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Bungarus multicinctus (B. multicinctus) is one of the top ten venomous snakes in China, ranking first in lethality at 26.9–33.3%. However, to our knowledge, no forensic autopsy-related cases of death from B. multicinctus bite poisoning have been reported. There are surprisingly few reported cases of death from poisoning by other species of neurotoxic snakes. Neurotoxic snake venom is often highly toxic, and death can quickly occur when bitten in the wild if victims are not taken to a doctor in time. We presented a case of an adult female in Fujian Province of China who was bitten by a poisonous snake while digging for bamboo shoots in the mountains and died from the bite of B. multicinctus confirmed by enzyme-linked immunosorbent assays (ELISA) results. The autopsy's results, histopathological findings, and ELISA results reported here can be helpful for future forensic practice in B. multicinctus venom poisoning; we also briefly review the pathological changes of neurotoxin poisoning, which may be useful in other types of neurotoxin snake venom poisoning. [ABSTRACT FROM AUTHOR]

Objective assessment of cardiac hypertrophy in forensic pathology practice is of great significance for forensic pathologists, for whom reference values for normal heart weights are needed. Developed regions such as Europe, the United States, and Japan recalculate the weight of human organs at regular intervals, but in China, there has been no systematic calculation of the weights of human organs since 2006. To statistically analyse the heart weight of Chinese adults postmortem and obtain a reference range. 4170 adult autopsy reports were collected from 12 forensic departments in 10 provinces in China. The causes of death were classified by sex, and heart weight and the heart weight/body height ratio reference values were further calculated according to different body mass index and body heights. Finally, the cutoff value of cardiac hypertrophy in Chinese adults was calculated. In the group of non-cardiovascular disease causes of death, the cardiac weight of the electric death group was higher, while the heart weight of the prolonged bed-rest group was significantly reduced. After the electric death and prolonged bed-rest groups were excluded, heart weight, the heart weight/body height ratio, and cutoff values for cardiac hypertrophy were further classified and analysed according to body mass index. The mean reference values for heart weight in men and women with normal weight status were 325.82 ± 41.60 g and 286.39 ± 44.84 g, and the heart weight/body height ratios were 1.95 ± 0.23 in men and 1.82 ± 0.27, respectively. The cutoff values for cardiac hypertrophy were 387.35 g for men and 346.80 g for women. The heart weight reference values of both sexes in this study were significantly higher than those in 2006, which is considered related to the development of China's economy and the improvement of people's living standards. This study also suggests the need for a new round of statistical surveys and updated data on the weight of other organs. • This study proposes updated references values for normal heart weight in China. • Gender, age, and BMI should be taken into account to measure heart hypertrophied. • Normal heart weight does not exclude cardiac pathology as the cause of death. • Heart weight does not necessarily increase in cases of sudden unexplained death. [ABSTRACT FROM AUTHOR]

Occurrence of 3-rooted mandibular molar varies from one geographical and ethnic group to other. Its prevalence is very high in Asian and Asian-derived populations, particularly Aleuts and Eskimos. The recently revealed individual from Xiahe, China--recognized as Denisovan shows a 3-rooted lower permanent molar, giving a direct morphological link between archaic and recent Asian Homo sapiens population. This area of study is useful in archaeology, palaeontology, physical anthropology and forensic pathology/dentistry. Its application is also important in clinical dentistry. [ABSTRACT FROM AUTHOR]

Background: Accumulated degree-days (ADD) refers to the temperature value and time within a certain period. More and more attention has been paid to the ADD in the study of postmortem interval (PMI) estimation. Aim and Objective: This study is to confirm whether ADD is applicable in China. Materials and Methods: We collected meteorological data of 10 different regions in China for 12 months, analyzed the distribution characteristics of ADD in different regions at different time periods, and tested the two ADD calculation methods (accumulated hourly temperature and accumulated daily average temperature), in an attempt to establish a more precise calculation method of ADD. Results: The results show that when the yearly or monthly effective temperature data is taken as the research object, the law of daily ADD mean value gradually decreases from south to north, and the average value of accumulated hourly temperature at each region is larger than the average value of accumulated daily average temperature (the difference was significant). In addition, in different periods of each day, ADD obtained at different regions is different, and the variation of its specific gravity also has a north-south difference. We take the daily average temperature as the independent variable and accumulated hourly temperature as the linear equation fitted by the dependent variable, showing a good linear relationship (0.992 ≤ R2 ≤ 0.999). At the same time, we also identify that extra caution should be exercised when using ADD in some special regions (such as Lhasa) or during the cold season of some regions. It may be unrealistic to attempt divide daily ADD into equal parts and accurately estimate PMI to a certain hour on the day of the crime. However, accurate estimation of PMI can be improved by dividing ADD on the day of the crime according to proportion of different periods and checking the time period of the final ADD value. Conclusion: At present, the study results on ADD need to be further developed. our study provides a preliminary research basis for the future establishment of an unified, simple, accurate, and suitable for the ADD model in China. [ABSTRACT FROM AUTHOR]

Deinagkistrodon acutus (D. acutus), also known as the Chinese moccasin, is a viper species found throughout the southeastern parts of China, northern Vietnam and Laos. D. acutus envenomation can result in coagulopathy and lead to death if not treated correctly. A 20‐year‐old man was discovered with a severely swollen left thigh with overlying dark purple, discolored skin. He was immediately transported to hospital. Laboratory examinations revealed dysfunctional coagulation and fluid‐electrolyte imbalances. He died 2 h later despite resuscitation efforts. Surveillance footage revealed that he had walked through a grass field while returning home that night. Autopsy and pathological examination findings revealed a large area of muscle necrosis of the left thigh, renal tubular necrosis, and hepatocyte necrosis. Potential fang marks were found on the decedent's jeans. Due to our suspicions, we performed specific enzyme‐linked immunosorbent assays (ELISA) and detected D. acutus venom in the kidneys, left thigh muscle, liver, lung, spleen, and heart tissues of the decedent. In conclusion, the clinical manifestations, autopsy, histopathological examination, ELISA, and investigation results confirmed D. acutus envenomation. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is a coronavirus responsible for COVID-19 (coronavirus disease 2019) which resulted in a cluster of cases of pneumonia that originated in China around 31 December 2019 and has subsequently spread across the globe. Currently, COVID-19 represents a health emergency worldwide, leading, in severe cases, to pneumonia, severe acute respiratory syndrome, multiorgan dysfunction or failure, and death. In the context of limited scientific knowledge and evidence of SARS-CoV-2 infection, guidance is becoming increasingly necessary for pathologists who have to perform postmortem investigations on COVID-19 cases. The aim of the present report is to share a procedure applicable to cases of COVID-19-related death, particularly in cases of death without medical intervention and in the absence of an ascertained SARS-CoV-2 infection and/or COVID-19 diagnosis, therefore providing support for diagnostic activity in the present COVID-19 pandemic. For this purpose, a standard operating procedure for correct swab collection, autopsy investigation and tissue sampling is provided. [ABSTRACT FROM AUTHOR]

Custodial deaths refer to the death of an individual who is in prison, a detention center, or a police station. The present study aims to retrospectively analyze cases of custodial deaths examined at Tongji Medico Legal Expertise Center in Hubei (TMECH). A total of 172 out of 5853 cases were screened at TMECH from January 1999 to December 2016. Male preponderance was observed in 172 cases (male–female ratio: 5:1). Natural deaths accounted for the majority (70.93%), followed by suicide (16.28%), accidents (3.49%), homicides (4.65%), and undetermined causes (4.65%). The most common natural cause was cardiovascular disease. Custodial deaths occurred more frequently in prisons and detention houses than in police cells (63%, 63%, and 46%, respectively). Among the 172 cases, 105 deaths occurred after resuscitation failure despite the individual being sent to the hospital. The average age across cases was 36.3 years, and 90% of the deceased were aged under 50 years. Since there is no officially reported data regarding the prevalence of causes and manners of custodial deaths in China, our analysis contributes to enhancing the understanding of such deaths in central China and serves as a reference for law enforcement to develop a prevention program to reduce incidents of mortality in custody. [ABSTRACT FROM AUTHOR]

The diatom test is the most reliable approach that provides scientific support for diagnosis of drowning. However, there are limitations, which, made forensic scientists stop using the test, such as the fact that it is time-consuming and lack of domain knowledge of the diatom identification. This study aims to find different types of diatoms that are commonly present in water bodies in China for a possible application of an automatic forensic diatom test. In total, 119 different water samples were obtained from different locations of the Yellow River, the Yangtze River and the Pearl River (China) and were analysed. About 50 ml of water of each sampling site was digested and then observed by a scanning electron microscopy. The diatom genera found in samples were recorded. Twenty-four diatom genera were found in all samples. Among them,Navicula,Nitzschia,Cyclotella,SynedraandGomphonemawere commonly presented (>70%) across the broad geographic regions.Navicula,Nitzschia,Cyclotella,SynedraandGomphonemawould be the main diatoms used in designing an automatic diatom identification system for forensic diatom test. [ABSTRACT FROM PUBLISHER]

Context: The autopsy rate gradually decreased during 1950–1999, and increased during the most recent decade (2000–2009). The diagnostic inaccuracy rate was continuously high during the 60 years. Objective: To investigate disagreement between the pathological and clinical diagnosis during 60 years (1950–2009). Data Sources: A 60-year retrospective study was carried out on the 4140 autopsy cases performed in Zhejiang University School of Medicine. Results: The highest number of cases was 1037 during 1960–1969, while the lowest was 102 during 1990–1999. During the 1999–2009 period, 978 cases were completed, which ranked second within the 60 years. The total clinical misdiagnosis rate was 46.38%, while the highest was 73.82% in 2000–2009. During the 60 years, the diseases associated with highest diagnostic inaccuracy rates were circulatory diseases (76.97%), cancer (60.99%), and brain diseases (54.48%). The invasive fungal infection rate was 1.84% of the 4140 cases, and the diagnostic inaccuracy rate for this condition reached as high as 86.10%. In the autopsied disease spectrum over the 60 years, the most common diseases were respiratory (1349, 32.58%), circulatory (495, 11.96%), and brain diseases (424, 10.24%). Conclusion: Although the number of autopsies decreased from 1950 to 1999, it increased from 2000 to 2009, while the discordance rate between clinical and autopsy diagnosis remained high throughout. [ABSTRACT FROM AUTHOR]

A block of an injury instrument will be left in wounds sometimes, and the suspect instrument can be discriminated by comparison with the block that was left through elemental analysis. In this study, three brands (Shibazi, Zhangxiaoquan, Qiaoxifu) of kitchen knives with forged, chop, and slice application series were analyzed by inductively coupled plasma atomic emission spectroscopy (ICP-AES) and Infrared Absorption to investigate the type, number of elements and the reference range used for comparing. The results show that when regarding one or more element as the discriminative threshold, together with 5 % relative standard deviation (RSD) as the reference range, all the samples could be distinguished among different series. Furthermore, within the same series, the discriminative capability could reach up to 88.57 % for all samples. In addition, elements with high content, such as Cr, Mn, and C, were useful to discriminate among different series, and trace elements, such as Ni, Si, and Cu, were useful within the same series. However, in practice, it is necessary to evaluate the accuracy of the method by Standard Reference Material (SRM) before an examination is performed. [ABSTRACT FROM AUTHOR]

Medico-legal death investigation in China has a long history that can be traced back to the Chhin era in the third century BC. We conducted a national study on the current medico legal death investigation system in China. Our study showed that, at present, medico-legal death investigations in China are conducted by c. 12,000 forensic medical experts mainly within five relatively independent agencies: the police organizations, the prosecutors’ offices, the departments ⁄ divisions of forensic medicine ⁄ science in medical colleges and universities, the Institute of Forensic Science in the Ministry of Justice, and the government or private forensic societies. Owing to China’s large population and area, the medico-legal death investigation is largely based on the administrative divisions. There is a wide variation in the scope, extent, and quality of investigations among the agencies and at the different levels of county ⁄ district, municipal, and provincial governments. This article gives a general overview of medicolegal death investigation in modern China. [ABSTRACT FROM AUTHOR]

Among 112 homicides involving sexual intimates that occurred in Hong Kong between 1989 and 2002, 38% ( n = 42) of offenders remained voluntarily at the homicide scene, 21% (n = 24) committed suicide, 20% (n = 22) escaped and denied involvement, 13% (n = 14) disposed or hid the body of their victim, and 9% (n = 10) escaped but later voluntarily surrendered. This study used police investigation reports, coroner’s reports, witness statements, and other relevant documents to compare these five types of postkilling behavior. The type of response was explained by the offender’s characteristics, the strength of attachment to the victim, and situational factors. The offender’s prior criminal conduct or history of violence was not significant in predicting the type of postkilling response. [ABSTRACT FROM PUBLISHER]

Abstract: Widmark formula suggests estimating blood alcohol concentration level (BAC) on a given amount of alcohol administrated with knowledge of subject’s body weight and sex. The idea has been referenced extensively in forensic science with application in drink driving prosecution. A sample of Chinese subjects was collected in the drinking experiment, and in this study we mainly focus on the verification of the validity of Widmark formula on Chinese male population. A promising result is obtained where the extrapolated BAC measurement is directly proportional to the amount of alcohol administrated, and inversely to the subject’s body weight. The results noted in the general linear model is further supported by the nonlinear regression analysis and a concordant argument reaches by deploying the concept to the BAC level attained at peak. [Copyright &y& Elsevier]

Simple Summary: Forensic entomologists utilize sarcosaprophagous insect species to estimate the postmortem interval to aid death investigations. In this paper, we present the recent chronology of forensic entomology in China and illustrate how identification, development, and succession data are obtained and applied at the scale of such a large country. To overcome the difficulties and challenges forensic entomology faces in China, a number of countermeasures are provided. While the earliest record of forensic entomology originated in China, related research did not start in China until the 1990s. In this paper, we review the recent research progress on the species identification, temperature-dependent development, faunal succession, and entomological toxicology of sarcosaprophagous insects as well as common applications of forensic entomology in China. Furthermore, the difficulties and challenges forensic entomologists face in China are analyzed and possible countermeasures are presented. [ABSTRACT FROM AUTHOR]

The severe acute respiratory syndrome (SARS)-CoV-2 was identified for the first time in China, in December 2019. Confirmed cases of COVID-19 have been reported around the world; indeed, this infection has been declared a pandemic. Consequently, the scientific community is working hard to gain useful information about the history of this virus, its transmission, diagnosis, clinical features, radiological findings, research and development of candidate therapeutics as well as vaccines. This review aims to analyze the diagnostic techniques used to ascertain the COVID-19 infection, critically reviewing positive points and criticism for forensic implications, obviously including autopsy. Finally, this review proposes a practical workflow to be applied in the management of corpses during this outbreak of the COVID-19 infection, which could be useful in cases of future infectious disease emergencies. Analyzing the diagnostic methods, to date, virus nucleic acid RT-PCR represents the standard method used to ascertain the COVID-19 infection in living subjects and corpses, even if this technique has several criticisms: mainly, the staff should be highly specialized, working in high-throughput settings, able to handle high workloads and aware of health risks and the importance of the results. Thus, IgG/IgM serological tests have been developed, overcoming RT-qPCR duration, costs, and management, not requiring highly trained personnel. Nevertheless, serological tests present problems; the WHO recommends the use of these new point-of-care immunodiagnostic tests only in research settings. Furthermore, nothing has yet been published regarding the possibility of applying these methods during post-mortem investigations. In light of this scenario, in this review, we suggest a flow chart for the pathologist called on to ascertain the cause of death of a subject with historical and clinical findings of COVID-19 status or without any anamnestic, diagnostic, or exposure information. Indeed, the literature data confirmed the analytical vulnerabilities of the kits used for laboratory diagnosis of COVID-19, particularly during postmortem examinations. For these reasons, autopsy remains the gold standard method to ascertain the exact cause of death (from or with COVID-19 infection, or other causes), to consequently provide real data for statistical evaluations and to take necessary measures to contain the risks of the infection. Moreover, performing autopsies could provide information on the pathogenesis of the COVID-19 infection with obvious therapeutic implications. [ABSTRACT FROM AUTHOR]

• We report 5 relatively rare reported cases of bongkrekic acid-induced food poisoning. The forensic pathological features and clinical manifestations of the poisoning were described in detail. • LC-MS/MS was used to detect victims' serums and suspected foods containing toxic substances. The results showed that certain concentrations of bongkrekic acid were detected. • We found that the difference in blood glucose between the deceased and survivors of the five victims may be an indication of the severity of the disease. • Comparing bongkrekic acid poisoning with other diseases which can also cause severe liver damage and multiple organ failure, several characteristics are summarized for forensic identification and early clinical diagnosis and treatment. Bongkrekic acid (BA) poisoning can be caused by eating spoiled or fermented foods contaminated with pseudomonas cocovenenans. Although some in vitro studies have been reported on the use of purified BA to interfere with cell metabolism, few clinical or pathological data of BA poisoning on human due to food-borne factors are available for forensic appraisal. For the first time, we retrospectively report five cases of food-borne poisoning caused by eating rice noodles, a popular traditional food in Guangdong, China, and three of the victims died. All five victims were hospitalized with gastrointestinal symptoms such as nausea, vomiting and diarrhea and were treated with admission diagnosis of liver failure and acute kidney damage. Certain concentrations of BA were detected in the victims' peripheral blood serums at the hospitalization (ranging from 70–345 μg/L) and the suspected poisonous foods (0–810 ng/g) with LC-MS/MS technique. The results of forensic pathological examination showed that all three deceased had severe liver and kidney damage, accompanied by multiple organ congestion and edema, which were consistent with clinical diagnosis. Combined with the clinical records, we found that the difference in blood glucose between the deceased and survivors of the five victims may be an indication of the severity of the disease. In addition, we compared BA poisoning with other diseases that can cause acute liver function damage in terms of pathological characteristics and clinical manifestations, which has important reference significance for the diagnosis and forensic appraisal of this food-borne poisoning. [ABSTRACT FROM AUTHOR]

To investigate the sudden death of a 36-year-old Chinese man, a medicolegal autopsy was performed, combining forensic pathological examinations and genetic sequencing analysis to diagnose the cause of death. Genomic DNA samples were extracted from blood and subjected to high-throughput sequencing. Major findings included a dilated aortic root with a ruptured and dissected aorta and consequent tamponade of the pericardial sac. Moreover, arachnodactyly and other skeletal deformities were noted. By sequencing the fibrillin-1 gene (FBN1), five genetic variations were found, including four previously known single nucleotide polymorphisms (SNPs) and a novel frameshift mutation, leading to the diagnosis of Marfan syndrome. The frameshift mutation (c.4921delG, p.glu1641llysFsX9) detected in exon 40 led to a stop codon after the next 8 amino acids. The four SNPs included a splice site mutation (c.3464-5 G>A, rs11853943), a synonymous mutation (p.Asn625Asn, rs25458), and two missense mutations (p.Pro1148Ala, rs140598; p.Cys472Tyr, rs4775765). Genetic screening was recommended for the relatives as it was reported that the father and brother of the deceased had died at the ages of 40 and 25, respectively, from sudden cardiac failure. The son of the deceased lacked the relevant mutations. This report emphasizes the important contribution of medicolegal postmortem analysis on the molecular pathogenesis study of Marfan syndrome and early diagnosis of at-risk relatives. [ABSTRACT FROM AUTHOR]

Abstract: Herbal remedies have been used since ancient times and it is now known that they are not completely free of adverse effects. We present the case of a 41-year-old Chinese man, who died in renal failure because he consumed a herbal preparation called “Fen Qing Wu Lin Wan”, having GuanMu Tong as main ingredient, for about 1 month. GuanMu Tong is derived from the plant Aristolochia manshuriensis which contains aristolochic acid. Aristolochic acid is being reported as the causative agent of what is now called aristolochic acid nephropathy (AAN) which includes Chinese herb nephropathy (CHN) and Balkan endemic nephropathy (BEN), all having renal impairment as hallmark for the disease. The gross autopsy showed multiple punctate hemorrhages over the limbs, pleural effusion, and edematous lungs with consolidation, mild myocardial hypertrophy and normal-looking kidneys. Microscopic renal tissue examination showed severe degeneration, necrosis and desquamation of renal tubular epithelial cells, presence of protein cast and a widened, edematous interstitium with interstitial fibrosis. We also provide the clinical presentation of the deceased as reported in the medical records and briefly review the literature pertinent to similar cases. [Copyright &y& Elsevier]