According to the current requirements for forensic medical examination of a body almost none thoroughly performed examination can receive evidential value without appropriate laboratory and additional investigations. For solving some questions confronting forensic expert during a body examination with cases of strangulation asphyxia, such as identifying the manner and cause of death, the mechanism of a skin injury, identifying the cause of death was given as asphyxia due to ante-mortem constriction of neck and the time of hanging, in practice of examination is widely used microscopic, in particular histological, investigations. However, traditional morphological methods of tissues examination removed during autopsy have certain shortcomings in determining the dynamics of tissue reactions. Therefore, in recent years, forensic experts are looking for newer and more reliable in terms of evidence-based medicine methods for diagnosing the ante-mortem strangulation asphyxia.
Data on the use of IHC markers to study this problem are isolated, mainly in the works of scientists from China, Japan, the United States and indicate the possibility and feasibility of their use.
The dissertation is devoted to the study of morphological and immunohistochemical characteristics that occur in the skin of the strangulation mark, lungs and brain in those who died due to strangulation asphyxia.
The material is presented by samples of strangulation mark of skin, lungs and brain of those who died due to strangulation asphyxia and those who died of acute heart failure. A careful analysis of the description of macroscopic changes based on the results of the forensic autopsy reports was performed. Microscopic changes in the skin of the strangulation mark, lungs and brain were studied using standard methods of making histological slides with staining of sections with hematoxylin-eosin. Immunohistochemical study was performed using 11 markers, namely: Cytokeratin pan [AE1 / AE3], CD68, CD15, CD117, endothelial nitric oxide synthase (eNOS), induced nitric oxide synthase (iNOS), transforming β-growth factor TG1 type, fibrinogen, glucose-regulating protein GRP78 BiP and neuron-specific enolase NSE.
Two groups of research were formed: Group I (main) consisted of 48 cases of death due to strangulation asphyxia, Group II (comparison) - 20 cases of death due to acute heart failure in patients with cardiomyopathy or coronary heart disease. The average age of deaths of group I was 47.63 ± 18.2 years; 38 men and women - 10. The average age of the dead of the II group was 49.1 ± 17.5 years; there were 15 male deaths and 5 female deaths.
The epidemiological characteristics of deaths from strangulation asphyxia in the Kharkiv region have been studied. It was found that among the deceased who were subject to forensic examination, strangulation asphyxia was the cause of death in 3.08% (960/31149), which was 64.6% (960/1486) of cases of mechanical asphyxia. The ratio of women to men who died of strangulation asphyxia was 1: 4. The average age of women was 55.43 ± 3.08 years, men - 50.3 ± 1.26 years.
In the IHC brain, the reaction with Collagen IV, Fibrinogen, oxidative stress markers eNOS, iNOS, TGF-β1 and with markers of immunocompetent cells CD15, CD68, CD117 was uninformative. The main group was characterized by a higher level of GRP78 expression compared to group II (p<0.0001), which defines this marker as the most informative IHC criterion for the ante-mortem strangulation asphyxia in the brain.
For those who died of strangulation asphyxia, significant decrease of NSE expression in brain neurons was found (p<0.001). There is an inverse correlation between the expression of NSE and GRP78 in neurons (p<0.01) as a result of cerebral hypoxia in strangulation asphyxia, and therefore these markers
