[Problems of expert application of «Medical criteria to determine the severity of harm caused to human health¼ in closed injury of the shoulder joint]. / Problemy ekspertnogo primeneniya «Meditsinskikh kriteriev opredeleniya stepeni tyazhesti vreda, prichinennogo zdorov'yu cheloveka¼ pri zakrytoi travme plechevogo sustava.

The represented analysis shows the mechanism of formation of traumatic shoulder dislocation and potential intra-articular anatomic-morphological damages of humeral head according to the Hill-Sachs type in order to objectify the criteria of determination the severity of harm caused to human health. The potential Hill - Sachs classifications of shoulder dislocation are considered depending on size of humeral head defect. During the period of 2015 to 2020, 250 «conclusions¼ of forensic investigations of patients with the injuries of the shoulder joint were analyzed, performed by an expert traumatologist. It was identified, that in 8 patients with shoulder joint dislocation among 32 cases of shoulder injury, experts interpret this injury as a severe harm caused to human health without sufficient justification, using the conclusions of radiology specialists who gave a very brief description of X-rays indicating the diagnosis «fracture of humeral head according to the Hill-Sachs type¼. The severe harm caused to human health was detected correctly only in 2 patients with impression fracture of humeral head.

[Primary injuries of corpus callosum vessels in craniocerebral injuries]. / Pervichnye povrezhdeniya sosudov mozolistogo tela pri cherepno-mozgovoi travme.

The aim of the scientific work is to establish morphological characteristics of hemorrhages in the corpus callosum as a marker of primary vascular injuries in diffuse axonal injury (DAI) in relation to the goals and objectives of forensic examination. Changes in the structures of corpus callosum were analyzed in 45 corpses of persons with traumatic brain injury who died in hospital from DAI diagnosed according to clinical and instrumental data within 24 hours after the trauma. The changes were characterized by rectic hemorrhages (haemorrhagia per rhexin) in combination with successively developing vascular, tissue, and cellular post-traumatic reactions. These changes were not observed in the control group. The following morphological characteristics of hemorrhages were established: small focal, elongated, clearly contoured hemorrhages of different sizes, up to 4 mm long, up to 0.8 mm wide, unidirectional at an angle from the lower to upper surface of the sagittal corpus callosum section, at least three, grouped in limited areas sized up to 1.5 × 1.0 cm without clear borders. The detected hemorrhages and the course of changes give reason to consider them the result of primary traumatic effects, making them a diagnostic marker of DAI.

[Morphological markers of pathophysiological changes in the neuronal processes in the acute post-traumatic period of diffuse axonal injury]. / Morfologicheskie markery patofiziologicheskikh izmenenii otrostkov neironov v ostrom posttravmaticheskom periode diffuznogo aksonal'nogo povrezhdeniya mozga.

The purpose of the study was to establish morphological markers of pathophysiological changes in the neuronal processes of in the acute (up to 36 hours) post-traumatic period of diffuse axonal injury (DAI) for the purposes of expert practice. Histological examination of the body of corpus callosum of the corpses of 66 persons dead from DAI and of 25 persons dead from various non-violent and violent causes, excluding head trauma, was performed (control group). Morphological markers of specific pathophysiological changes in the neuronal process were established by light microscopy with the use of immunohistochemical examination in acute period DAI. Uneven contours of the processes suggested displacement of cytoskeletal elements, areas of vacuolization of the cytoplasm of the processes suggested violation of intracellular transport caused by a change of permeability with preserved integrity of the process shell without mechanical separation of the process, uneven thickness (3.9 ± 1.6 µm) of the processes, varicose and cone-shaped thickening of them was a manifestation of focal edema of the neuronal process and compression of the cytoskeleton as a result of ion-enzymatic disorders, uneven coloration, areas of fragmentary compaction of neurofilaments indicated the zones of deformation and compression of the cytoskeleton, zones of granular-lumpy decay and fibrillolysis of neurofilaments indicated destruction of the cytoskeleton. Changes in the neuronal processes are a manifestation of a polyethological general pathological process and are not a differential diagnostic criterion of DAI.

[Expert errors in formulating a forensic diagnosis and conclusions in cases of diffuse axonal brain damage]. / Ekspertnye oshibki pri formulirovanii sudebno-meditsinskogo diagnoza i vyvodov v sluchayakh diffuznogo aksonal'nogo povrezhdeniya mozga.

The study objective is to review expert errors in the wording of a post-mortem diagnosis and expert conclusions in cases of traumatic brain injury with diffuse axonal brain damage. We reviewed 50 corpse examinations of those who died from a traumatic brain injury with diffuse axonal brain damage. A retrospective analysis of the results of expert examinations, the structure of the post-mortem forensic diagnosis, and the validity of expert conclusions showed that expert errors were made in 30% of cases. In 93% of cases, the errors were epistemological due to the lack of a scientifically based methodological approach to the expert opinion on a particular mechanism for the development of traumatic brain injury with diffuse axonal brain damage; and lack of professional expertise. A case is provided demonstrating the most common expert errors in the examination of this type of traumatic brain injury.

[Medical expert evaluation of medical care for patients with musculoskeletal injuries]. / Mediko-ekspertnaya otsenka okazaniya meditsinskoi pomoshchi patsientam s travmami oporno-dvigatel'nogo apparata.

The objective of the study is to analyze 220 forensic medical examinations on criminal and civil cases and pre-investigation checks concerning the quality of emergency trauma care, involving an orthopedic traumatologist as a member of the expert panel. The main aspects of the forensic evaluation of medical care for patients with musculoskeletal injuries are described, including a thorough review of medical documentation data, completeness of past and present medical history in the medical records, injury mechanism, and completeness of the trauma course description in the medical records. The reasons for the forensic examinations, the causes of the main types of defects in medical care, and their relation to adverse outcomes were determined.

[Clinical presentation and gross appearance of diffuse axonal injury in the early post-injury period]. / Klinicheskaya i makroskopicheskaya kharakteristika diffuznogo aksonal'nogo povrezhdeniya mozga v ostrom posttravmaticheskom periode.

The objective of the study was to investigate and characterize the clinical presentation, and establish macroscopic diagnostic signs of diffuse axonal injury (DAI) in the early (up to 3 days) post-injury period. In DAI, coma develops immediately after head injury and persists for 3 days post-injury until death. The coma is accompanied by dominant primary stem neurological symptoms, hemodynamic and respiratory disturbances and does not progress to a vegetative state. Lifetime computed tomography reveals cerebral hemorrhage in 40.5% of cases. We established the macroscopic signs of head injury in DAI. For the postmortem diagnosis of DAI, a detailed macroscopic appearance of pathognomonic cerebral hemorrhages is given, which are most frequently (67.5%) localized in the corpus callosum (CC), namely in the area from its genu to the middle of the trunk (97%). A rational, improved scheme of excision of CC trunk areas for the histological study is proposed.

[Prevention of adverse events following the use of local anesthetics in traumatology and orthopedics]. / Profilaktika nezhelatel'nykh sobytii pri primenenii mestnykh anestetikov v travmatologii-ortopedii.

The article analyzes the frequency of development of adverse toxic reactions when using local anesthetics in the practice of an orthopedic traumatologist; based on the conclusions of commission forensic medical examinations conducted in the framework of criminal proceedings on the death of patients, the features of the onset of LAST syndrome are studied, which significantly increases the medical risk for the patient and the legal risk for the doctor. An analytical study of scientific publications on the possibilities of using the local anesthetic Articaine-Binergia 20 mg/ml in the daily work of both polyclinic and inpatient doctors to ensure the safety of medical activities was conducted.

[Problems of forensic diagnosis of diffuse axonal brain injury in the acute post-traumatic period]. / Problemy sudebno-meditsinskoi diagnostiki ostrogo perioda diffuznogo aksonal'nogo povrezhdeniya golovnogo mozga.

The article refers to actual problems of forensic diagnostics of diffuse axonal brain injury in the acute post-traumatic period, that is of particular importance in the case of head trauma in conditions of non-evidence. To solve the existing problems, it is necessary to conduct a comprehensive study aimed at improving the diffuse axonal brain injury examination by developing a unified methodological approach to running the forensic medical diagnostics of this form of traumatic brain injury and determining the duration of the acute (up to three days) post-traumatic period.

[Methodology for forensic diagnosis of diffuse axonal injury]. / Metodologiya sudebno-meditsinskoi diagnostiki diffuznogo aksonal'nogo povrezhdeniya golovnogo mozga.

An original methodological approach for forensic diagnostics of diffuse axonal injury (DAI) was developed based on the comprehensive study results. The approach is based on the algorithm of expert actions, including utilizing the developed rational methods set to identify pathognomonic morphological features using accessible and effective histological techniques. Also, the approach includes ways of analysis and estimation of these features. The proposed methodological approach aims to provide an objective diagnosis of this type of traumatic brain injury (TBI) and establish the age of its acute post-traumatic period. The known and generally accepted definitions of DAI and TBI are clarified.

[Diagnostic mistakes in diffuse axonal brain injury]. / Oshibki pri diagnostike diffuznogo aksonal'nogo povrezhdeniya mozga.

Based on the study results it were identified and systematized the most common deficiencies and mistakes that negatively affect the diagnosis of diffuse axonal brain injury and its genesis detection in the early post-traumatic period. It makes possible to organize correctly the diagnostic process and prevent an erroneous assessment of morphological changes in the brain during the examination of traumatic brain injury.

[The original method for corpus callosum autopsy study in the case of diffuse axonal brain injury]. / Original'nyi sposob sektsionnogo issledovaniya mozolistogo tela pri diffuznom aksonal'nom povrezhdenii golovnogo mozga.

The article offers an original method for human corpus callosum autopsy examination in the case of diffuse axonal injury (DAI) and a rational scheme for sampling its zones for microscopic examination, aimed at determining the morphological characteristics of injuries, taking into account their anatomical and topographic localization. The results of the comparative study prove the objectivity and high efficiency of the proposed approach to post-mortem diagnosis of DAI.

[Axotomy in the postmortem diagnosis of diffuse axonal brain injury]. / Aksotomiya v posmertnoi diagnostike diffuznogo aksonal'nogo povrezhdeniya golovnogo mozga.

The results of the study of the significance of axotomy in the postmortem diagnosis of diffuse axonal brain damage are presented. In the corpus callosum, two main types of changes in the processes of neurons were found: damage to the processes without mechanical rupture and axotomy. The revealed polymorphism of damage to the processes of neurons indicates the heterogeneity and staging of pathological processes caused both by the trauma itself and by developing reactive post-traumatic changes. Severe damage to the processes is secondary and not earlier than 2 days after the injury lead to axotomy, the morphological manifestation of which is retraction balls with a diameter of 15.5±6.33 µm, detected by staining with hematoxylin and eosin. Research results indicate that axotomy should not be differentiated into primary and secondary.

[Postmortem diagnostic of diffuse axonal injury considering histoarchitectonic of the corpus callosum]. / Posmertnaya diagnostika diffuznogo aksonal'nogo povrezhdeniya s uchetom gistoarkhitektoniki mozolistogo tela.

The results of studying the morphological signs of diffuse axonal injury (DAI) postmortem diagnosis in the brain are presented. It was investigated the histoarchitectonics of the corpus callosum in various types of non-violent and violent death. In the indusium griseum of the corpus callosum, neurons were identified; the features of the morphology and the interposition of the neurons processes, glia and vessels in various parts of the corpus callosum were studied. Taking into account the revealed architectonics of the corpus callosum, changes in DAI were determined. It was found that the main diagnostically significant morphological sign of DAI is hemorrhages localized in the trunk and indusium griseum on sagittal corpus callosum sections, which may be important in solving expert questions about the morphogenesis of hemorrhages in the corpus callosum.

[Determination of a person's growth by the parameters of the scapula]. / Opredelenie dliny tela cheloveka po otdel'nym parametram lopatki.

The aim of the work is within the framework of medical and forensic medical identification developing of scientifically based diagnostic criteria for determining growth by the parameters of the scapula. We examined 108 corpses aged 19 to 99 years old. from the Central region of Russia in 2016. Death reasons: cardiovascular diseases, acute poisoning with ethanol and/or narcotic drugs and concomitant mechanical trauma. Were used research's methods: morphological, morphometric, osteometric and as well mathematical statistics. New formulas have been obtained to determine the body's growth by individual parameters of the scapula. Using those formulas will make possible to reasonably reduce the range of osteological studies aimed to targeted recruitment of a specific material, which will reduce the time and economic costs in general for conducting morphometric studies of bones, as well as increase the evidentiary value of expertise in criminal proceedings.

[New forensic criteria for identification of person using shoulder blade]. / Novye sudebno-meditsinskie kriterii identifikatsii lichnosti po lopatke.

The purpose of study is the development of scientifically based diagnostic criteria for determining body length, age, gender and degree of muscle development by individual parameters of the shoulder blade to identify the person. The material was 108 corpses of people aged 19 to 99 years old from the Central region of Russia in 2016, whose death came from diseases of the cardiovascular system, acute poisoning with ethanol and/or narcotic drugs, combined mechanical injury to the body. We used morphological, morphometric and osteometric research methods, as well as methods of mathematical statistics. New methods have been developed to determine the body length, gender, age and degree of muscular development by individual parameters of the shoulder blade with a high degree of reliability. Using the proposed methods will reduce the number of osteological studies, reduce economic and time costs in general for conducting morphometric studies of bones, as well as increase the evidence-based significance of expertise in criminal proceedings.

[Features of obtaining of biological material during emergency incidents with human victims, its referral and forensic chemical examination]. / Osobennosti iz"yatiya, napravleniya i provedeniya sudebno-khimicheskoi ekspertizy biologicheskogo materiala pri chrezvychainykh situatsiyakh s chelovecheskimi zhertvami.

In this article, we consider features of the referral of biological material and assessment of medical and legal chemical researches at emergencies of technogenic character, plane crashes, the fires with the numerous human victims. Practical recommendations on obtaining of biological material for a research on volatile organic compounds, including ethyl alcohol and its metabolites, volatile products of burning, including monoxide of carbon and cyanides are made. Features and the recommended order of conducting judicial and chemical examination at emergencies are designated.

[The age-specific changes in the glenoid cavity of scapula]. / Vozrastnye izmeneniia sustavnoi vpadiny lopatki.

The objective of the present study was to develop the diagnostic criteria for the medical criminalistic identification of the age group of the subjects based on the age-specific changes in the glenoid cavity of scapula. A total of 108 scapulae were available for the examination; they were obtained from the persons at the age between 19 and 99 years who had died from cardiovascular diseases, acute intoxication with ethanol and/or narcotic drugs, and a combined mechanical injury. The morphological, osteometric, and statistical methods were used. The data obtained made it possible to propose the morphological criteria that might be instrumental in decreasing the number of osteological studies and thereby reducing the financial burden associated with morphological studies of the skeleton. Moreover, they are likely to increase the evidentiary value of the expert conclusions.

[Forensic medical peculiarities of mechanical strangulation asphyxia in the hanged subjects aged above 50 years].

This paper presents the qualitative and quantitative characteristics of the morphological manifestations of mechanical strangulation asphyxia in the hanged subjects aged 50 years and the elder ones. In addition, the new diagnostic approaches to the expert confirmation of this condition are proposed.

[The problems of expert evaluation of the results of forensic chemical investigations of clozapine in the biological material].

The objective of the present review was to analyse the problems of expert evaluation of the results of forensic chemical investigations of clozapine in the biological material. Such an analysis is needed because many topical aspects of the quantitative evaluation of toxic clozapine concentrations remain unclear. The treatment with clozapine is associated with its accumulation in blood in concentrations up to 2 mg/l in the absence of any toxic effect allegedly due to the development of tolerability of this agent. In the tolerant patients the ratio of the main clozapine metabolite, norclozapine, to clozapine itself in the serum amounts to 0.6-0.9. This value falls down to 0.3-0.4 in case of acute intoxication. In the case of identification of other pharmaceutical products narcotic drugs together with clozapine their influence on the activity of enzymes responsible for clozapine biotransformation should be taken into consideration. The concomitant intake of clozapine and alcohol may be dangerous for the clozapine-intolerant subjects. It is concluded that the above observations must be borne in mind in the assessment of the results of forensic chemical analysis.

[Biochemical diagnostics of fatal opium intoxication].

Biochemical diagnostics of fatal opium intoxication remains a topical problem in forensic medical science and practice. We investigated materials obtained in the course of forensic medical expertise of the cases of fatal opium intoxication. The study revealed significant differences between myoglobin levels in blood, urine, myocardium, and skeletal muscles. The proposed approach to biochemical diagnostics of fatal opium intoxication enhances the accuracy and the level of evidence of expert conclusions.