Legal medicine
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Basic fibroblast growth factor (bFGF) is a highly conserved and ubiquitously distributed mitogen, and much is known at the molecular level. However the available information about in vivo distribution in human tissues and expression changes in relation to causes of death is not sufficient. The present study investigated 35 autopsy cases, comprising five cases for each cause of death: acute myocardial infarction/ischemia (AMI), mechanical asphyxiation, blunt brain injury, drowning, hypothermia, intoxication and sharp instrument injury. ⋯ High positivity in the brain was seen for intoxication, but AMI, mechanical asphyxiation and drowning showed lower positivity. For the heart, spleen and pancreas, there was no evident difference among the causes of death. These findings suggested that bFGF expression in the lung, liver, kidney and brain varies depending on the cause of death, and is useful for investigating deaths.
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There have been an abundance of challenging publications on biochemical procedures for investigating death. However, such procedures do not appear to have been effectively incorporated in routine casework. Biochemical profiles at autopsy may show considerable case variations due to various factors involving preexisting disorders, the cause of death, complications, the survival period, and postmortem changes, distributions and localizations of analytes. ⋯ For this purpose, the usefulness of comprehensive analyses of pathological and biochemical findings is suggested as part of laboratory investigations, comprising morphology, toxicology, microbiology, biochemistry and molecular biology, along with diagnostic imaging procedures. These procedures can be effectively incorporated into a 'full autopsy' in the context of risk management. The application of these procedures may depend on the concept of medicolegal autopsy, and it is essential to establish postmortem databases through routine casework.
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To analyze pathophysiological dynamics of the death process using mRNA quantification, previous studies investigated pulmonary surfactant-associated protein (SP-A), as well as hypoxia-inducible factor 1 (HIF-1) and its downstream factors. Quantitative assays of these mRNA transcripts were established using TaqMan real-time RT-PCR. Experimental studies showed that most of these factors in forensic autopsy materials gradually degraded in patterns similar to those of endogenous references during the early postmortem period within 48h; postmortem interference might not usually be significant in relative mRNA quantification. ⋯ Further analyses of VEGF and GLUT1 mRNA in the lung and skeletal muscle shed light on tissue ischemia/hypoxia and subsequent tissue-dependent pathological changes leading to death after injury. Animal experiments partly supported the above-mentioned findings and also suggested further potential mRNA targets for practical use. These studies on postmortem quantitative mRNA analyses might offer insight into pathophysiological mechanisms in the death process, suggesting that systemic postmortem quantitative mRNA analyses from multi-faceted aspects of molecular biology can be developed and incorporated into death investigations in forensic pathology, to support and reinforce morphological evidence.
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Case Reports
Pathological and biochemical analysis of the pathophysiology of fatal electrocution in five autopsy cases.
Five autopsy cases involving electrocution were examined to determine the pathophysiology of death. Cases 1-4 (industrial accidents: about 160-3800 V-AC) showed pathological findings of acute death, whereas Case 5 (suicide: 100 V-AC) showed those of subacute death. Electrical marks were observed as collapsed blisters with/without charring in Cases 1-4, and markedly charred burns with erythema in Case 5. ⋯ Case 5 showed findings of prolonged hypoxia and skeletal muscle injury involving elevations in serum uric acid and creatinine, and a typical pattern of acute respiratory distress in pulmonary surfactant immunostaining. These findings suggest that the main fatal factors were acute circulatory failure following myocardial injury in Cases 1 and 2, more advanced myocardial injury in Cases 3 and 4, and respiratory failure due to skeletal muscle injury in Case 5. The present study suggested that the mode of death due to electrocution might be closely related to the macromorphology of electrical marks.
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Jehovah's Witnesses love life and do whatever is reasonable in order to prolong it. Hence, they seek quality health care and accept the vast majority of medical treatments. However, for Bible-based religious reasons, Jehovah's Witnesses do not accept allogeneic blood transfusion. ⋯ Also, the treatment for minors often becomes an issue. When a patient is a mature minor, his wishes should be respected. In the case of a minor patient lacking decision-making capacity, the wishes of the parents should be respected as much as possible.