[Analysis of claims to conclusions of forensic medical examinations in legal proceedings relating to personal injury during dental treatment]. / Analiz pretenzii k zaklyucheniyam sudebno-meditsinskikh ekspertiz v sudebnykh protsessakh, kasayushchikhsya prichineniya vreda zdorov'yu pri stomatologicheskom lechenii.

OBJECTIVE: To analyze the quantitative and qualitative composition of main claims from proceeding parties, submitted to the conclusions of forensic medical examinations, based on appellate complaints from trial participants and associated with personal injury as a result of dental treatment. MATERIAL AND METHODS: The judgment materials for the period from 2013 to 2022 yrs. were examined. RESULTS AND CONCLUSION: The multiple increase in the claims frequency to the absence of normative references in experts' conclusions (from 5.7% in 2013-2017 yrs. to 32.2% in 2018-2022 yrs.) and answers on the presence of causal link (from 1.8% in 2013-2017 yrs. to 22.6% in 2018-2022 yrs.), as well as to ignoring the findings of other independent experts (from 7.9% in 2013-2017 yrs. to 19.1% in 2018-2022 yrs.), to the lack of documentation on used examination methods in research part (from 4.4% in 2013-2017 yrs. to 20.9% in 2018-2022 yrs.), to production of expert evidence without patient's observation (from 6.1% in 2013-2017 yrs. to 12.2% in 2018-2022 yrs.) and to a number of other issues, requiring a new approach to develop a system of internal quality and safety control for forensic medical examinations, have been revealed.

[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.

[Age determination by microstructural features of human cricoid cartilage]. / Opredelenie vozrasta po mikrostrukturnym parametram perstnevidnogo khryashcha cheloveka.

THE AIM OF THE STUDY: Was to develop the age determination's technology by the morphometric features of the human cricoid cartilage using a regression analysis method. Cricoid cartilages of 65 variously-aged males were examined. The number of histomorphometric parameters equal 16 for each sample were determined and measured on the histological sections. A descriptive statistical processing of data using the regression analysis method was done, as a result of which the model of age determination was developed. This model has a high predictive accuracy, where the prediction error was less than 5 years in 64.62% of cases. The practical use of this model may be limited by the morphometric parameters' number translating complication to calculate the formula. The developed method can be improved while increasing the sample and conducting further statistical processing, and in the future it can be used in the age determination in forensic medical examination.

[Forensic medical assessment of lidocaine and bupivacaine systemic toxicity]. / Sudebno-meditsinskaya otsenka sistemnoi toksichnosti lidokaina i bupivakaina.

THE AIM OF THE STUDY: Was to assess the lidocaine and bupivacaine systemic toxicity in forensic medical practice. The number of patients' clinical observations equal three with local anesthetic systemic toxicity (LAST) from the practice of forensic medical experts were studied, and a search of scientific publications for the last 5 years in PubMed database was conducted. The amount of publications, describing cases with LAST, equal four were selected. Differential diagnostic features between LAST and anaphylaxis were considered. The literature data about relationship between lidocaine's concentration in the blood serum and clinical features are shown. The forensic medical assessment of LAST is proposed.

[Forensic medical assessment of venous thromboembolic complications of mechanical injury of the lower limb after surgery]. / Sudebno-meditsinskaya otsenka venoznykh tromboembolicheskikh oslozhnenii mekhanicheskoi travmy nizhnei konechnosti posle operativnogo vmeshatel'stva.

In forensic medical practice, venous thromboembolic complications (VTEC) are relatively rare, due to hereditary and acquired factors. The issue of expert evaluation of the VTEC after the performed surgical intervention as an alleged defect in medical care causes discussion. The purpose of this publication is to demonstrate an expert case in the assessment of VTEC mechanical injury of the lower limb after surgery. The above case with the development of PATE after surgery clearly demonstrates the possibility of the appearance of a «medical case¼. The key to the correct expert assessment of the alleged defect of medical care during the forensic medical examination is not only a thorough and scrupulous study of medical documentation, but also a qualitatively performed forensic medical examination of the corpse.

[COVID-19 pandemic and alcohol use patterns in Moscow population: forensic aspects]. / Pandemiya COVID-19 i patterny upotrebleniya alkogolya sredi naseleniya Moskvy: sudebno-meditsinskie aspekty.

The presents an analysis of the trend of the postmortem ethanol tests in biological samples obtained from the deceased in Moscow in April-May 2019 and 2020. In total, 7110 reports of forensic chemistry studies were examined; all cases were classified by the age of the deceased, following the modern generational theory to study patterns of alcohol consumption in these age groups and the impact of the COVID-19 pandemic. Stable patterns of alcoholic behavior were revealed in the groups of the deceased. It was shown that, on average, every 3rd representative of Generations «X¼ and «Y¼ consumes alcohol shortly before death; the highest average blood ethanol levels were found in representatives of Generations «Y¼ and «X¼. The number of positive ethanol test results increased in April-May 2020 among males of the baby boom and Generation «X¼ compared to the same period in 2019. The patterns identified can be used to further study the contribution of alcohol consumption to mortality.

[Forensic medical characteristics of fatal injuries in a traffic accident in the car cabin]. / Sudebno-meditsinskaya kharakteristika smertel'nykh povrezhdenii, prichinennykh pri dorozhno-transportnom proisshestvii v kabine legkovogo avtomobilya.

The study objective is to identify the most common fatal injuries in car accidents and observe the trends of the proportion of deaths at the scene, in an ambulance, and a hospital. We analyzed all forensic examination reports (protocols) of those who died in the car due to a traffic accident in Moscow from 2018 to 2020. Male drivers died 15 times more often than female drivers, and male passengers died twice as often as females. Most of the victims were young and middle-aged. Both drivers and passengers most commonly had traumatic brain injury with fractures of the bones of the vault and base of the skull, intracranial hemorrhages, crushing, and dislocation of the damaged brain. At the scene of traffic accidents, the cause of death was fatal bodily injuries. An increased risk of fatal traffic accidents was identified in autumn and winter.

[The possibilities for gender determination based on the specific anatomical features of the human cricoid cartilage]. / Vozmozhnost' ustanovleniya pola po antropometricheskim parametram perstnevidnogo khryashcha cheloveka.

THE AIM OF THE STUDY: Is to establish the morphometric features of the human cricoid cartilage structure using anthropometric research. Cricoid cartilage was examined from 37 men and 30 women. Using an electronic caliper and scales, 17 metric parameters and the mass of the cricoid cartilage were established, and a statistical analysis of the results obtained was carried out. It was found that the greatest relationship with the gender had the following dimensions: the distance from the upper outer edge of the plate to the outer edge of the arch and the height of the cricoid cartilage plate, the distance between the arytenoid articular surfaces, and the mass of cricoid cartilage. The data obtained confirmed the gender dimorphism of the cricoid cartilage. The data of this study can be used in expert practice for forensic medical identification of a person.

[The sudden death among the young persons under effect of the different forms of physical loads]. / Vnezapnaia smert' lits molodogo vozrasta pri razlichnykh vidakh fizicheskoi nagruzki.

The present review of the literature publications concerns the problem of sudden death (SD) among the young persons under effect of the different forms of physical loads. The statistical data on the frequency of sudden death are presented together with information about risk factors of SD, the morphological substrates and structural changes that promote death coming. The cases of sudden death among the young persons associated with the amateur sports activities and the professional sport of records are presented. The role of physical exercises and psycho-emotional stresses in the development of the terminal processes is considered with special reference to the risk factors and genetic predisposition to sudden cardiac death, largely among male athletes. The questions of sudden death in connection with cardiac pathologies as its main causes are discussed.

[The diagnostic criteria for the improper care of the elderly subjects and their forensic medical significance]. / Diagnosticheskie kriterii nenadlezhashchego ukhoda za liud'mi preklonnogo vozrasta i ikh sudebno-meditsinskoe znachenie.

The demographic ageing of the population is accompanied by the gradual increase in the number of the people of the advanced age both in Russia and in other countries all over the world. This situation enhances the probability of violence and the improper care of the elderly subjects both in their families and in the specialized socio-medical facilities. The objective of the present work was to study the experience of the foreign specialists dealing with the problem of the improper care for the elderly subjects with a view to the identification of the diagnostic criteria for the application in the forensic medical practice. The improper care of the elderly subjects is one of the most widespread forms of violence because the associated inadequate actions or the absence of thereof are likely to be a cause of high morbidity and mortality among the persons of this age group as a result of infectious diseases. In the case of the lethal outcomes, the measures of investigation have the purpose not only to elucidate the cause of death but also to establish the relationship between the fact of death and the form of violence including the improper care. The latter can be manifested as the poor hygienic conditions, untidiness of attire, marked dehydration, nutritional dystrophy, injuries and skin burns, persistent and/or refractory cutaneous eruption in the anogenital and inguinal regions, inadequately treated decubital sore of atypical localization. The most dangerous complication of decubital ulcers in the elderly subjects is the systemic infection making up the commonest case of death. Such lethal outcomes are considered to be accidents and sometimes are qualified as murder. The report of the careful forensic medical examination is indispensable for the reliable evaluation of the circumstances of death and the quality of the medical treatment provided for the elderly subjects. Not infrequently it is of crucial importance in the civil and criminal procedures.

[The conditions and the character of the work of the mortuary personnel in the Great Britain: the problems of health protection, anti-infectious prophylaxis, and reduction of the risk of contamination]. / Usloviia i kharakter raboty meditsinskogo personala morgov Velikobritanii: voprosy okhrany zdorov'ia, obespecheniia infektsionnoi bezopasnosti i snizheniia riskov zarazheniia.

The objective of the present work was to study the specific approaches to the organization of the work of the foreign specialists performing post-mortem autopsies of the subjects who died from infectious pathology and consider the proposals of the representatives of the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) concerning accreditation of mortuaries in the Great Britain. It is shown that the algorithm for the evaluation of the possible risks of contamination of the medical personnel suggests the solution of five problems that envisages obtaining the answers to the following questions: (1) what biological agents can be present in a particular case? (2) what is their virulence factor? (3) what are the transmission routes (mechanisms)? (4) what are the manner of their realization? (5) what is the amount of the pathogen(s) needed to cause a given infectious disease? The anti-infectious prophylactic measures and the prevention of the contamination risks for the medical personnel of the British mortuaries are designed to safeguard the people against the infection with the causative agents of tuberculosis, viral hepatitis B and C, HIV, and Kreutsfield- Jacob's disease. All the employees engaged in the pathological studies must wear specialized clothing in a mandatory manner and make use of the equipment for the personal and collective protection. An indispensable condition for the safe work in a mortuary is the efficient ventilation system, the special viewing equipment, and separate premises. The NCEPOD experts maintain that the general approach to the investigations of the cases of infectious diseases presently adopted in the country needs to be radically re-considered and standardized. Diagnostics of contamination and morbidity of the medical personnel from the corpses has not yet become a routine practice. The principal recommendation to be implemented at the national level consists of the strict observance of the safety precautions as opposed to the total pre-mortem testing of the suspicious cases.

[The joint scientific research projects carried out by the Department of Forensic Medicine of the Sechenovsky University and the Bureau of Forensic Medical Expertise of the Moscow Health Department]. / Sovmestnaia nauchno-issledovatel'skaia rabota kafedry sudebnoi meditsiny Sechenovskogo universiteta i Biuro sudebno-meditsinskoi ékspertizy Departamenta zdravookhraneniia Moskvy.

This article was designed to report the results of scientific research and practical forensic medical work carried out jointly by the personnel of Department of Forensic Medicine of the Sechenovsky University and the Bureau of Forensic Medical Expertise of the Moscow Health Department during the last 5 years.

[The history of collaboration between the Bureau of Forensic Medical Expertise of the Moscow Health Department and the Department of Forensic Medicine of the Sechenovsky University]. / Istoriia vzaimodeistviia Biuro sudebno-meditsinskoi ékspertizy Departamenta zdravookhraneniia Moskvy i kafedry sudebnoi meditsiny Sechenovskogo universiteta.

This article presents the materials devoted to the long-term history of collaboration between the Bureau of Forensic Medical Expertise of the Moscow Health Department and the Department of Forensic Medicine of the Sechenovsky University. Special attention is given to the contribution made by the Department of Forensic Medicine to the scientific and practical activities, methodological and staffing support first of the Moscow forensic medical services and thereafter of the Bureau of Forensic Medical Expertise operating under the auspices of the Moscow Health Department. Simultaneously, the influence of the work of the Moscow Bureau of Forensic Medical Expertise on the development and improvement of the scientific, methodological, and pedagogical activities of the Russia's oldest Department of Forensic Medicine is overviewed. The personal contribution of the most prominent forensic medical experts and physicians of Moscow to medical science and practice is illustrated by concrete examples.

[The HIV-associated diseases encountered in the practice of forensic medical autopsies]. / VICh-assotsiirovannye zabolevaniia v praktike sudebno-meditsinskikh vskrytii.

The present article deals with the problems pertaining to the forensic medical diagnostics of the HIV-associated pathological conditions taking into consideration the materials available from the Moscow City Centre for AIDS Prophylaxis and Control with special reference to the number and structure of the diagnosed HIV-associated diseases. We undertook the analysis of co-morbid HIV/AIDS causes of violent and sudden deaths documented at the Bureau of Forensic Medical Expertise of the Moscow Health Department during the period from 2013 till 2016. The study revealed the tendency toward a rise in the number of deaths from the HIV-associated infections including tuberculosis, pneumonias, chronic immunodeficiency conditions refractory to the treatment, and from malignant neoplasms. A peculiar feature of the aforementioned period was the increased age of the deceased subjects. In the cases of violent deaths, the HIV-associated conditions were diagnosed as the concomitant diseases, with the markedly predominant ones being acute drug and alcohol intoxication, injures, and attempts at suicide. The available results of the studies give evidence of the necessity and importance of the cooperative work of the specialists for the further improvement of forensic medical diagnostics and monitoring of HIV-associated conditions.

[The forensic medical characteristic of the non-identified corpses based on the materials of Bureau of Forensic Medical Expertise of the Moscow Health Department]. / Sudebno-meditsinskaia kharakteristika neopoznannykh trupov po dannym Biuro sudebno-meditsinskoi ékspertizy Departamenta zdravookhraneniia Moskvy.

We undertook the analysis of the archive data of forensic medical expertises of the non-identified corpses accumulated at the tanatological divisions of the Moscow Bureau of Forensic Medical Expertise for the period from 2012 till 2016. Special attention was given to sex and age composition of the deceased as well as the structure of mortality and the traces of ethyl alcohol, if any, present in the blood. It was shown that the majority of the unidentified bodies were those of the young men, with the main cause of the non-violent deaths being the cardiovascular pathology. Ethyl alcohol was found in the blood of 43% of the corpses. The analysis encompassed also the most frequently used methods for personality identification based on the data available from the medical-criminalistic department of the Bureau of Forensic Medical Expertise. The statistical treatment of the results of the study provided materials making it possible to envision the tendencies of the further development and improvement of the methods for personality identification for the purpose of forensic medical expertise and judicial practice.

[The detection of the biomolecular markers of the axonal damage resulting from the craniocerebral injury by the immunohistological methods]. / Immunogistokhimicheskaia detektsiia biomolekuliarnykh markerov aksonal'nogo povrezhdeniia pri cherepno-mozgovoi travme.

The objective of the present study was to define and evaluate the parameters of validity of the diagnostic signs of the diffuse axonal damage resulting from the craniocerebral injury with the use of the immunohistological reaction for the presence of amyloid precursor protein (beta-APP) in the brain tissue associated with the craniocerebral injury. Both histological and immunological methods were used. The positive beta-APP reaction was documented in 2 of the six cases. It is concluded that the positive results of the immunohistological reaction for the presence of beta-APP protein provide an additional information about the mechanism behind the damage and confirm the diagnosis of the craniocerebral injury in the cases when its macroscopic signs are either absent or unapparent.

[The efficiency of the application of the modern computed technologies in the clinical practice and the prospects for the further use of the biomechanical 3D-models in forensic medicine]. / Éffektivnost' ispol'zovaniia sovremennykh komp'iuternykh tekhnologii v klinicheskoi praktike i perspektivy primeneniia biomekhanicheskikh 3D-modelei v sudebnoi meditsine.

To-day, the computer-assisted 3D-technologies for the mathematical simulation of the engineering facilities are extensively used for the purpose of technical calculations in all branches of industry and building. The positive experience gained with the application of the 3D-models finds wide application in the joined investigations on the topical problems of the prosthetic and surgical treatment of bones, teeth, joints, cardiac valves, blood vessels, etc. The objective of the present study was the analysis of the positive experience with the involvement of the specialists in the design and practical application of 3D-models for the solution of problems facing the medical prosthetics and the management of various pathological conditions. Another objective was to discuss the possible prospects for the interdisciplinary collaboration in these fields with a view to improving the quality of expert conclusions in the framework of forensic medical and criminalistics examinations. The data readily available from the official domestic and foreign Internet resources were used for the purpose of the study. The analysis of the published data has demonstrated the obvious advantages of the application of the mathematical 3D-models and the biomechanical studies for the solution of the concrete medico-biological problems. The currently available positive experience gained due to the participation of domestic specialists in biomechanics in the solution of the specific clinical problems gives hope that their collaboration between themselves and with the forensic medical experts will open up the promising prospects for the further investigations of the issues of common interest.

[The importance of marker proteins of the nervous tissue for morphological diagnostics of the craniocerebral injury]. / Znachenie belkov-markerov nervnoi tkani dlia morfologicheskoi diagnostiki cherepno-mozgovoi travmy.

The present review of the literature involves 50 publications concerning various substrates of importance as the biological markers of axonal damages with special reference to the secondary molecular and cellular mechanisms on which to base in vitro and in vivo modeling of the craniocerebral injury. The results of the investigations with the application of mass-spectrometry for the identification of the proteins specifically synthesized in response to the injury are presented; their biological functions are described. The use of the sequential microscopic imaging technique and the immunohistochemical methods made it possible to determine that the majority of the marker proteins are involved in the specific intracellular processes that are triggered in response to the traumatic impact including apoptosis, proliferation, formation of lamellipodia, axon regeneration, actin remodeling, cell migration and inflammation. In addition, a rise in the amount of intracellular actin-associated proteins has been observed. It is concluded that the investigations into the properties and the physiological role of beta-amyloid precursor protein (beta-APP) are of special value for the characteristic of nervous tissue damages and morphological diagnostics of the craniocerebral injury.

[The analysis of the subject-matter and the structure of scientific articles related to forensic biology published in the journal "Sudebno-meditsinskaya ekspertiza (Forensic Medical Expertise)" in 1960-2010].

This paper reports the results of the analysis of the subject-matter and the structure of scientific articles related to forensic biology published in the journal "Sudebno-meditsinskaya ekspertiza" over the period from 1960 till 2010. The sceintometric analysis made it possible to distinguish the main avenues along which forensic biology developed during its most productive period. The results of this analytical study have provided in the summarized form the entire spectrum of the main trends in the forensic biology throughout the half-century period.

[A case of unrecognized iatrogenic cardiac tamponade with the pareneteral nutrition fluid].

The authors describe the peculiarities of the commissionary expertise with respect to medical practice and the difficulties facing this procedure using as an example a case of the lethal outcome caused by the injury to the right atrium as a result of unrecognized iatrogenic cardiac tamponade with the pareneteral nutrition fluid administered through the catheterized subclavian vein. It was shown that the great variety and complexity of the problems arising in such expertises should draw enhanced attention not only of forensic medical experts but also medical law specialists and other legal practitioners. It is argued that the majority of the cases of the inadequate medical care provided to the patients as exemplified by the case of death of the 43 year-old patient B resulting from the application of the unsafe technique of catheterization of the main blood vessels are usually due to the subjective ("human") factors. They may occur in any health care facility regardless of its location, staff composition and competence.