Acupuncture, a component of traditional Chinese medicine, is also a well-known form of complementary and alternative medicine. Serious adverse events of acupuncture have been reported, including the acupuncture-related pneumothorax which is a rare but fatal condition sometimes. The pneumothorax was related to needle insertion in the upper back or paraspinal area and the reported victims suffered from either unilateral or bilateral pneumothorax. Postmortem computed tomography has advantages in the detection of pathologic gas and is being considered as a useful visualization tool for diagnosing the cause of death. A 52-year-old man underwent acupuncture and cupping treatment at an illegal Chinese medicine clinic for neck and back discomfort and was admitted to the hospital with severe gasp and dyspnea about 30 hours later. The patient suddenly became unconscious with heart rate and blood pressure lost and died after cardiopulmonary resuscitation. Diagnosis, interventions and outcomes: Whole-body postmortem computed tomography of the victim revealed collapse of the both lungs and mediastinal compression, which was also confirmed by autopsy. More than 20 pinprick injuries were found on the skin of the upper and lower back in which multiple pinpricks were located on the body surface projection of the lungs. The cause of death was concluded as acute respiratory and circulatory failure due to acupuncture-induced bilateral tension pneumothorax. Acupuncture-induced tension pneumothorax is rare and should be recognized by forensic pathologists. Postmortem computed tomography can be used to detect and accurately evaluate the severity of pneumothorax before autopsy and can play a supporting role in determining the cause of death.

Background and aims: Epilepsy is a common and chronic neurological disorder characterized by seizures that increase the risk of mortality. SUDEP is the most common seizure-related category of death. The study aimed to evaluate the key characteristics between SUDEP and not-SUDEP death cases.Methods: A retrospective study of forensic autopsy cases from 2002 to 2021, performed by the Academy of Forensic Science (Ministry of Justice, China), identified a total of 31 deaths associated with epilepsy. We compared the different characteristics between individuals who died of SUDEP (SUDEP group) and individuals with epilepsy died suddenly due to unrelated causes (not-SUDEP group).Results and conclusions: 13 cases met the general accepted definition of SUDEP; and 18 cases were classified as not-SUDEP. The mean age of the not-SUDEP group was significantly higher than that of the SUDEP groups (p < 0.05) and there were more cases without a clear cause of epilepsy in the SUDEP group than in the not-SUDEP group (p < 0.05). Death position differed significantly between the two groups, with more cases dying in the prone position in the SUDEP group (p < 0.05). Complete autopsies were performed in 24 of the 31 cases. There were no significant differences in heart, lungs and brain weights, or in ventricular thickness (p > 0.05) between the SUDEP and not-SUDEP groups. In addition, compared to the not-SUDEP group, the SUDEP group featured a significantly more cases with coronary lesions (grades 1-3, p < 0.05). Neuropathological lesions were identified in 12 of the 13 SUDEP cases (92.3%), cardiac lesions were present in 10 cases (76.9%) and pulmonary edema and pulmonary congestion were present in all cases. The primary cause of death in 13 of the 31 cases was seizure disorder or epilepsy. The primary mechanism of death in SUDEP group was mainly asphyxia while that in the not-SUDEP group was cardiopulmonary failure (p < 0.05). Patients in the prone position had a significantly higher risk of asphyxia than those who were not. Here, we investigated the key characteristics between SUDEP and not-SUDEP death cases, which may help to facilitate forensic diagnosis in presumed SUDEP cases.

This study aimed to systematically simulate the responses of pelvic fracture under impact and run-over to clarify the effects of boundary and loading conditions on the pelvic fracture mechanism and provide complementary quantitative evidence for forensic practice. Based on the THUMS finite element model, we have validated the simulation performance of the model by a real postmortem human pelvis side impact experiment. A total of 54 simulations with two injury manners (impact and run-over), seven loading directions (0°, 30°, 60°, 90°, 270°, 300°, 330°), and six loading velocities (10, 20, 30, 40, 50, and 60 km/h) were conducted. Criteria of effective strain, Von-Mises stress, contact force, and self-designed normalized eccentricity were used to evaluate the biomechanism of pelvic fracture. Based on our simulation results, it’s challenging to distinguish impact from run-over only rely on certain characteristic fractures. Loads on the front and back were less likely to cause pelvic fractures. In the 30°, 60°, 300° load directions, the overall deformation caused a “diagonal” pelvic fracture. The higher is the velocity (kinetic energy), the more severe is the pelvic fracture. The contact force will predict the risk of fracture. In addition, our self-designed eccentricity will distinguish the injury manner of impact and run-over under the 90° loads. The “biomechanical fingerprints” based on logistic regression of all biomechanical variables have an AUC of 0.941 in discriminating the injury manners. Our study may provide simulation evidence and new methods for the forensic community to improve the forensic identification ability of injury manners.