{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T01:21:22Z","timestamp":1783128082246,"version":"3.54.6"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2021,12,17]],"date-time":"2021-12-17T00:00:00Z","timestamp":1639699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,6,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To elucidate pathologic markers of acute and chronic stress found but rarely reported in chronic child abuse.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Autopsies of 3 cases of fatal child abuse with well-documented chronic maltreatment are reported, with an emphasis on the nontraumatic findings of acute and chronic stress.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Besides the overwhelming physical injuries, all 3 children and 1 additional case obtained for consultation had telogen effluvium, a form of alopecia well known to be associated with stress in adults and some children but never reported in chronic abuse. All 3 had the microscopic findings of markedly involuted thymus, a well-known marker of physiologic stress in children but only occasionally referred to in child abuse. All 3 also had microscopic findings of myocardial necrosis associated with supraphysiologic levels of catecholamine, a well-documented finding associated with stress but rarely reported in fatalities associated with child abuse. Two of the 3 children also had Anitschkow-like nuclear changes in cardiac tissue, markers associated with prior, nonischemic myocardial pathologies that may be associated with prior episodes of acute stress.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Pathologists are urged to explore these markers as supportive evidence in their own investigations of possible child abuse fatalities, especially when associated with stress.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajcp\/aqab204","type":"journal-article","created":{"date-parts":[[2021,11,5]],"date-time":"2021-11-05T20:15:11Z","timestamp":1636143311000},"page":"823-835","source":"Crossref","is-referenced-by-count":3,"title":["Morphologic Markers of Acute and Chronic Stress in Child Abuse"],"prefix":"10.1093","volume":"157","author":[{"given":"Mark 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