[Forensic medical characteristic of hanging incidents among juvenile]. / Sudebno-meditsinskaya kharakteristika sluchaev povesheniya sredi nesovershennoletnikh.

THE AIM OF THE STUDY: Was to conduct the epidemiological analysis of juveniles' deaths by hanging, registered in the Bureau of Forensic Medical Expertise, Moscow for 2017-2021 years. The number of incidents equal 61 was revealed (2.65% of whole hanging incidents for the researched period). The amount of hanging deaths among juveniles and their percent in the total quantity of deaths from this type of strangulated asphyxia increased in 2017, 2018 and 2019 years to 8 (1.6%), 15 (3.1%) and 18 (3.6%) incidents respectively; decreased in 2020 year to 7 (1.7%) incidents and increased again in 2021 year to 13 (3.0%) incidents. Juveniles died by hanging were mostly male (73.8%) aged from 15 to 18 years (63.9%). The median age for girls was 16 years (IQR 15.0-16.75) and for boys 15 years (IQR 13.0-16.5). Most of juveniles' corps were found in their place of residence: in apartments or residential houses (the whole number was 49 or 80.4%). Generally, juvenile hanging occurred between November and January (36.1% of all incidents) and in April (11.5%); less frequently were in February (1.6%), June and July (9.8%). Alcohol was found in blood of 18.2% juveniles aged from 15 to 18.

[Dissection technique for organs of the neck in hanging]. / Tekhnika sektsionnogo issledovaniya organokompleksa shei pri poveshenii.

The aim of this study is to develop a comprehensive dissection technique to examine the deep structures of the neck in hanging, including extraction of the cervical spine and investigation of the removed segment with access to vertebral arteries and spinal cord. Its advantages include the unnecessity of any special instruments usage, the short period of time, which is necessary for performing dissection techniques, as well as the possible detailed examination of the spine, spinal cord and vertebral arteries. The improved dissection technique simplifies the diagnosis of injuries and increases the objectivity of the forensic medical examination in hanging.

[Morphofunctional characteristics of the heart in sudden death of children under 1 year of age in the forensic medical aspect]. / Morfofunktsional'naya kharakteristika serdtsa pri vnezapnoi smerti detei do 1 goda v sudebno-meditsinskom aspekte.

The aim of this study is to describe the morphological and functional characteristics of the cardiac in sudden infants death syndrome (SIDS) in children under one year of age. Twenty eight cases of SIDS were studied histologically and immunohistochemically. Histological examination of the sectional material was carried out using standard and additional stains. The study of cardiac muscle tissue with routine staining with haematoxylin-eosin revealed interstitial oedema, uneven plethora of blood vessels: dystonia and weak plethora of part of the coronary arteries, excess of red blood cells in the veins as well as microcirculatory plethora with stasis of the erythrocytes. An immunohistochemical study revealed a mild over expression of p53 in cellular elements, small-focal expression of CD68 in cardiomyocytes apoptosis intramural areas, activation of mast cells (CD117), expression of ki-67 in macrophages, proliferation of fibroblasts. Additional forensic criteria for the diagnosis of SIDS were determined in the form of atrial endocardial fibrosis and interventricular septum; the expression of CD68, CD117 in fibroblasts, mast cells and lymphocytes; apoptosis of cardiomyocytes (expression of p53), proliferation of fibroblasts and remodeling of the heart (expression of ki-67).

[Morphological markers of liver function in alcohol intoxication]. / Morfologicheskie markery funktsional'noi aktivnosti pecheni pri alkogol'noi intoksikatsii.

The aim of this study was to find additional diagnostic markers characterizing the functional state of the liver to substantiate the cause of death from ethanol poisoning. A total of 95 deaths from acute ethanol poisoning and 15 deaths from craniocerebral injury were studied. Signs of steatosis, chronic hepatitis or cirrhosis were taken into account in histological examination of the liver. The histochemical activity of ethano-locking enzymes was determined in structurally functional zones of the acini: portal pathways (Zone 1), liver beams (Zone 2) and central veins (Zone 3). Quantitative indices characterizing functional-metabolic activity of the liver during acute ethanol poisoning were obtained.

[Determining the prescription of brain injuries based on the changes of the nucleolus organizer in astrocytes]. / Opredelenie davnosti povrezhdenii golovnogo mozga po izmeneniiam iadryshkovogo organizatora v astrotsitakh.

The well apparent signs of the proliferative reaction and activity of the nucleolus organizer in astrocytes within the zone of injury and at its periphery are considered to be the indicators of the participation of these cells in all the phases of the inflammatory and reparative processes associated with the brain injury. The objective of the present study was the evaluation of the changes in the number of the nucleoli in the nuclei of astrocytes during the acute post-traumatic period following the craniocerebral injury. A total of 26 cases of death of the men and women at the age from 36 to 50 years caused by the craniocerebral trauma were available for the examination. The tissue samples were stained with hematoxylin and eosin, based on the use of the Perls' Prussian blue staining protocol or by means of the AgNOR staining technique. The astrocytes in the regions immediately adjacent to the sites of brain injury were shown to undergo areactive necrosis during the first hours after the damage had been inflicted. The evaluation of the changes in the astrocytes required taking into consideration the influence of autolysis on the character of the signs being identified. The increase of the number of points in the astrocytes in which RNA replication occurs within days 2-4 after the injury can be accounted for by the accumulation of the granules containing silver in the cell nuclei. The cross reactions between hemosiderin and RNA await further investigations. It is concluded that the methods employed in this study may be of diagnostic significance for the purposes of forensic medical histology if used in the combination with other specialized techniques for determining the prescription of the craniocerebral injuries. The combination of the morphological and functional studies opens up the promising prospects for the investigations into the necrotic and proliferative processes in astrocytes associated with brain injuries of different origin.

[The morphological characteristic of the cerebellar cortex in the case of a burning injury]. / Morfologicheskaia kharakteristika kory mozzhechka pri ozhogovoi travme.

The objective of the present study was the development of the additional forensic medical criteria for the diagnostics of the intravitality and prescription of the burning injury making use of the morphological changes in the cerebellar cortex. A total of 82 cases of the death from the second- and third a, b-degree flame burns in 63 men and 19 women at the age from 20 to 65 years were available for the analysis. The condition of the cerebellar cortex was evaluated within 0 to 72 hours after the trauma had been inflicted. The routine histological staining technique using hematoxylin and eosin were employed as well as the Nisslin staining carried out in the combination with the immunohistochemical reaction based on the application of the antibodies against the glial fibrillary acidic protein (GFAP). In the case of death during the acute period after the burning injury, the histological study revealed a characteristic complex of the morphological features including the acute swelling of neurons, the increasing expansion of perivascular and pericellular spaces, as swell as hyperoxyphilia of microglia. The astrocytes of cortical II-III layers proved highly sensitive to tissue hypoxia as appears from their reaction with anti-GFAP antibodies. It is concluded that the results of the evaluation of the blood supply of the cerebral hemisphere cortex with the use of immunohistochemical methods may be helpful as the additional criteria for the purpose of forensic medical documentation of intravitality and prescription of the burning injury.

[Forensic medical determination of the age based on the analysis of CT-scanograms of the skull and the craniovertebral region in the sagittal projection]. / Sudebno-meditsinskoe ustanovlenie vozrasta po KT-skanogrammam cherepa i kraniovertebral'noi oblasti v sagittal'noi proektsii.

The objective of the present study was to determine the biological age of the unrecognized individuals based on the analysis of CT-scanograms of the skull and the craniovertebral region in the sagittal projection. We investigated the structure of the spongy substance of the clinoid plate of the sella turcica and the clivus of the cranium, involution of the vertebrae configuration in the medial atlantoaxial articulation, frontal and sphenoidal sinuses. A total of 80 skulls of Caucasoid individuals at the age ranging from 4 to 84 years belonging to an Eastern Slavonic population (free from the pathological lesions in the above cranial structures) were available for the examination. The results of the multifactorial analysis gave evidence of the possibility to estimate the age of individual subjects based on the comprehensive aggregate qualitative and quantitative characteristic in the framework of the linear regression model by making use of the age-related changes in the frontal and sphenoidal sinuses, the sella turcica and the clivus of the cranium, the first and the second cervical vertebrae with an accuracy to within 6 years. It is concluded that the application of the systems for the automated statistical analysis of the images for the purposes of forensic medical expertise would allow to obtain the results of great practical and scientific value.

[The forensic medical characteristic of sudden death associated with metabolic syndrome]. / Sudebno-meditsinskaia diagnostika vnezapnoi smerti pri metabolicheskom sindrome.

The detection of grade II-III central obesity on a corpse in conjunction with the identification of two additional criteria (such as arterial hypertension and impaired glucose tolerance) provides, if combined with the autopsy data (including the visual reduction of muscular mass, the increased total amount of the adipose tissue, gynecomastia in men together with hypertrophied abdominal adipose tissue accumulation, decreased face and body pilosis), a basis for diagnostics of metabolic syndrome (MS). The objective parameters for this purpose are waist circumference measurements, corpse weight and height, the degree of visceral obesity, narrowing of the renal arteries as a result of their compression by the surrounding adipose tissue, and accumulation of epicardial fat confirmed by the results of the biochemical analysis. The signs of plasmorrhagia combined with fibrinoid degeneration of the vascular walls in the microcirculatory bed make it possible to suspect, with a high degree of probability, the development of hypertensive crisis that may result in a sudden death of the patients presenting with metabolic syndrome.

[Forensic medical expertise of the deaths by drowning in a bath].

The objective of the present work was to estimate the incidence and characteristic features of the deaths by drowning in living apartments of Moscow as exemplified by the South-Western administrative district and nearby areas. Because the majority of the known and described morphological signs can not be considered as associated exclusively with drowning, new criteria for the assessment of this condition and the enhancement of reliability of the data obtained need to be developed. The author maintains that this goal could be achieved through a more close cooperation between forensic medical experts and law enforcement officers.

[Forensic medical characteristic of the thermal injury caused by inflammation of combustible fluids].

The diagnostics of thermal injuries caused by inflammation of combustible fluids should be based on the comprehensive assessment of the results of examination of the scene of the accident, autopsy studies, forensic chemical expertise, and analysis of the circumstances of the case and/or medical documentation. Special attention should be given to the choice of adequate methods for taking samples to be used in forensic chemical studies. The assessment of thermal injuries caused by inflammation of combustible fluids must take into consideration the time and conditions under which they were inflicted (e.g. closed or open space, vertical or horizontal position, etc.).

[Forensic medical evaluation of pancreatic lesions in cases of lethal hypothermia].

The objective of the present study was to evaluate changes in the human pancreas in case of lethal hypothermia (LH). Scarce data available from the forensic medical literature give evidence of considerable morphological changes in the pancreas including irregular blood filling with areas of venous hyperemia, focal spasm of arterioles, slowed down autolysis, spasm of pancreatic ducts in the absence of desquamation of their epithelium into the lumen, secretion deposited and visualized in accessory cells. Hepatitis develops despite general hypothermia. Morphological alterations in Langerhans islets and qualitative changes in the relative number of endocrinocytes remain to be assessed more thoroughly.

[The variant of forensic-medical examination of the hypothalamic-hypophyseal system in cases of death due to a mechanical trauma].

The authors propose the method of total isolation of the hypothalamic-hypophyseal system for more effective study of causes of death in craniocerebral injury and pathology in expert practice. The method can be also applied for making an anatomic preparation of the brain and hypophysis in teaching anatomy.

[Determination of a mechanism of the coming of death by morphological methods in strangulation mechanical asphyxia].

Described in the paper are morphological data characterizing the tempo and type of thanatogenesis in strangulation asphyxia. The cerebral thanatogenesis was shown to prevail in mechanical asphyxia. The results of determination of a degree of hydration of the brain by drying its samples are described. Medullary substance was demonstrated to be hypohydrated in such death.

[Pathomorphological manifestations of various forms of alcohol disease]. / Patomorfologicheskie proiavleniia razlichnykh form alkogol'noi bolezni.

In acute poisoning with ethanol a cardiac variant of tanatogenesis prevails. Signs for ethanol surrogates of DIC syndrome are more characteristic. Alcohol cardiomyopathy and liver cirrhosis are typical as causes of death for chronic forms of alcoholic disease. Histochemical features in the brain are found characteristic for some forms of alcoholic disease.

[Forensic and medical evaluation of vascular malformations of the brain in cranio-cerebral trauma]. / Sudebno-meditsinskaia otsenka sosudistykh mal'formatsii golovnogo mozga pri cherepno-mozgovoi travme.

A classification of vascular malformations (VM) is defined in the article including a differentiation between their macroscopic and histological variations; an independently-authors-observed case of arterial-and-venous malformation (AVM) in a minor cranial-cerebral trauma (CCT) is described. Published data reflecting the forensic-and-medical value of AVM and cavernous malformations as well as of telangectasias and of arterial-and-venous fistulas in minor head traumas are analyzed. Issues of the forensic-and-medical expertise of VM and remote consequences of CCT are under consideration. VM are assessed in CCT patients with epilepsy and other pathologies. An algorithm of the forensic medical expertise of VM is suggested.

[Mycotic lesions in the brain in chronic opium-ephedrone addiction]. / Mikoticheskoe porazhenie golovnogo mozga pri khronicheskoi opiino-éfedronovoi narkomanii.

Histological examination of the brain of a opium-ephedrone addict has detected large spherical cells resembling Coccidioides or Paracoccidioides spherules. Roundish and oval structures were found in subependymal space of the fourth ventricle. These structures may be spores of many fungi. Areas of normal structure and these with productive inflammation were observed in the surrounding nervous tissue.

[Thanatogenesis variants in drug use poisoning]. / Varianty tanatogeneza pri otravlenii narkotikami.

The study of 179 autopsy cases of narcotic poisoning has distinguished four main types of tanatogenesis, the "brain death" being most frequent. The second type was tanatogenesis by type of "sudden cardiac death" with ventricular fibrillation. The third one is tanatogenesis by type of "toxic edema of the lungs" with severe respiratory failure. Rare types of tanatogenesis were acute adrenal failure, anaphylactic shock and others. Combination of several tanatogenesis types was frequent.

[Role of alcoholization in pathogenesis of morphological changes in substance abusers]. / Rol' alkogolizatsii v patogeneze morfologicheskikh izmenenii u narkomanov.

Morphological manifestations of combined intoxication with ethanol and narcotics are described. Special attention is paid to changes in the liver which were studied both qualitatively and quantitatively. Specific features in the pathological processes concomitant with combined intoxication are described; high incidence and expression of morphological markers of alcoholism in subjects abusing both ethanol and narcotics in comparison with "pure" alcoholics were determined. These features can be used in forensic medical and pathological (autopsy) diagnosis of chronic narcotic intoxication and its combination with alcoholism.