Vol 10, No 4 (2024)

Background: The analysis of cerebrospinal fluid has been repeatedly recognized in the scientific literature as a promising forensic tool for addressing critical questions related to fatal traumatic brain injuries, such as determining its age and assessing its severity. Conductometry has long been used in medicine as an objective method for studying biological samples. However, the influence of individual characteristics of the object on the conductometric properties of cerebrospinal fluid remains insufficiently studied.

Aim: To investigate the electrical conductivity properties of cerebrospinal fluid in deceased individuals who died from traumatic brain injuries, considering individual characteristics of autopsy material to substantiate the poteвntial of conductometric analysis as a research tool for determining the time of traumatic impact leading to injury formation.

Materials and methods: The experimental conductometric study was carried out on cerebrospinal fluid samples from 124 corps of persons aged 17 to 93 years who had died from traumatic brain injury and its consequences (with post-injury intervals ranging from 0 to 10 days). The electrical conductivity was measured using the AKIP RLC 6109 device, with an error of 0.1%, at frequencies of 0.1 kHz, 1 kHz, and 10 kHz. The study considered the subject’s sex, age, postmortem interval, presence of ethanol in the blood at the time of death, and the ethanol concentration.

Results: The subject’s sex was found to be a significant factor influencing the value of electrical conductivity of cerebrospinal fluid. In contrast, the deceased’s chronological age did not significantly affect the measured cerebrospinal fluid properties, nor did the postmortem interval within the first 24 hours. The absolute ethanol concentration (in ‰) had no substantial effect on cerebrospinal fluid conductivity. However, the mere presence of ethanol in the sample significantly altered its ability to conduct electrical current.

Conclusion: The influence of the above factors must be considered when developing a conductometric method for studying cerebrospinal fluid in those deceased from traumatic brain injury, as it can impact the assessment of injury severity and the age of injury.

Background: The study of skeletal trauma is one of the key aspects of forensic medical examination in cases involving living individuals. When the circumstances and timing of an injury are unclear due to deliberate concealment by involved parties, delayed medical consultation, or an unreported crime against personal health, determining the age of fractures presents certain challenges. In such cases, radiographic examination of the affected bone serves as an important source of information.

Aim: To identify radiographic characteristics of diaphyseal fractures of long bones specific to different stages of consolidation.

Materials and methods: A retrospective study was conducted on 192 radiographs (initial and follow-up images taken during the observation period) of male and female patients (n=56) aged 20 to 80 years with long bone fractures, both with and without metal osteosynthesis. The study systematically analyzed the progression of radiographic fracture changes at different consolidation stages, described key morphological features, performed comparative group analysis, and structured the findings.

Results: Distinct timeframes for fracture consolidation were identified, along with key diagnostic criteria for tracking healing dynamics. A sequential pattern of morphological changes in fractures throughout the healing process was established. No significant differences in consolidation dynamics were found based on gender. Surgical intervention (metal osteosynthesis) did not play a substantial role in the speed of consolidation.

Conclusion: The radiographic appearance of diaphyseal fractures of long bones exhibits specific morphological features depending on the age of the injury.

Background: The World Health Organization states that approximately 1.19 million people worldwide die annually as a result of road traffic accidents. Driving under the alcohol influence significantly increases the risk of traffic accidents and associated fatalities, which may be attributed to the severity of injuries sustained or the masked progression of traumatic disease during acute alcohol intoxication.

Aim: To evaluate the impact of acute alcohol intoxication on the severity of injuries sustained in road traffic accidents in Moscow and their outcomes based on forensic medical data.

Materials and methods: The study included two stages. At the first stage, data on all fatalities resulting from road traffic accidents in Moscow in 2023 (329 cases) were analyzed. At the second stage, cases with available ethanol testing results (247 cases) were studied. The study objects were forensic medical examination and autopsy reports. Demographic profiles of the deceased, involvement in traffic, time of death, injury patterns, and blood ethanol levels were analyzed. For the first time in Russian practice, injury severity was evaluated using the Forensic Injury Severity Score Template (FISST) scale (an objective and quantitative injury severity assessment system based on autopsy findings).

Results: In 2023, over half of the fatalities from road traffic accidents in Moscow occurred at the time of receiving medical assistance. Most victims were men (239/329; 72.6%; mean age 43.9 years [41.8–46]). Ethanol was detected in 32.4% of cases (80/247) among the victims tested for ethanol (247/329; 75%). Pedestrians and drivers were the most frequent victims of alcohol-related fatalities. The most severe injuries were observed in victims with blood ethanol levels exceeding 3‰; however, no direct correlation between injury severity and blood ethanol level was established in this study. The most severe injuries were found in victims who died during the pre-hospital phase, with chest injuries being the primary contributors to the severity of their condition. Victims who died during the pre-hospital phase also had the highest mean blood ethanol levels.

Conclusion: Ethanol was detected in one-third of road traffic accident fatalities in Moscow. One-quarter of drivers and pedestrians in Moscow died with blood ethanol levels above 0.3‰. All intoxicated drivers died within the first 24 hours following the accident. The most severe injuries were observed in individuals with blood ethanol levels exceeding 3‰. However, the frequency of ethanol detection and blood ethanol levels did not directly influence injury severity or hospitalization duration in this study.

Background: The determination of acute and fatal poisoning caused by cytotoxic substances remains a critical issue in forensic medical examination. Ricin belongs to this group of substances and is its most toxic representative. It may cause irreversible health consequences in the human body.

Aim: To develop a rapid analysis method for detecting marker substances to establish ricin poisoning in biological samples for forensic medical purposes.

Materials and methods: The study describes optimal conditions for the isolation of ricinine and ricinoleic acid as marker substances indicating the presence of ricin. The extraction process was examined in blood and urine. The study utilized advanced chromatographic techniques, including high-performance liquid chromatography (HPLC) and gas chromatography (GC) combined with tandem mass spectrometry (MS/MS).

Results: Based on the study findings, a rapid method for detecting ricinine and ricinoleic acid in biological fluids was developed, requiring only 200 µL of biological material. Chromatographic and mass spectrometric characteristics for the identification of ricinine and ricinoleic acid were determined. The presence of toxic ricinine was confirmed in processed products of castor bean (Ricinus communis) seeds, which may pose a risk of human poisoning.

Conclusion: The study presents an express method for forensic chemical and toxicological investigation of ricin poisoning using chromatographic techniques — high-performance liquid chromatography coupled with tandem mass spectrometry (HPLC-MS/MS) and gas chromatography combined with tandem mass spectrometry (GC-MS/MS). This method is based on the detection of marker substances, ricinine and ricinoleic acid, in biological samples.

Background: The issue of age assessment is not only relevant in modern society but also socially significant. According to official statistics, 2021 saw a record number of migrants and refugees — over 89 million and 27.1 million, respectively. A significant proportion of them are children and adolescents under the age of 18, many of whom lack proper legal documents confirming their date of birth. In such cases, forensic age determination is necessary. From the perspective of safety and effectiveness, magnetic resonance imaging is considered the method of choice for age assessment. This highlights the need to explore its potential as a method for documenting and assessing the developmental status of the studied anatomical structure.

Aim: To analyze published data on the feasibility of using knee magnetic resonance imaging findings to determine the stage of epiphyseal ossification for forensic age estimation in children, adolescents, and young adults.

Materials and methods: A study protocol was developed and registered in PROSPERO (registration number CRD42022344779, 2022). Several search engines were used, including PubMed, Web of Science, and the Scopus database, to ensure a comprehensive review of current knowledge. Articles published in English from 1985 to 2021 were considered. Literature searches were conducted using the following keywords and term combinations: “age estimation”, “age determination”, “knee”, and “magnetic resonance imaging of the knee”.

Results: A total of 13 publications were selected and thoroughly analyzed. Differences among the studies were identified regarding magnetic resonance imaging research protocols, classifications used for determining the stage of epiphyseal ossification by age, and the specialization and experience level of the researchers. Significant heterogeneity in population samples was noted, including variations in the number of study subjects, the age range, and the uneven distribution within age groups.

Conclusion: The amount and heterogeneity of data in the studies included in this systematic review did not allow for a meta-analysis of the results or for predicting the risk of misclassification in the target age group. Therefore, at present, MRI-based knee age assessment cannot be considered an objective and legally substantiated forensic method.

Background: One of the most promising modern approaches in thermometric diagnosis for estimating the time of death is the finite element analysis method of postmortem heat transfer. This method overcomes the limitations of phenomenological cooling equations for corpses. However, the software packages enabling this method are typically expensive and require users to independently set up task parameters. This article introduces an open-access online tool with a simple interface for finite element analysis of postmortem convective heat transfer of the human head. The tool is designed to determine the time of death through cranioencephalic thermometry of the corpse.

Aim: To develop an online tool for finite element analysis of postmortem convective heat transfer of the head.

Materials and methods: A scalable finite element model of the head, approximated as a multi-layered sphere, was created. The model consists of 1,311 nodes and 9,277 finite elements. A computational algorithm was developed to calculate the initial and postmortem temperature fields of the head using the Python 3.

Results: The Simple Finite Element Model of Postmortem Convective Heat Transfer of the Head online application was developed. It considers the specifics of the initial temperature field, dimensions and thermophysical properties of the primary anatomical layers of the head, intensity of convective heat transfer, diagnostic point coordinates, and variations in external temperature during the cooling process. The application generates cooling curves at the diagnostic point and the head surface during the first 24 hours postmortem, providing numerical data, geometric and mesh properties, and temperature distribution along the integration contour from the model’s center to the diagnostic point.

Conclusion: The developed solver requires neither high-performance computer systems nor specialized user training. This feature makes the proposed online tool applicable in forensic practice for determining the time of death using cranioencephalic thermometry of corpses.

Head injuries are among the most serious and severe types of trauma in both peacetime and wartime conditions. This article examines head injuries sustained during various large-scale military conflicts and identifies correlations between the localization and nature of injuries, the tactics of combat operations, the weapons used, and the terrain features. This analysis is particularly relevant in light of the ongoing special military operation and may be utilized in the development of individual protective gear and strategies for treating head injuries in field hospitals.

The article incorporates scientific and specialized literature sourced from eLibrary, ResearchGate, CyberLeninka, and PubMed. A statistical and systemic-structural analysis of the literature was performed using methods such as description, comparison, generalization, and hypothesis formulation. The authors analyzed the Syrian Civil War, as well as the military operations “Iraqi Freedom” and “Enduring Freedom.” Average injury characteristics were derived and classified into groups based on the type of affected structures for better visualization. We revealed that the nature of head injuries varies significantly depending on the specifics of the military conflict. However, the most commonly affected areas in any conflict remain the lower and upper jaw, the orbit, and the nasal region.

This article makes a significant contribution to medical research and may be of value to military physicians as well as researchers and engineers involved in the design and improvement of individual protective gear.

This article presents the prospects of histological and genetic diagnosis in cases of sudden cardiac death where primary autopsy findings do not reveal obvious pathological changes.

In recent years, the number of autopsy-negative sudden cardiac deaths has increased, creating a need for more precise diagnostic methods to determine the cause of death and potentially prevent such cases in the future. The article examines modern histological examination techniques for cardiac tissues, as well as molecular genetic testing approaches that may be useful in identifying subclinical conditions leading to sudden cardiac death.

Molecular genetic methods for investigating sudden cardiac death remain underexplored. To date, large-scale studies on the molecular genetic causes of such fatalities are lacking in Russia, highlighting the need for further research at the intersection of medical genetics, pathological anatomy, and forensic medicine.

This article provides a brief review of histological and genetic diagnosis of sudden cardiac death, where the authors propose integrating these methods into the diagnostic process to enhance their effectiveness in pathological and forensic medical practice. The authors emphasize the necessity of further research, including the application of advanced technologies in histological and genetic analysis, as well as big data analytics to identify new pathological mechanisms of sudden cardiac death.

Medical genetic counseling on predisposition to sudden cardiac death can help identify at-risk individuals and reduce mortality. In the future, it may become possible to establish links between genetic predictors of sudden cardiac death and defects in myocardial contractile protein expression, with subsequent confirmation using immunohistochemical analysis.

Осложнения внематочной беременности, особенно связанные с разрывом анатомических структур, могут приводить к внезапным критическим состояниям. Случаи внезапной смерти по умолчанию считаются насильственными, пока экспертиза не докажет обратное. Вскрытие является ключевым методом, проводимым судебно-медицинским экспертом для установления причины смерти.

В данной статье представлен предполагаемый случай неестественной смерти, который расследуется полицией. Молодая незамужняя женщина, проживавшая одна, была найдена мёртвой в своей комнате. Для установления причины смерти проведена судебно-медицинская экспертиза, по результатам которой обнаружены увеличенная в размерах матка и разрыв правой фаллопиевой трубы. Уровень β-хорионического гонадотропина человека в крови составил 5224,07 мМЕ/мл. Наличие внематочной трубной беременности подтверждено заключением гистопатологического исследования. Обнаружено также массивное кровоизлияние из места разрыва правой фаллопиевой трубы в брюшную полость с общим объёмом кровопотери 1946,7 мл, которое привело к развитию геморрагического шока. При гистопатологическом исследовании выявлены отёк лёгких, некроз почек и желудка, что свидетельствует о полиорганной недостаточности. Путём исключения других вариантов было установлено, что внезапная смерть наступила по естественным причинам.

This article commemorates the 100th anniversary of the birth of Vadim A. Sundukov (1924–2014), Doctor of Medical Sciences, Honored Professor of Astrakhan State Medical Institute, and Honored Physician of the Russian Federation. His life and career were inextricably linked to the Department of Forensic Medicine, science, and people dedicated to the pursuit of knowledge. At the core of his professional activity was educational and methodological work with students, reflecting his profound understanding of the importance of cultivating the ethical and moral foundations essential for future physicians in their medical practice.

Under Vadim A. Sundukov’s initiative, the significant merger of the Department of Forensic Medicine and the Bureau of Forensic Medical Expert Evaluation led to establishing the Astrakhan Forensic Medical Expert Evaluation and Educational Association. Professor Vadim A. Sundukov emphasized the development, expansion, and strengthening of the association’s facilities, enabling optimal organization of educational and operational facilities. This, in turn, significantly improved the quality of student training and the efficiency of expert activities.

Vadim A. Sundukov mentored a generation of highly qualified forensic medical experts and educators who continue his work across Russia and the CIS countries. His achievements earned him numerous medals and honorary titles, underscoring the high regard for his career and scientific contributions.

The article provides extensive information on Vadim A. Sundukov’s educational, scientific, medical, and public service activities, highlighting his importance in the history of forensic medicine and medical education in Russia. Vadim A. Sundukov’s contributions to the development of forensic medicine continue to inspire new generations of professionals.