect the virtual anatomical features in drowning, and provide a diagnostic basis for the forensic identification of drowning.

Analysis of Hanging Cases Brought to Mortuary of Lok Nayak Hospital, New Delhi: A 3-Year Retrospective Study

The incidence of hanging as a means adopted for committing suicide has been on the rise. Hanging provides painless death so it is one of the commonly adopted methods for suicide. This retrospective study including 173 hanging cases was conducted with an objective to find the pattern of hanging cases as a method of suicide. Male victims constituted 72.8% with male:female ratio being 2.7:1. Young adults in the age group of 16 to 35 years were more involved. Rainy season recorded maximum cases of hanging, that is, 67 cases (38.7%), whereas winter season recorded the least number, that is, 42 cases (24.3%). Most commonly used ligature material in this study in 149 cases (86.1%) was sari/dupatta/bedsheet. Autopsy findings revealed dribbling of saliva in 129 cases (74.6%), cyanosis in 150 cases (86.7%), and petechial hemorrhages on lungs in 115 cases (66.5%). Ligature mark was above the level of thyroid cartilage and parchmentized in all the cases. Additional injuries were present in 1.2% of cases. Neck structures were normal in all the cases and cause of death was mechanical asphyxia in 169 cases (97.6%).

Fatalna aspiracija kukuruznog zrna - prikaz slučaja

Introduction: Asphyxiation by aspirationinhalation of foreign bodies is a form of violent mechanical asphyxia and can occur at any age, most commonly in children and the elderly. In children up to third age choking is a significant cause of morbidity and mortality. Mortality due to aspiration of foreign bodies is higher in children because of the relatively narrow airways and less developed protective mechanisms. The size, type, shape and place of obstruction with foreign body leads to the diversity of clinical picture. Case report. We present the case of a 15 month-old girl, who was found by her mother in her house in a village, lying down, cyanotic, collapsed, without breathing. Autopsy showed that the cause of death was acute respiratory obstruction with impacted grains of corn in two places, on the larynx entrance and in the right bronchus. Conclusion. The diagnosis of death by asphyxiation due to aspiration of foreign bodies is set at autopsy, when the place of airway occlusion is found. If a foreign body was removed during providing assistance, the diagnosis would be made based on medical records or history data of persons who were provided assistance. In cases of sudden deaths of young children, in order to clarify pathophysiological mechanism and mode of death in each case, a pathologist should always keep in mind the possibility of aspiration of foreign bodies, and in accordance with this, carefully apply appropriate autopsy techniques to locate the place of obstruction, with special regard to local finding in airways.

Feature of Ligature Mark and Fractures in Hanging and Ligature Strangulation Cases in Ajmer Region Population of India

Human race is one of the most intellectual living creatures among the whole living world. Human race has the potential to think and act, but unfortunately humans have also by desire searched the way to end their own by adopting various ways of mechanical asphyxia which is most commonly encountered in medicolegal practice. Hanging is one of the most common method of suicide in India and around the world, other types of hanging are, homicidal hanging judicial hanging, autoerotic hanging. A study was conducted in the Department of Forensic Medicine & Toxicology at JLN Medical College, Ajmer for a period of one year i.e. from January 2009 to December 2010. During this period a total number of 105 cases were observed; of which 100 were of hanging and 05 cases of ligature strangulation. In the investigation 100 hanging cases reported in Ajmer region were studied for injuries to bones and cartridge of neck. In the study, hyoid bone (13%) and thyroid cartridge fracture (5%) were most commonly observed among male and female respectively, no case of larynx and trachea fracture was recorded.

Pathological Changes of Petechial Hemorrhage after High Temperature Treatment.

To study the main features of mechanical asphyxia--the pathological characteristics of petechial hemorrhage after high temperature effect （roasted, boiled） and its changing rules. Rabbit model of mechanical asphyxia death with choking neck and death from anteposition hanging was established. The experimental rabbits were randomly divided into roasted group and boiled group （n=4, in each group）. The laryngeal ventricles and cardiopulmonary tissues in the roasted group were roasted for 3, 6 and 10 min, and the positions of petechial hemorrhage were observed and photographed. The same organs and tissues in the boiled group were heated in boiling water （100 ℃）, and were observed and photographed at 30 and 60 s. Then histopathological examination was performed on all the laryngeal ventricles and cardiopulmonary tissues. The petechial hemorrhage originating from laryngeal ventricle, trachea and lung did not disappear after high temperature treatment in the eight rabbits. The deepened color was visible to naked eyes and distinct from the surrounding normal tissues, with bleeding under the microscope. Petechial hemorrhage caused by mechanical asphyxia would not disappear under high temperature, which might be related to the manner of death, the intensity and time of action, and the individual differences.

Café coronario o muerte absurda debido a trozo de comida grande

Las muertes accidentales en el mundo han sido históricamente un problema de salud pública que ha pasado desapercibido. Su relevancia en el incremento de la mortalidad en el sistema de salud, así como su impacto judicial, ha permitido generar más atención por las autoridades de salud. Muchos años atrás, los franceses definieron la muerte asociada a consumo de alcohol y alimentos, generalmente al amanecer, como " café coronario" por su supuesta asociación con evento isquémico cardíaco. Presentamos un caso de hombre adulto que fallece por asfixia mecánica secundaria a atragantamiento en vías respiratorias altas por material alimenticio semisólido (carne), posterior a ingesta importante de alcohol.

ALGORITHM FOR ESTABLISHING LIFETIME OF STRANGULATION MECHANICAL ASPHYXIATION

Methods of immunohistochemistry are of great importance in morphology, namely in forensic histology. 19 observations of statutory mechanical asphyxia were studied in the age group from 28 to 48 years. For comparison, 3 observations of mechanical asphyxia as a result of drowning in the age group from 35 to 50 years have been studied. The control group consisted of 11 observations of the acute form of coronary heart disease, 6 cases of death from traumatic shock. In the process of research, fibrinogen can be evaluated as the substance of early response to damage and the marker of intactness of strangulation mechanical asphyxia. This algorithm can be proposed for the diagnosis of strangulation asphyxia.

Sexual Abuse Identified after Suicide: Case Report

Child abuse is a maltreatment of a child under the age of 18 by his or her parent, carer, someone living in their home, or someone working with children. Abuse of a child is anything that causes injury or puts the child in danger of physical injury. Child abuse can be physical, sexual or emotional. Sexual abuse has been reported to be the largest component of suicide attempts in childhood. Between 1950 and 1993, children under the age of 15 had a 4-fold increase in suicide-related deaths among causes of death. In 1994, 6 percent of deaths between 5 and 14 years of age were found to be suicidal. Case; on a 14-year-old girl’s body’s external examination, where dead stiffness continued and purple-colored dead stains began to appear in unprinted areas. It was recorded that the telem was viewed as a parchmented area starting from the middle line, 10cm long and 1.5cm wide in the thickest area. On the outer side of the left knee there was a 3x2cm scar tissue. It was observed that the hymen was 2cm wide and had a notched structure and a partial tear at the level of 7 o’clock. There was no ecchymosis and hemorrhage around the anus and hymen. On the internal examination, a 2.5 centimeter fetus was detected in the uterus between 6-8 weeks of gestation. Only male DNA profiles were detected from the pregnancy material. Toxicological analyzes result in no detectable substance. It was determined that death was caused by mechanical asphyxia, the result of hanging. A 14-year-old girl who has been diagnosed with suicide mortality and pregnancy after autopsy will be examined in the light of literature in terms of child abuse and pregnancy

Technical note: A histochemical approach in diagnosing hanging mechanical asphyxia on cadavers undergoing advanced putrefactive phenomena.

The authors used a particular protocol on putrefied corpses to highlight the cutaneous furrow. Two groups of cadavers were selected: in the first group (suicide by hanging mechanical asphyxia), the authors sampled cutaneous lozenges on the furrow still macroscopically recognisable, while in the second group (corpses deceased by different means), we sampled cutaneous lozenges in the hypostatic leaning. All specimens were divided in two: one underwent standard fixation while the other, previously rehydrated in Sandison's solution, was then fixed in formalin. All specimens were stained with hematoxylin and eosin and Resorcin-Fuchsin. Samples processed with formalin and the H&E staining underlined various artifacts; vice versa, the Sandison solution associated with Resorcin-Fuchsin staining demonstrated the compression of the elastic fibres, with focal positivity in hanged corpses, and diffuse positivity in the entire hypostatic leaning. Sandison's rehydrating solution and Resorcin-Fuchsin staining exalt the supposed application of an asphyctic mean even on putrefied corpses in those cases burdened by a diagnostic doubt.

Characterization With Scanning Electron Microscopy/Energy-Dispersive X-ray Spectrometry of Microtraces From the Ligature Mean in Hanging Mechanical Asphyxia: A Series of Forensic Cases.

The authors applied scanning electron microscopy with energy-dispersive x-ray spectrometry to the furrow derived from hanging means. The study was conducted with the purpose to detect possible extraneous microtraces, deriving from the ligature, that could have had an interaction with the cutaneous biological matrix, thanks to a transfert mechanism, in the proximities of the lesion.Fifteen cutaneous samples of the furrow and an equal number of fragments of graphite tape, directly positioned on the lesion produced by the ligature mean and used as a "conductor" of possible traces, were analyzed using scanning electron microscopy with energy-dispersive x-ray spectrometry.The research of microscopic traces on the furrow using this technique highlights extraneous traces leading to 3 main categories: natural fabrics, and synthetic and metallic materials, excluding possible environmental pollutants. The analysis, run on 7 hanging deaths, made available by the judicial authority, found a morphological and compositional compatibility with the traces found on the cutaneous furrow produced during hanging.The technique used in this study is innovative in the pathological-forensic field, and can be considered useful in clarifying and studying this typology of asphyxia leading to a specific ligature material, when missing, or attributing the cause of death to hanging when the furrow is not macroscopically obvious.

The principal and auxiliary immunohistochemical markers of intravital mechanical strangulation asphyxia

The materials on which the study was based included 17 cases of mechanical strangulation asphyxia involving 13 men and 4 women at the age from 8 to 28 years. All cases of hanging were associated with different blood alcohol levels. Their characteristic feature was the formation of the obliquely ascending constriction marks. The group of comparison was comprised of three cases of death by drowning and one case of manual strangulation. The control group consisted of 10 patients who died from the acute form of coronary heart disease and 5 cases of death from traumatic shock. All the corpses were examined with the use of the traditional methods within the first 24 hours after death. The special laboratory studies were performed by means of the standard histological and immunohistochemical methods with the use of the polyclonal antibodies against total cytokeratin, fibrinogen, immunoglobulin-lambda, fibronectin, and CD-117 antigen. The histological preparations were stained by the method of Spielmeyer and with toluidine blue. The results of the study give evidence of the possibility of diagnostics of mechanical strangulation asphyxia making use of the reaction with anti-fibrinogen antibodies in the stromal tissue of the constriction mark even in the absence of other intravital signs of death. Such diagnostics is also possible with the use of the CD-117 antigen in the pulmonary tissue. The expression of this antigen is characteristic of the cases of alveolar hypoxia. The possibility of application of other markers for the differential diagnostics of mechanical strangulation asphyxia from other causes of death is discussed.

On the occasion of the 200th birthday anniversary of D.E. Min

This article is dedicated to the memory of the outstanding Russian forensic doctor and literary figure professor D.E. Min on the occasion of his 200th birthday anniversary. The assignment of D.E. Min to the position of the head of Department of the State Medical Practice at the Emperor's Moscow University coincided with the large-scale judiciary reform carried out in the country at that time which envisaged, among other innovations, the practice of questioning of an expert in the court room. The new developments in the practical expert activities required the revision of the former approaches to the education and training of forensic medical experts. D.E. Min was the first to introduce the practice of public defense of expert judgements by the students of the Department as an indispensable component of their routine learning activities. He founded the museum of forensic medicine and pioneered the method for teaching the intravital forensic examination. D.E. Min initiated and supervised original research on mechanical asphyxia, forensic-medical toxicology, and traumatology. D.E. Min and his co-workers were frequently engaged by the agencies in charge of preliminary investigation to participate in forensic medical expertise associated with the inquiries into the most lurid criminal cases of those times. The scientist made the essential contribution to the development of forensic medicine in this country and the modernization of the academic process at the Department of the State Medical Practice that greatly promoted satisfaction of the basic requirements of practical forensic medical activities.