Background: Free fatal falls (FFF) represent a distinct form of blunt force trauma (BFT) that is frequently encountered in forensic practice. Distinguishing FFF injuries from other forms of BFT, such as motor vehicle accidents (MVAs), can pose challenges. Despite its growing usage, the role of postmortem computed tomography (PMCT) in diagnosing FFF and its comparison with autopsy remains underexplored. Purpose: This review synthesizes fracture patterns in FFF, examining both extrinsic and intrinsic variables that influence skeletal injuries. It also compares PMCT and autopsy findings to establish a replicable database for forensic analysis. Methods: PubMed and Google Scholar were systematically searched by three independent reviewers. The inclusion criteria required studies to be published in English, report at least 10 cases, focus on fatal falls, and provide precise data on skeletal injuries. Studies lacking detailed descriptions, focusing on survivors, or involving non-free falls were excluded. Data extraction tables facilitated synthesis and analysis. Key Findings: FFF are characterized mainly by axial skeletal fractures, particularly of the chest, skull, and pelvis. A history of intoxication and psychiatric disorders often correlates with the manner of death. Fracture patterns vary by fall height, impact surface, and cause: accidental falls show greater chest and skull involvement, whereas suicidal falls present more pelvic and skull fractures. PMCT detects fractures more frequently than traditional autopsy. Conclusions: Distinct fracture patterns aid in differentiating suicidal from accidental FFF, shaped by extrinsic and intrinsic factors. Given its superior fracture detection capabilities, PMCT should be integrated into forensic protocols for FFF investigations.

Background: Free fatal falls (FFF) are a frequent occurrence in forensic medicine. Many variables, such as the victim’s sex, BMI, intoxication, height of the fall, and mental illness, can influence injury patterns. Previous studies identified fracture patterns and frequencies mostly with general anatomical detail, focusing on broad areas. As specific fractures might be roots for new statistical connections, this leaves a gap in our understanding. Using postmortem computed tomography, we aim to establish fracture frequencies and identify possible new statistical connections. Methods: In total, we retrospectively analyzed seventy-nine cases of confirmed deaths due to falls using the database of the Department and Institute of Forensic Medicine in Lublin. Our inclusion criteria were death due to free fall onto hard, non-deformable surfaces. We excluded cases of ground-level falls. All victims must have undergone postmortem computed tomography. Furthermore, each analyzed case documented individual intrinsic variables (sex, age, body mass, height, pre-existing mental conditions, and drug or alcohol use) and extrinsic variables (fall height, landing surface, time between the fall and death, and known cause of the fall). Results: Injuries in free fatal falls tend to focus on the axial skeleton. Suicides experience more severe, bilateral fractures, often involving the pelvis and limbs, while accidents tend to have unilateral injuries with rare limb involvement. We established new correlations with the height of the fall for the maxilla, mandible, anterior and posterior regions of the occipital bone, and the temporal bone. Moreover, our research confirmed previously noted correlations between the height of the fall and fractures of the limbs (and their individual bones), the lumbar vertebrae, and the chest. Conclusions: Our findings highlight that free fatal falls are characterized by distinct skeletal injury patterns that differ between accidents and suicides, with bilateral pelvic and limb fractures being particularly indicative of intentional falls. The integration of PMCT with autopsy improves the detection of these patterns. It provides valuable diagnostic and medico-legal insights, supporting a more precise determination of the cause and manner of death.

The female reproductive system, particularly the ovary, exhibits a high sensitivity to the effects of environmental xenobiotics. This group of substances includes micro- and nanoplastics (MNPs) as well as trace elements. This literature review summarises the current knowledge on the individual and combined effects of MNPs and trace elements—including essential bioelements (zinc (Zn), selenium (Se), copper (Cu), chromium (Cr), manganese (Mn)) and toxic elements (cadmium (Cd), Lead (Pb), arsenic (As), mercury (Hg))—on ovarian physiology and clinical conditions such as polycystic ovary syndrome (PCOS), gonadal dysfunction and infertility. Essential trace elements play irreplaceable roles as enzyme cofactors (e.g., superoxide dismutase (SOD), glutathione peroxidase (GPX)) and transcriptional regulators; however, their biological action is confined to a narrow homeostatic window, within which both deficiency and excess disrupt cellular redox status and the hypothalamic–pituitary –gonadal axis. The effect of toxic heavy metals is different; these exhibit threshold-independent cytotoxic, genotoxic and endocrine-disrupting effects, inducing apoptosis of granulosa cells, endoplasmic reticulum stress and the silencing of steroidogenic genes (e.g., Steroidogenic acute regulatory protein (StAR), CYP11A1, CYP19A1) via epigenetic modifications, which accelerates the depletion of the ovarian reserve (measured by a decline in anti-Müllerian hormone (AMH)). Concurrently, MNPs overcome biological barriers and accumulate within the ovarian microenvironment, thereby inducing reactive oxygen species (ROS)-dependent apoptosis, NLR family pyrin domain-containing 3 (NLRP3) inflammasome-mediated pyroptosis, cytoskeletal disruption, and tissue fibrosis. A key element of this review is the identification of mechanistic convergence and potential toxic synergism between MNPs and heavy metals. Co-exposure enhances toxin retention within cells by inhibiting ATP-binding cassette (ABC) transporters, potentiates mitochondrial depolarisation, and activates protein kinase RNA-like endoplasmic reticulum kinase–eukaryotic translation initiation factor 2 alpha (PERK/eIF2α) stress signalling. Understanding these shared molecular pathways forms the basis for assessing multi-component risk in female reproductive toxicology and for developing targeted protective strategies.

Fatal free falls (FFF) represent a distinct form of blunt force trauma and pose a significant challenge in forensic investigations, particularly in estimating fall height and differentiating between accidental and suicidal events. Postmortem computed tomography (PMCT) enables detailed assessment of skeletal injuries, including quantitative evaluation of skull fracture patterns. Total Cranial Fracture Length (TCFL), derived from three-dimensional CT skull fracture scoring (3D-CT-SF), has been proposed as an objective indicator of impact severity; however, available evidence remains limited. This study aimed to assess the relationship between TCFL and fall height in fatal free falls and to evaluate the influence of selected anthropometric and biomechanical variables on cranial fracture severity. A retrospective analysis of 76 fatal free-fall cases examined between 2016 and 2024 was conducted using PMCT and autopsy data. TCFL was measured on three-dimensional volume-rendered CT reconstructions of calvarial fractures. Statistical analyses were performed for the entire cohort and separately for accidental and suicidal falls. No significant correlation between TCFL and fall height was observed in the overall cohort or among suicide cases. In contrast, a significant negative correlation between TCFL and fall height category was identified in accidental falls. TCFL showed significant positive correlations with body mass, body mass index (BMI), and kinetic energy, particularly in the suicide subgroup. TCFL is a promising objective parameter for assessing the severity of cranial injury in fatal free-fall cases. While its utility in estimating fall height appears limited in suicidal falls, TCFL may support forensic interpretation of fall dynamics and contribute to distinguishing the manner of death, especially in accidental cases. Further studies in larger, more diverse populations are warranted.

Left ventricular noncompaction (LVNC) is a heterogeneous form of cardiomyopathy associated with abnormal myocardial maturation and characteristic prominent trabeculation of the left ventricular wall. The classification of the disease remains controversial, and some authors consider LVNC to represent a phenotypic manifestation of other cardiomyopathies. The clinical presentation, particularly in children, is highly variable, ranging from asymptomatic forms to heart failure, arrhythmias, and thromboembolic events. Echocardiography remains the cornerstone of diagnosis, complemented by cardiac magnetic resonance imaging; however, the lack of universally accepted diagnostic criteria contributes to the risk of overdiagnosis. Treatment is primarily symptomatic and depends on the disease phenotype and the degree of left ventricular dysfunction. Prognosis is determined mainly by cardiac function and the presence of arrhythmias, whereas isolated LVNC with preserved systolic function is generally associated with a favorable clinical course.

The pancreas is an organ with two functions: endocrine and exocrine. The proper functioning of the pancreas depends on many factors. One of these is trace elements—precise control of trace element homeostasis is important for both the endocrine and exocrine parts. This review provides a comprehensive summary of current knowledge regarding the role of trace elements: iron (Fe), copper (Cu), cobalt (Co), iodine (I), manganese (Mn), zinc (Zn), silver (Ag), cadmium (Cd), mercury (Hg), lead (Pb), and selenium (Se) in pancreatic physiology and their influence on the pathogenesis of key diseases of this organ, such as diabetes (DM), acute (AP) and chronic pancreatitis (CP), autoimmune pancreatitis (AIP), and pancreatic cancer (PC). Trace elements, including Fe, Cu, Zn, Se, and Mn, play a fundamental role in maintaining endocrine and exocrine homeostasis, participating in insulin synthesis, stabilizing digestive enzymes, and the functioning of antioxidant systems. It has been demonstrated that disturbances in their concentrations lead to the activation of pathological molecular pathways, including oxidative stress, chronic inflammation, and beta-cell apoptosis. In the context of diabetes, excess Fe promotes ferroptosis, whilst exposure to heavy metals such as Cd, Pb, and Hg induces insulin resistance and pancreatic islet dysfunction. In the course of pancreatitis, elements such as Zn and Se exhibit protective potential by stabilizing tissue barriers, whereas toxic metals impair ion transport, exacerbating fibrotic processes. Furthermore, analysis of available data indicates a significant association between heavy metal accumulation and pancreatic carcinogenesis, driven by DNA damage and oncogene modulation. Understanding pancreatic metallomics opens new prospects for early diagnosis, environmental prevention, and the development of targeted therapeutic strategies that restore the body’s micronutrient balance.