Vol 6, No 3 (2020)

REVIEWS
Estimation of individual biological age in individual in forensic medicine (review)
Kil’dyushov E.M., Egorova E.V., Dvornikov A.S.
Abstract

The authors review the current state of diagnosis in the vital and postmortem estimation of biological age on the basis of morphological variability of osseous and chondral structures of the body, teeth, nails and skin. Despite nearly a century of research in the age estimation of corpses and live individuals, certain aspects remain to receive proper acknowledgment. Macroscopic methods for the morphological assessment of external characters do not provide for a sufficient precision and vary in the age estimation bias. This circumstance highlights the importance of developing novel approaches and extending the toolkit of forensic medicine to improve the deterministic power of establishing the human biological age.

Russian Journal of Forensic Medicine. 2020;6(3):4-11
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ORIGINAL INVESTIGATIONS
Patterns of changes in the fluorescence of nadh and fad coenzymes and their relationship in skeletal muscle in the early post-mortem period (an experimental study)
Babkina A.S., Sundukov D.V., Golubev A.M.
Abstract

Background. The paper presents changes and mathematical models of autofluorescence of reduced nicotinamide adenine dinucleotide (NADH) and flavin adenine dinucleotide (FAD) and their redox ratio (RR) in rat skeletal muscle during the first 24 hours after death. Aim. To establish a pattern of change in the fluorescence intensity of NADH and FAD coenzymes, as well as their relationship in skeletal muscle during the first 24 hours after death using mathematical modeling. Material and methods. The experiment was performed on Sprague Dawley rats. The fluorescence intensity of FAD and NADH coenzymes in skeletal muscle was measured in situ in living rats under general anesthesia, 5 minutes after euthanasia, and at intervals of 1.5–3 h during the 24-hour postmortem period. To estimate the fluorescence intensity of NADH and FAD coenzymes and to calculate the RR, a Lasma MC-3 fluorescence measuring device with special software was used. The obtained data were analyzed by non-linear regression analysis. The summary, accuracy estimation, and significance of the regression equation coefficients were assessed using SigmaPlot 10.0 software. The significance of the regression model was tested using the Fisher F-criterion. Results. During the first 3 hours of the postmortem period, an increase in the mean values of RR and NADH fluorescence was detected; starting from 4.5 and lasting until 24 hours post mortem, their gradual decrease was observed. The relationship between NADH, RR, and time since death is characterized by the Weibull equation. The statistical significance of the NADH and RR models, based on the obtained equations, was considered high. Conclusion. The analysis of the obtained data allowed us to create mathematical models describing the relationship between RR and NADH fluorescence intensity and time after death, which confirms the non-randomness and regularity of the discovered patterns.

Russian Journal of Forensic Medicine. 2020;6(3):12-19
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Comparative characteristics of polymorphic allele propagation in the hemostasis system genes PAI-1 (-675 5G/4G) and FGB (-455 G/A) in sudden cardiac death and acute coronary syndrome in patients undergoing coronary artery stenting
Berezovskiy D.P., Kolomoets I.A., Bachurin S.S., Egorov V.N., Tayutina T.V.
Abstract

Aim. To give comparative characteristics of the prevalence of polymorphic alleles in the genes of the hemostatic system PAI-1 (-675 5G/4G) and FGB (-455 G/A) in patients with sudden cardiac death and those with acute coronary syndrome undergoing coronary artery stenting. Material and methods. Genetic typing of biological material (BM) was performed for the prevalence of polymorphic alleles in two genes of the hemostasis system. BM was selected from people with a diagnosis of coronary artery disease, divided into three comparison groups: I-suddenly deceased citizens with a diagnosis of coronary artery disease, II-patients with ACS who underwent urgent coronary artery stenting, and III-patients with a chronic form of coronary artery disease in whom endovascular surgery was performed as planned. Results. The calculated criterion χ2 of the prevalence of polymorphisms in the FGB (-455 G/A) and PAI-1 (-675 5G/4G) genes turned out to be more than the critical (tabular) value, which indicates an existing relationship between the presence of IHD and the carriage of one of the polymorphic alleles. Based on the same data, the χ2 criterion was calculated without taking into account data for a group of healthy citizens. For carriers of the polymorphic allele of the FGB gene (-455 G/A), no statistically significant differences were found. For carriers of the PAI-1 gene polymorphic allele (-675 5G/4G), statistically significant differences were found. Conclusions. ACS with a favorable outcome (subject to emergency surgical intervention) occurs at an earlier age than in patients diagnosed with coronary artery disease who die suddenly. The presence of a mutant allele in the PAI-1 gene (-675 5G/4G) requires further studies in order to expertly assess the death rate in patients after surgery with coronary stenting.

Russian Journal of Forensic Medicine. 2020;6(3):20-26
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Assessment of internal organ stub injury frequencies and their infliction causes
Devyaterikov A.A., Kulichkova D.V., Vlasyuk I.V.
Abstract

Aim. Determination of most frequently cut-wounded internal organs and injury infliction causes. Material and methods. The article reports the results of a retrospective statistical assay of forensic medical reports of corpse examination conducted at the Khabarovsk Inter-District Forensic Examination Department of the Bureau of Forensic Medical Expertise, Ministry of Health of the Khabarovsk Region, in the years 2014–2018. Results. The study identified the frequency of sharp force injuries, the most frequently wounded internal organs and the average lengths of wound tracks in the entire body and particular internal organs.

Russian Journal of Forensic Medicine. 2020;6(3):27-30
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Possible neurogenic mechanisms in sudden infant death syndrome
Kopylov A.V., Berlay M.V.
Abstract

Background. Sudden infant death syndrome (SIDS) is the unexpected, non-violent death of an apparently healthy child aged 7 days to 1 year, in which the anamnesis and autopsy data do not reveal the cause of the fatal outcome. Researchers have not come to a consensus on the thanatological role of morphological changes in the brain. Aim. To determine pathomorphological changes in the brain in the case of sudden death syndrome in children. Material and methods. Forensic medical studies of 118 deaths of healthy children who died suddenly for the period 2008–2017 were carried out and analyzed on the territory of the Stavropol region. Autopsy material was divided into groups: the main group (1) consisted of 74 observations (62.8%), where SIDS was the main final sectional diagnosis. The comparison group (2) consisted of 44 (37.2%) observations; the children died suddenly at home as a result of viral-bacterial pneumonia. For the control, the third group was formed (3), which included 45 observations, where the death of children occurred as a result of drowning and carbon monoxide poisoning. Results. A histological examination of pieces of the brain in the case of sudden death syndrome revealed the foci of angiomatosis of the vessels of the pia mater and brain matter with the normal structure of the elastic membrane of the arteries, the effects of glial proliferation in the subependymal region of the lateral ventricles and subcortical formations. In the medulla oblongata, in a detailed study of the posterior (vegetative) nucleus of the vagus nerve, degenerative changes in neurons were detected in the form of chromatolysis and karyolysis, a glial reaction of the neuronophagic type. Conclusion. Pathomorphological changes in the brain stem may be due to combined intrauterine hypoxic and intrapartum traumatic factors, which, potentiating each other, lead to dysregulation of the respiratory rhythm with the development of a fatal outcome during sleep.

Russian Journal of Forensic Medicine. 2020;6(3):31-35
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Characteristics of fatal road traffic injuries in the Moscow region
Maksimov A.V., Kuchuk S.A.
Abstract

Aim. To determine the regularities and features of the formation of indicators of fatal outcomes in the Moscow region as a result of injuries caused by road accidents. Material and methods. We studied the dynamics of indicators of road traffic injuries with fatal outcomes in the Moscow region for the period 2015–2019. The study is continuous. The scope of the study is 5.112 cases of fatal traffic injuries. Research methods: documentary, statistical, graphic, and comparative analysis. Descriptive statistics are presented in the form of relative intensive and extensive coefficients. Results. It was found that in the Moscow region in the period 2015–2019 there was a decrease in the number of deaths from road accidents by 1.7 times. At the same time, there is a 2.2-fold decrease in the number of deaths with the presence of ethyl alcohol in the blood. Conclusion. During the five-year observation period, the structure of the dead showed a predominance of young people with a tendency to decrease their number in dynamics, changing the structure of the dead at the place of registration due to an increase in the share of dead residents of the Moscow region and a decrease in the share of dead residents of Moscow and other regions of the Russian Federation.

Russian Journal of Forensic Medicine. 2020;6(3):36-40
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New method for postmortem determination of alcohol intake
Nedugov G.V., Nedugov V.G.
Abstract

Background. One of the tasks of the forensic medical examination of acute alcohol intoxication on a corpse is to determine the amount of alcohol taken shortly before death. The disadvantage of existing methods for solving this problem is the need to remove fluid by spinal puncture of the corpse and determine the concentration of ethanol in it. This article shows for the first time the possibility of automated post-mortem determination of the amount of alcohol consumed without knowledge of the parameter ethanol concentration in the spinal fluid. Aim. To develop a mathematical model for postmortem determination of ethanol intake, based on objective parameters of ethanol kinetics and not containing the parameter of ethanol concentration in the spinal fluid, to implement the developed model in the format of a computer program. Material and methods. Regression and simulation mathematical modeling of single-dose ethanol kinetics. Writing the text of a computer program in C#. Results. A set of mathematical models has been developed to enable objective post-mortem determination of the amount of ethanol intake without the need for sampling and chemical-toxicological analysis of the spinal fluid. The set of computational procedures is implemented in the format of the computer program “Alcohol calculator Z 4.0.” Conclusions. The developed method of postmortem determination of ethanol intake and the program “Alcohol calculator Z 4.0” created on its basis are recommended for use in the forensic examination of acute alcohol intoxication on a corpse.

Russian Journal of Forensic Medicine. 2020;6(3):41-46
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Histomorphological changes in the lungs induced by poisoning with baclofen and its combination with ethanol (experimental study)
Romanova O.L., Sundukov D.V., Golubev A.M., Blagonravov M.L., Ershov A.V.
Abstract

 Aim. Detection and assessment of histomorphological changes in the lungs in acute poisoning with Baclofen and its combination with ethanol three hours after poisoning. Material and methods. Experimental studies were conducted in 15 Wistar lineage rats divided into three groups. The control group included five intact animals, group 1 was treated with Baclofen at a dose of 85 mg/kg, group 2 — with a combination of Baclofen (85 mg/kg) and ethanol (7 mL/kg of 40% ethanol). Results. No pathological changes were observed in the lungs of the controls. Both treated groups manifested the capillary and venous plethora, sludge syndrome, atelectases and dystelectases, emphysema and infiltration of white blood cells into the interalveolar septa. Bronchioles in the group 2 animals contained secretion. Conclusion. In the conducted trials, a complex of pathological changes was observed in the lungs of animal models shortly after the administration of Baclofen, including circulatory disorders in all departments of the microcirculatory bed (plethora of capillaries and venules), emphysema, atelectases and dystelectases, leucocyte infiltration into the interalveolar septa. Morphometric studies are necessary to quantify the severity of histomorphological changes in the lungs.

Russian Journal of Forensic Medicine. 2020;6(3):47-52
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VIRTOPSY
New diagnostic signs of drowning based on virtual autopsy results
Klevno V.A., Chumakova Y.V., Kislov M.A., Popova O.M., Dubrova S.E.
Abstract

 Background. The article presents a case study of the local forensic Department GBUZ MO “Bureau of forensic medical examination” in which the investigation of the corpse of a girl who died from drowning utilized the method of pre-sectional computed tomography (virtual autopsy), with subsequent radiological-anatomical comparison of the results. Aim. Identification of possibilities of computed tomography for establishing diagnostically significant signs of drowning; pre-sectional identification/exclusion of injuries. Material and methods. Computed tomography was performed in the Radiology Department of the district hospital at MSCT Optima of General Electric (64-slice tomograph, with 1.5-mm- and 2-mm-thick sections). Results. When studying the Russian medical literature, there was no description of the presence of fluid in the maxillary and frontal sinuses of corpses extracted from water. Conclusions. The presence of fluid in the maxillary and frontal sinuses revealed during CT examination allowed us to supplement the number of objects for the algological study. The discovery of plankton and quartz-containing particles in the fluid from the paranasal sinuses expanded the evidence base for death by drowning.

Russian Journal of Forensic Medicine. 2020;6(3):53-57
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EXPERT PRACTICE
Finite elemental analysis of local osteoporosis formation in the surgical treatment of fubilar fractures
Krupin K.N., Kislov M.A.
Abstract

Background. When providing surgical medical care to patients with fibular fractures, one of the most common types of treatment is fixing the fracture area with a metal plate with screws during metallosteosynthesis surgery. During treatment, bone tissue is often thinned in the area of the fracture, which significantly increases the duration of treatment. Aim. Establishment of the mechanism of formation of osteoporosis in the fracture area after the operation of osteosynthesis of the fibula. Material and methods. The finite element method is used to simulate the destruction process using ANSYS. Results. A comparative study of the location of formation of focal osteoporosis formed in the fracture area of the distal part of the fibula diaphysis, under a metal plate installed during osteosynthesis, and the area of formation of maximum equivalent loads in the experimental mathematical model of the stress-strain state revealed complete similarity of the location. Conclusions. The formation of a zone of local osteoporosis in the area of a fibular fracture after osteosynthesis surgery is explained by a combination of factors, which are the presence of a fibular fracture fixed with metal screws with a metal plate, the support of the foot on the foot with pressure on the fibula. The zone of local osteoporosis in the area of the fibula fracture after osteosynthesis surgery occurs from the compression of compact plates of the fracture edges with limited mobility under the metal fixing plate.

Russian Journal of Forensic Medicine. 2020;6(3):58-61
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A case of fatal hypertensive crisis in response to stress
Frolov V.V., Frolova I.A.
Abstract

The article reviews the organismal response to psycho-affective situations in the form of neuroses, hormonal dysfunctions and pathologies of the vascular, alimentary and other systems extending to fatal outcomes.

Russian Journal of Forensic Medicine. 2020;6(3):62-64
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