Starvation-related deaths are not uncommon worldwide particularly in economically underdeveloped regions. However, the forensic characterization of such cases remains limited due to underdeveloped local forensic systems. Here we presented a case of a neonate who died of starvation after being abandoned in the wild for 14 days, and 9 additional reported cases were identified by a systematic search of PubMed and MEDLINE databases. Based on these findings, the key forensic characteristics were summarized. Significant reductions in body or organ weight were consistently documented across all ten cases; PAS staining of the liver revealed markedly depleted glycogen stores in four cases. Of the four cases involving children under ten years of age, three demonstrated severe thymic atrophy. In our case, we observed pronounced calcification of thymic corpuscles. These findings suggest that thymic pathological changes may play a potential role in the forensic assessment of starvation deaths in children. In the absence of forensic standards for diagnosing starvation deaths, our case report and consolidated review provide valuable reference points for the forensic evaluation of similar incidents.

Infective endocarditis (IE) and myocardial abscesses caused by Rhodococcus erythropolis are rare clinical manifestations in healthy individuals. We report the autopsy of a 43-year-old male who suffered from IE caused by R. erythropolis infection and died of an atrioventricular node abscess, arrhythmia, and heart failure. This case indicates that the possibility of infection affecting the cardiac conduction system should be considered in arrhythmia-related IE cases. Our findings suggest that clinicians should consider the possibility of R. erythropolis infection in arrhythmia cases associated with IE.

In forensic practice, spinal cord injury (SCI) resulting in death has rarely been reported. Here, we present the case of a 65-year-old woman who on admission was conscious without dyspnea or dysphagia. Physical examination revealed two sharp objects penetrating the neck: a pair of scissors lodged in the neck on the right side of the thyroid cartilage and a knife embedded in the nuchal region accompanied by minor seepage of bloody exudate. Radiography showed that the scissors and knife were retained in the cervical spine. Despite a series of medical interventions, the patient died 26 days later. Method: A systematic forensic autopsy was performed. Results: The cause of death was confirmed to be respiratory failure associated with SCI, which was caused by the combination of scissors and a knife. Conclusion: Based on this case, we believe that when there are multiple causes of death, forensic pathologists should determine the primary, immediate, contributory, and other causes of death to ascertain criminal responsibility.

虚拟解剖在我国法医病理学检案方面尚处于初步探索与应用阶段,其中虚拟解剖联合传统尸检鉴定新生儿死亡的案例报道数量较少.本单位受理一例尸表检验未见明显损伤的新生儿死亡案例,在传统尸检的基础上,尝试采取虚拟解剖,最终鉴定为高坠他杀,本文对传统尸检与虚拟解剖结果进行比较分析,为今后虚拟解剖对新生儿死亡的法医鉴定提供借鉴.

结节病(Sarcoidosis)在我国法医学实践非常少见,容易导致漏诊及误诊.本单位曾尸检一例"肺中叶综合征"肺切除术后大出血死亡的医疗纠纷案件,法医病理学检查证实死者患有肺、心、脾等多器官结节病,参考国内外文献对结节病的病理诊断标准及法医鉴定注意事项报道如下.

Arterial stiffness forms the basis of cardiovascular diseases (CVD) and is also an independent predictor of CVD risk. Early detection and intervention of arterial stiffness are important for improving the global burden of CVD. Pulse wave velocity (PWV) is the gold standard for assessing arterial stiffness and the molecular mechanism of arterial stiffness remains to be studied. Extracellular matrix (ECM) remodeling is one of the major mechanisms of arterial stiffness. Partial quantitative changes of ECM proteins can be detected in plasma. Therefore, we examined the hypothesis that a discovery proteomic comparison of plasma proteins between high arterial stiffness (baPWV ≥ 1,400 cm/s) and normal arterial stiffness (baPWV < 1,400 cm/s) populations might identify relevant changed ECM proteins for arterial stiffness. Plasma samples were randomly selected from normal arterial stiffness (n = 6) and high arterial stiffness (n = 6) people. Isobaric tags for relative and absolute quantitation (iTRAQ) based quantitative proteomics technique was performed to find a total of 169 differentially expressed proteins (DEPs). Nine ECM proteins were included in all DEPs and were all up-regulated proteins. Fibulin-1 had the highest statistically fold-change (FC = 3.7, p < 0.0001) in the high arterial stiffness population compared with the control group during the nine ECM proteins. The expression of plasma fibulin-1 in normal arterial stiffness (n = 112) and high arterial stiffness (n = 72) populations was confirmed through enzyme-linked immunosorbent assay (ELISA). Similarly, ELISA results showed that plasma concentrations of fibulin-1 in the high arterial stiffness group were higher than those in the normal arterial stiffness group (12.69 ± 0.89 vs. 9.84 ± 0.71 μg/ml, p < 0.05). Univariate analysis of fibulin-1 with brachial-ankle pulse wave velocity (baPWV) indicated that fibulin-1 was positively correlated with baPWV in all participants (r = 0.32, p < 0.01) and a stronger positive correlation between baPWV and fibulin-1 in high arterial stiffness group (r = 0.64, p < 0.0001) was found. Multiple regression analysis of factors affecting baPWV showed that fibulin-1 was also a significant determinant of the increased ba-PWV (R 2 = 0.635, p = 0.001). Partial correlation analysis showed that baPWV increased with the growth of plasma fibulin-1(r = 0.267, p < 0.001). In conclusion, our results demonstrated that fibulin-1 is positively correlated with ba-PWV and an independent risk factor for arterial stiffness.

Bungarus multicinctus (B. multicinctus) is one of the top ten venomous snakes in China, ranking first in lethality at 26.9-33.3%. However, to our knowledge, no forensic autopsy-related cases of death from B. multicinctus bite poisoning have been reported. There are surprisingly few reported cases of death from poisoning by other species of neurotoxic snakes. Neurotoxic snake venom is often highly toxic, and death can quickly occur when bitten in the wild if victims are not taken to a doctor in time. We presented a case of an adult female in Fujian Province of China who was bitten by a poisonous snake while digging for bamboo shoots in the mountains and died from the bite of B. multicinctus confirmed by enzyme-linked immunosorbent assays (ELISA) results. The autopsy's results, histopathological findings, and ELISA results reported here can be helpful for future forensic practice in B. multicinctus venom poisoning; we also briefly review the pathological changes of neurotoxin poisoning, which may be useful in other types of neurotoxin snake venom poisoning.

Fatal pulmonary thromboembolism (PTE) following percutaneous vertebroplasty is rare in medical practice. Here, we report the case of a 70-year-old woman who suffered from lumbago with lower extremity pain and lameness and for whom lumbar osteoporotic vertebral compression fractures (L4, L5) were seen on MRI examination. Percutaneous vertebroplasty and posterior vertebral lamina fenestration discectomy were performed. One day later, her condition deteriorated after defecation, and she died suddenly. Pulmonary thromboembolus and deep venous thrombosis in the inferior vena cava were the major findings at forensic autopsy. Due to the rather uncommon components of the thromboembolus (chondrocytes, calcium deposits, and collagen fibers), the pulmonary thromboembolism was attributed to deep venous thrombosis in the inferior vena cava, which was injured during percutaneous vertebroplasty. The present study highlights the conclusion that pulmonary thromboembolism is a rare complication of percutaneous vertebroplasty that should attract the attention of clinical physicians and forensic pathologists.

Allan-Herndon-Dudley syndrome (AHDS) is a very rare, X-linked psychomotor disability syndrome with delayed myelination, almost exclusively affecting boys. We present a case of a 4-year-old boy with AHDS who was found cyanotic, with intermittent vomiting and paroxysmal convulsions about 4 h after his parents went out, and was then taken to the hospital, where he eventually died the next day. The autopsy revealed foreign bodies in the tiny bronchi and alveoli of the deceased, congestion, and punctate hemorrhage in multiple organs, consistent with the diagnosis of asphyxia. Compared with a normally developing 4-year-old boy, the deceased showed cerebral atrophy and cerebral edema, and Luxol Fast Blue (LFB) stain indicated delayed cerebellar, hippocampal, and basal ganglia development and myelination. A novel frameshift mutation c.584delG in the SLC16A2 gene was detected. Family lineage investigation showed that the mutation was also detected in the deceased’s 8-year-old brother and biological mother. The present work enriches the profile mutations in SLC16A2 related to AHDS and emphasizes the importance of autopsy and postmortem genetic analysis in such cases.

性行为及相关性活动是成年人生活的重要组成部分,通常危险性较低,但在特殊体位及患有自身疾病的中老年人中可发生性活动相关的死亡 [1,2],本文报道一例性活动致腹主动脉瘤破裂出血死亡的法医学鉴定.

The incidence of paraquat poisoning has significantly decreased with the addition of odorizer and emetics to the liquid concentrate. Paraquat poisonings are usually attributed to suicidal and accidental or occupational exposure. Here, we report an unusual fatal case of homicidal paraquat poisoning. An intoxicated, a 37-year-old man consumed a mixture of white wine and paraquat prepared by his wife. This resulted in intermittent vomiting, which he attributed to being intoxicated. The man was admitted to the hospital for treatment 3 days later. Due to the lack of knowledge of paraquat exposure, the man did not receive effective treatment and died of respiratory failure 22 days later. High-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was applied to detect paraquat in 16 postmortem specimens: kidney (1.31 ug/g), urine (0.91 ug/ml), liver (0.62 ug/g), lung (0.39 ug/g), muscle (0.35 ug/g), bile (0.32 ug/ml), heart (0.28 ug/g), brain (0.22 ug/g), pancreas (0.22 ug/g), spleen (0.18 ug/g), cardiac blood (0.15 ug/ml), cerebrospinal fluid (0.14 ug/ml), pericardial effusion (0.12 ug/ml), pleural effusion (0.09 ug/ml), peripheral blood (0.08 ug/ml), and vitreous humor (0.06 ug/ml). The highest concentration of paraquat was detected in the kidney followed by the urine in all tissues and body fluids. At present, although the cases of paraquat poisoning have decreased, the high mortality rate resulting from its irreversible lung damage and respiratory failure makes paraquat poisoning, especially occult paraquat poisoning, still needs to be carefully identified in forensic practice and clinical diagnosis.

OBJECTIVES To analyze the characteristics of sudden death associated with sexual activity to provide recommendations for forensic identification. METHODS A retrospective analysis was conducted on autopsy cases accepted by Forensic Identification Center of Huazhong University of Science and Technology from 1998 to 2018, and a total of 15 cases of sudden death associated with sexual activity were screened out. The general information, case data and pathological changes of 15 cases were collected to find the relationship between sexual activity and sudden death. RESULTS The ratio of male to female was 1.5∶1. The average age of males was 50.1 years and that of females was 35.0 years. Coronary artery diseases and brain diseases accounted for most of the cases (12/15). Sexual partners were associated with locations of deaths and body dumping behaviors. CONCLUSIONS Sudden death associated with sexual activity, although rare, may occur in people over 30 years old with pre-existing heart or brain diseases, which should be paid attention to in forensic practice.

目的 比较虚拟解剖与尸检结果,分析两者的优势及不足.方法 选取死后在医院行全身CT检查并完成尸检的3例案例,将CT影像资料交给放射科医师判读并与尸检结果进行对比.结果 在交通事故死亡案例中,两者结论较为一致;在心源性猝死案例中,虚拟解剖提供的信息价值有限;虚拟解剖显示某些病变如积气、骨折等更有优势.结论 虚拟解剖在交通事故案件有很高的应用价值,在某些猝死类案件的鉴定尚有改进的空间.

The rupture of spleen is common in clinical and forensic practice. Trauma is the most common cause of splenic rupture. Although rare, traumatic splenic rupture may occur in these individuals with asymptomatic underlying disease, and clinical and forensic pathologists may neglect the disease and diagnose only the traumatic splenic rupture. Here, we present a case of postinjury splenic rupture resulting in splenectomy, where the patient was diagnosed with Niemann-Pick disease type B through histopathological examination and genetic testing. In forensic practice, in cases of isolation splenic rupture, full microscopy should be done to differentiate traumatic rupture from a spontaneous bleed due to an underlying disease process.

1 案例 1.1 简要案情 某女,36岁,无业.某日被发现晕倒于自家床上,身上有多处挫伤(疑似被殴打),遂送医救治,5日后因医治无效死亡. 该女平素身体一般,无糖尿病及发作性低血糖病史,亦无降糖药物服用史.据病历记录载:某日6:40,被发现意识不清,呼之不应,伴口角少量呕吐物,无大小便失禁等,测指尖血糖0.9mmol/L,给予葡萄糖静点后,其意识无恢复.反复低血糖.血清毒物分析未见异常.给予积极治疗,出现多脏器功能衰竭(持续酸中毒,体温最高40.5℃,R 21次/分,P 125次/分,BP 100/49 mmHg,GCS评分3分),入院第5日16:08宣告临床死亡.

主动脉食管瘘(AEF)是食道和主动脉之间的异常通道,是一种罕见且致命的疾病,通常由各种主动脉和食道疾病引起,可导致致命的上消化道出血 [1].本文报道1例因胃肠道出血死亡法医学鉴定中确诊为AEF的案例.

The objective of the study is to compare the results of virtual autopsy and traditional autopsy and then to analyze the advantages and disadvantages of them. three cases with postmortem computed tomography (CT) examination and autopsy were selected. The CT images were sent to radiologists for interpretation and were compared with autopsy results. In the cases of death in traffic accidents, the two examination conclusions are relatively consistent; in the cases of sudden cardiac death, the information provided by virtual autopsy is limited; virtual autopsy has more strength on showing some lesions such as pneumatosis and fracture. Virtual autopsy has high application value in traffic accident cases, while its application in some sudden death cases remains to be improved.

1 案例 1.1 简要案情 某女,67岁,农民,某年3月4日20:00许在家中睡觉时被蛇咬伤,当晚至3月6日每日到当地一无证蛇医诊所就医,并诉失眠、全身疼痛及右下肢肿胀, 3月7日08:00许在家中死亡.毒蛇经鉴定为当地的常见毒蛇——长江短尾蝮蛇.

A 53-year-old woman was admitted to the hospital due to unexpected dizziness and died the following morning. To investigate the cause of death, a forensic autopsy along with histological examination was performed 3 days after her death. The major findings of the autopsy were that a fish bone had pierced the left subclavian artery after perforating the esophagus with 680 mL of blood in the stomach and bloody and tarry contents were present in the intestines, and the cause of death was confirmed to be subsequent hemorrhagic shock. Unfortunately, none of her family realized that she had eaten a fish 4 days before the tragedy until the fish bone was found. The present case is rare and instructive. The histopathological findings of left subclavian artery-esophageal fistula induced by a fish bone can be used as a reference in forensic practice.

1 案 例 1.1 简要案情 某女婴,4 个月,因"右肾盂输尿管交界处狭窄合并右肾积水"就诊于某市三甲医院,入院后于全身麻醉下行"腹腔镜下肾盂输尿管成形术",术后 18 h 患儿出现呼吸、心率持续下降,经抢救无效死亡.死者家属认为该女婴的死亡系医方的诊疗过失行为所致,要求行尸体解剖查明死亡原因,并分析医方在医疗过程中是否存在医疗过失,与患儿的死亡结果之间有无因果关系及其原因力.