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The identification of body fluids is an important area of forensic genetics. In particular, the susceptibility to degradation of casework samples is of crucial importance, as the traces can often be exposed to different environmental conditions over a long period of time. RNAs especially are used as molecular markers for the identification of body fluids in forensics. Messenger RNAs (mRNAs) show an increased susceptibility to degradation, e.g. under humidity and UV radiation but are highly body fluid-specific. The shorter micro RNAs (miRNAs), however, are less susceptible to degradation, but only a few body fluid-specific markers could be investigated. In this study, a self-developed mRNA/miRNA multiplex assay for capillary electrophoresis from a preliminary study was further adapted and validated. The approach was applied to casework samples, animal samples, and a storage study. The advantages and disadvantages of the mRNA/miRNA assay were investigated in order to review a possible application for forensic casework. Some miRNA markers were also detected in animal samples, which once again underlines the possible non-specificity of miRNAs. In the storage study, the different markers were detected for different lengths of time depending on the body fluid examined. For almost all body fluids, the miRNA markers were still detectable after a period of 35 days under environmental conditions compared to the mRNA markers. The mRNA peaks were often already clearly reduced or no longer detectable after 14 days. The results show the advantage of the new mRNA/miRNA assay compared to established mRNA approaches, especially for older and degraded samples, but the assay has its limitations due to the limited number of specific miRNA markers., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

In forensic age determination, e.g. for legal proceedings, exceeded age limits may be relevant. To investigate age-related differences in skeletal development, the recommendations of the Study Group on Forensic Age Diagnostics (AGFAD) rely on imaging techniques using ionizing radiation (including orthopantomograms and radiographs of the hand). Vieth et al. and Ottow et al. have proposed MRI classifications for epi-/diaphyseal fusion of the knee joint to determine different age limits. The aim of the present study was to verify whether these two classifications could also be applied to MRI of the ankle.MRI images of the ankle from 333 patients (160 female, 173 male) ranging in age from 10 to 28 years were retrospectively analyzed. T1-weighted turbo spin-echo (TSE) sequences and T2-weighted fat-suppressed sequences were analyzed for the two classifications. The different ossification stages of the two classifications were determined and the corresponding chronological ages were assigned. In addition, gender-specific differences were analyzed. Intra- and inter-observer variability was determined using Cohen's kappa.With the classification of Ottow et al., the completion of the 14 th year of life could be determined in both sexes. With the classification of Vieth et al, the completion of the 14 th year of life could be determined in both sexes and the 18 th year of life in male patients. Intra-observer and inter-observer variability was very good and good, respectively (κ > 0.87 and κ > 0.72).In the present study, it was also possible to use both classifications for MRI of the ankle joint. The method offers the potential of an alternative or at least supplementary radiation-free assessment criterion in forensic age estimation. · MRI scans of the ankle can be used for forensic age determination.. · Classifications developed for the knee joint can also be used on the ankle.. · The applied classifications based on Vieth et al. and Ottow et al. can be used as an alternative or, at the least, an additional method when determining legally relevant age limits.. · Wernsing MF, Malokaj V, Kunz SN et al. Forensic Age Determination Using MRI Scans of the Ankle: Applying Two Classifications to Assess Ossification. Fortschr Röntgenstr 2024; DOI 10.1055/a-2379-8785., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Aluminum and silicon are contaminants found in formulations used to prepare parenteral nutrition. Both elements are leached from glass containers, mainly during the heating cycle for sterilization. Insoluble and biologically inactive species of hydroxyaluminosilicates have been shown to form in solutions containing Al and Si. Therefore, this interaction may play an important role in protecting the body against Al toxicity. In this study, the bioavailability of Al in the presence of Si, calcium gluconate (Gluc.), and potassium phosphate (Phosf.) was investigated in rats. The rats were divided into 10 groups of 5 animals each: control, Al, Si, Al + Si, Gluc, Gluc + Al, Gluc + Al + Si, Phosf, Phosf + Al, and Phosf + Al + Si. The doses, consisting of 0.5 mg/kg/day Al and 2 mg/kg/day Si in the presence or absence of Gluc. or Phosf., were intraperitoneally administered for 3 months. Tissues were analyzed for Al and Si content. Al accumulated in the liver, kidneys, and bones, and the simultaneous administration of Si decreased Al accumulation in these tissues. The presence of Si reduced the amount of Al present by 72% in the liver, by 45% in the kidneys, and by 16% in bone. This effect was lees pronounced in the presence of parenteral nutrition compounds though. Si tissue accumulation was also observed, mainly when administered together with phosphate. These results suggest that Si may act as a protector against Al toxicity, by either reducing Al absorption or increasing its excretion, probably through hydroxyaluminosilicates formation. The presence of calcium gluconate and potassium phosphate decreases or inhibits this effect., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Abstract: Multiple studies have documented various factors that influence or determine forensic pathologist classification of manner of death. There do not appear to be any published studies on manner of death classification specifically regarding arrest-related deaths (ARDs). The goal of this study was to consider a large body of cases of nonfirearm ARDs to analyze the homicide classification with regards to numerous decedent and practitioner (medical examiner/coroner [ME/C]) variables. We analyzed 1145 US autopsy reports from the years 2006-2020, inclusive, and considered decedent variables of age, ethnicity, height, weight, body mass index, toxicology, and mention of a conducted electrical weapon and ME/C influence variables of gender, country region, and year. We found that the homicide classification likelihood increased by a factor of 1.04-1.05 per year, 1.34-1.37 for a female medical examiner, and 1.4-1.5 going from Southern states to Western states. There is an increasing trend for ME/C to label nonfirearm ARDs as homicides in the United States. The homicide classification is more common in Western states and less common in Southern states, and it was more common with a female ME/C., Competing Interests: Conflicts of interest and sources of funding: M.W.K. is a member of the Axon Corporate as well as Scientific and Medical Advisory Board. H.E.W. is a retired police chief. S.N.K. is a member of the AXON Scientific and Medical Advisory Board. The other authors report no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

In forensic genetics, massively parallel sequencing (MPS) offers several advantages over the current golden standard, capillary electrophoresis (CE): additional sequence information, shorter amplicon lengths, and the simultaneous analysis of many markers. These benefits result in a reduced number of reactions necessary while improving the amount of data obtained, thereby conserving valuable sample extracts. This proves particularly advantageous for the analysis of trace DNA. This study assessed the suitability of MPS for short tandem repeat (STR) typing of low template samples compared with results obtained through CE. The MPS genotypes showed higher concordance to reference genotypes, with donor alleles being more frequently assigned to be the major contributor, meeting the requirements for database entry. However, the MPS workflow is more time-consuming and associated with higher costs., (© 2023 The Authors. Electrophoresis published by Wiley-VCH GmbH.)

Background: Although postnatal transfer patterns among high-risk (eg, extremely preterm or surgical) infants have been described, transfer patterns among lower-risk populations are unknown. The objective was to examine transfer frequency, indication, timing, and trajectory among very and moderate preterm infants., Methods: Observational study of the US Vermont Oxford Network all NICU admissions database from 2016 to 2021 of inborn infants 280/7 to 346/7 weeks. Infants' first transfer was assessed by gestational age, age at transfer, reason for transfer, and transfer trajectory., Results: Across 467 hospitals, 294 229 infants were eligible, of whom 12 552 (4.3%) had an initial disposition of transfer. The proportion of infants transferred decreased with increasing gestational age (9.6% [n = 1415] at 28 weeks vs 2.4% [n = 2646] at 34 weeks) as did the median age at time of transfer (47 days [interquartile range 30-73] at 28 weeks vs 8 days [interquartile range 3-16] at 34 weeks). The median post menstrual age at transfer was 34 or 35 weeks across all gestational ages. The most common reason for transfer was growth or discharge planning (45.0%) followed by medical and diagnostic services (30.2%), though this varied by gestation. In this cohort, 42.7% of transfers were to a higher-level unit, 10.2% to a same-level unit, and 46.7% to a lower-level unit, with indication reflecting access to specific services., Conclusions: Over 4% of very and moderate preterm infants are transferred. In this population, the median age of transfer is later and does not reflect immediate care needs after birth, but rather the provision of risk-appropriate care., (Copyright © 2024 by the American Academy of Pediatrics.)

In the context of further impact tests with various striking weapons against the skull, it turned out that the manufacturer had incorrectly calibrated the force measuring plate, which was used in our earlier experiments. When the tests were carried out again under the same conditions, the measurement results were significantly higher., (© 2023. The Author(s).)

Background: The anti-coronavirus disease 2019 (COVID-19) vaccines are of paramount importance in the fight against the COVID-19 pandemic. Both viral vector- and nucleic acid-based vaccines are known to effectively induce protection against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus by generating high antibody titers and effective T-cell responses to the spike protein they encode. Although these vaccines are being applied worldwide and have been extensively investigated, the immunomorphological events at the vaccination site with respect to SARS-CoV-2 spike protein expression have not yet been described., Methods: We had the opportunity to examine the deltoid muscles of three men who died shortly after vaccination for unrelated reasons. We examined the vaccination sites histologically and immunohistochemically with various antibodies. Furthermore we incubated two different cell lines with one vaccine and examined the expression of the spike protein., Results: The vaccination sites show a dense lymphohistiocytic interstitial infiltrate which surrounds the small vessels and extends into the perimysium. The spike protein is expressed by histiocytic cells with a dendritic shape that are CD68-positive and CD207-negative, fibrocytes, and very rare S100-positive cells. Interestingly, the skeletal muscle, being constitutively human leukocyte antigen (HLA)-A,B,C-negative, is induced at different levels in each specimen. In a cell culture experiment, we confirmed the ability of fibroblasts and interdigitating dendritic sarcoma cells to express spike protein in vitro after incubation with the Comirnaty vaccine., Conclusions: Histiocytic cells and fibrocytes are the heralds of spike protein synthesis at the vaccination site. The underlying cause of this apparent cell specifity is unknown. This needs to be investigated in future experiments, for example in an animal model., (© 2023 The Authors. Immunity, Inflammation and Disease published by John Wiley & Sons Ltd.)

The current focus in most routine forensic casework is detection of autosomal or gonosomal Short Tandem Repeats (STRs). With increasing degradation, STR analysis tends to be less successful up to complete failure. For challenging samples such as telogen hair roots and shafts, touch DNA samples or skeletal remains, mitochondrial DNA (mtDNA) analysis provides a powerful tool. Determination of DNA quantity is an important part in the casework workflow. Several ready-to-use kits are commercially available for nuclear DNA targets. However, quantification of mtDNA targets requires the establishment of an in-house method. Some assays even contain assessment of degradation, which alleviates the choice of target enrichment for sequencing through medium or small amplicons. As Sanger-type Sequencing (STS) still remains the golden standard in many laboratories, identification of heteroplasmies in C-tract regions prior to the sequencing reaction is advantageous. Firstly, primer selection can be expanded with primers binding near the C-tract and secondly, determination of the dominant variant is straightforward. All those quantity (nuclear and mtDNA) and quality (degradation and length heteroplasmies) evaluations usually require at least two separate reactions. Therefore, the aim of this project was the combination of all these targets in one multiplex assay using capillary electrophoresis to spare valuable sample extract. Amplification of representative autosomal and Y-chromosomal STRs allows estimate of success of (Y-)STR analysis. Simultaneously, five length heteroplasmies in the mitochondrial control region are targeted as well as three conservative regions of differing fragment lengths for assessment of the mitochondrial degradation state. Based on the outcome of this assay, forensic examiners can decide if STR analysis may be suitable. In case of absent STR peaks, appropriate proceeding of mtDNA sequencing can be determined., Competing Interests: Conflict of interest The authors declare no conflict of interests., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The body fluid identification of traces found at crime scenes is crucial in relation of the circumstance of crime. For this reason, the body fluid identification (BFI) by molecular biological methods has been increasingly investigated in recent decades. Especially the use of messenger RNA (mRNA) has been established and validated by various studies. mRNAs can resist degradation for several decades under dry and dark environmental conditions, but degradation increases greatly e.g., in humid environments and UV radiation. In contrast, the shorter and protein-protected micro RNAs (miRNAs) are less susceptible to degradation, but not all potential markers are tissue-specific. The aim of this study was to develop a simultaneous mRNA/miRNA multiplex assay to take advantage of both types of RNA. The final assay was tested for various body fluids, dilutions, and mixtures. To demonstrate the advantage of a combined mRNA/miRNA assay, older and mostly degraded samples were examined and compared to an established mRNA assay. Initial results from degraded samples show that tissue-specific miRNAs expected could be detected for 93% of the degraded samples compared to mRNA markers with 25% of the mRNA assay. The result is a simultaneous mRNA/miRNA multiplex assay on capillary electrophoresis (CE) for the first time., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Blunt force traumas by footwear can result in severe and even fatal head and upper body injuries. Oftentimes, footwear impressions are only partially available and evidential value is limited. DNA evidence on shoe soles could provide crucial evidence helping to solve crimes by linking target DNA to the activity of interest. Little is known about the persistence and detectability of biological material post such offenses and the interplay of factors affecting the analytical success. In this study, we assessed the persistence of blood on shoe soles under varying parameters such as blood location, different sneakers, weather condition, gait, amount of blood, underground and step count. We applied an optimized DNA/RNA workflow adapted to micro-traces without constraints for the primary DNA pipeline. There is a high probability to link donor DNA to the shoe sole for up to 300-400 steps, regardless of the underground, blood location, and amount of blood. Depending on the sole material and the degree of abrasion of the sole, a longer blood persistence can be observed. Considering blood, 98.2% of the initial DNA amount (1 μl initial blood volume) was lost after 100 steps walked on sole areas that are in constant contact with the ground. Proportion of foreign DNA was marginal (avg. 4.4 alleles), minimizing the probability of unintentional DNA transfer in this context. RNA typing showed high specificity but lower sensitivity than presumptive tests used for body fluid identification (BFI). Luminol is essential for targeted sampling on shoe soles, as latent blood traces (>100-200 steps) provided sufficient biological material for DNA/RNA typing. The generated data help to address the activity of interest and evaluate probabilities about prevalence of target DNA important for casework implications and assessments on activity level., (Copyright © 2021 Elsevier B.V. All rights reserved.)

DNA evidence on shoes can play an important role in solving a variety of crimes. We investigated the transfer, persistence, prevalence and recovery of DNA (DNAtppr) on shoes (sneakers) and their soles in realistic handling scenarios taking into account the shedder status. This study aims to increase the understanding of the expected composition of DNA profiles and their probative value, providing a basis for activity level assessments. Samples were analyzed using a direct lysis method, suggesting its versatility and increasing the DNA typing success compared to previous studies on footwear. The data showed surface-dependent background DNA (bDNA) levels on shoe soles and prevalence of bDNA on the upper parts of the shoe. The owner of the shoe was allocatable to the mixture for almost every shoe and sampling location. Alternating scenarios of shoe handling were simulated through different pairs of shedders to distinguish shoe owner and subsequent user. Secondary users were attributable to DNA mixtures regardless of shedder status after wearing shoes a single time. The influence of the shedder status follows specific trends in this context. However, particularly intermediate shedders show inconsistent results. The prevalence of bDNA appears to have a greater effect on the impact of the shedder status on DNA profile composition than previously reported. The data help researchers to better resolve suspect statements and determine if a person of interest wore the shoes relevant to the investigation., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: Regionalized care reduces neonatal morbidity and mortality. This study evaluated the association of patient characteristics with quantitative differences in neonatal transport networks., Study Design: We retrospectively analyzed prospectively collected data for infants <28 days of age acutely transported within California from 2008 to 2012. We generated graphs representing bidirectional transfers between hospitals, stratified by patient attribute, and compared standard network analysis metrics., Result: We analyzed 34,708 acute transfers, representing 1594 unique transfer routes between 271 hospitals. Density, centralization, efficiency, and modularity differed significantly among networks drawn based on different infant attributes. Compared to term infants and to those transported for medical reasons, network metrics identify greater degrees of regionalization for preterm and surgical patients (more centralized and less dense, respectively [p < 0.001])., Conclusion: Neonatal interhospital transport networks differ by patient attributes as reflected by differences in network metrics, suggesting that regionalization should be considered in the context of a multidimensional system., (© 2021. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Molecular identification of body fluids and tissues is crucial in order to understand the circumstances of crimes. For that reason, molecular investigations used to identify body fluids/tissues have increasingly been examined recently. Various studies have proved that messenger RNA (mRNA) profiling is a sensitive and robust method for body fluid/tissue identification. The forensically relevant body fluids/tissues blood, semen, saliva, vaginal secretion, menstrual blood and skin have all been detected successfully by applying suitable mRNA assay. However, rectal mucosa, which can be found as evidence in sexual assault cases, has been neglected in forensic investigations. So far there is no mRNA marker to detect rectal mucosa, although anal penetration occurs in a large number of sexual assaults (23.2% of female victims and 50% of male victims). In this study, specific and sensitive mRNA markers for forensically relevant body fluids were adapted and validated in an mRNA multiplex assay for routine casework. This included the implementation of a DNA/RNA re-extraction method for automated extraction that can be integrated into casework without loss of DNA. This re-extraction method and the mRNA multiplex assay were tested using casework samples. PCR-primers were designed for the identification of rectal mucosa and the more effective marker MUC12 was integrated into an extended multiplex assay. The result of our study is a highly specific and sensitive mRNA multiplex assay plus an automated DNA/RNA re-extraction method, that can be integrated into casework and identify rectal mucosa for the first time., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The medical and biomechanical assessment of injuries from blows to the head is a common task in forensic medicine. In the context of a criminal justice process, the injury potential of different striking weapons is important. The article at hand compares the injury potential of assaults with a 0.5-l beer bottle and a 0.33-l Coke bottle, both made of glass. The research team hit 30 used empty 0.5-l beer bottles and 20 used empty 0.33-l Coke bottles manually on an aluminum dummy skull set on a force measuring plate, using acrylic and pork rind as a scalp surrogate. There was no significant difference in fracture threshold and energy transfer between the examined beer and Coke bottles. Both glass bottles are able to cause fractures to the facial bones while cranial bone fractures are primarily not to be expected. Blows with a 0.5-l beer bottle or with a 0.33-l Coke bottle to the head can transfer up to 1.255 N and thus are able to cause severe blunt as well as sharp trauma injuries., (© 2021. The Author(s).)

Arrest-related deaths in the context of Conducted Electrical Weapon (CEW) deployment are rare. The evaluation of such complex events is a challenge for the forensic scientist. We present a case of a 49-year old man, who was exposed to a Taser X26P during a confrontation with the police. He lost consciousness, vomited, aspirated and died after having been hospitalized for several days at the ICU. Based on the patient´s medical history, autopsy findings, witness testimonies, and reliable clinical and toxicological blood parameters, the most probable cause and mechanisms of his death are discussed. The present work demonstrates, based on one case report, the possibilities as well as limitations of forensic assessment in CEW-related deaths., Competing Interests: Conflict of interest This article is a result of forensic reconstruction work, which was done for the district prosecutor and police. The research was not funded. Plenzig S, Gruber H and Verhoff MA have no actual or potential conflict of interest to declare. Kunz SN is a member of the scientific medical advisory board of Axon Int., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Since the first shedder test was formulated almost 20 years ago, a plethora of different test strategies has emerged. The amount of data generated so far is considerable. However, because of the limited reproducibility of its results, the reliability of the shedder concept is frequently questioned. This study provides a literature overview of applied shedder tests that capture the diversity of the concept. It is pointed out to what extent different classification criteria, workflows, and trace evaluation can impair the classification outcome. The robustness of shedder status was assessed by applying a promising approach established by Fonneløp et al. (Forensic Sci Int Genet 29:48-60, 21). Data provide similar results to those in recent studies but also ambiguous shedder classifications. The applied shedder test was adapted based on our own as well as the reviewed data. With novel classification parameters, promising results were achieved. This study reveals uncertainties and inconsistencies of the shedder concept. Recommendations for harmonization and transparency are proposed. Implementation of the recommendations may result in an increased impact on casework and transfer studies, including activity-level assessments. Furthermore, this study shows that moisturizers affect participants' shedder status as well as DNA transfer. The impact appears to remain relevant even 60 min post ointment application but depends greatly on the type of moisturizer applied.

It has been suggested that an application of a conducted electrical weapon (CEW) might cause muscle injury such as rhabdomyolysis and an acute inflammatory response. We explored this hypothesis by testing the effects of electrical weapons on circulating markers of inflammation and muscle damage. In a prospective study, 29 volunteers received a full-trunk 5-s TASER® X26(E) CEW exposure. Venous blood samples were taken before, 5 min after, and at 24 h following the discharge. We tested for changes in serum levels of C-reactive protein (CRP), alkaline phosphatase (ALP), myoglobin, albumin, globulin, albumin/globulin ratio, aspartate and alanine aminotransferase, creatine kinase, total protein, bilirubin, and lactic acid dehydrogenase. Uncorrected CRP and myoglobin levels were lower in the immediate post exposure period (CRP levels 1.44 ± 1.39 v 1.43 ± 1.32 mg/L; p = 0.046 and myoglobin 36.8 ± 11.9 v 36.1 ± 13.9 μg/L; p = 0.0019) but these changes were not significant after correction for multiple comparisons. There were no changes in other biomarkers. At 24 h, CRP levels had decreased by 30% to 1.01 ± 0.80 mg/L (p = 0.001 from baseline). ALP was unchanged immediately after the CEW application but was reduced by 5% from baseline (66.2 ± 16.1 to 62.7 ± 16.1 IU/L; p = 0.0003) at 24 h. No other biomarkers were different from baseline at 24 h. A full-trunk electrical weapon exposure did not lead to clinically significant changes in the acute phase protein levels or changes in measures of muscle cellular injury. We found no biomarker evidence of rhabdomyolysis.

Aims: In typical arrest-related death (ARD) scenarios, the victims often show signs of excited delirium syndrome (ExDS), intoxication, exhaustion and/or suffered from a preexisting physical or psychiatrical condition, all of which could have caused or at least triggered the person's death. Since autopsy findings are very rare in such cases, a clear clinicopathologic diagnosis and thus mechanism of death is rarely found., Methods: We present a case of a 25-year old woman, who died while being arrested by the police. Based on the patient's medical history, autopsy findings, contradicting witness testimonies, and reliable clinical and toxicological blood parameters, the most probable diagnosis is discussed., Results: The cause of death was determined as cardiac arrest subsequent to a combination of excited delirium syndrome, physical exhaustion and respiratory impairment. The manner of death was unnatural and juridically, the charges were dropped., Conclusions: In cases, where the cause and mechanism of death can only be diagnosed by exclusion, police collaboration, detailed clinical history (past and present) as well as clinical blood parameter analyses are necessary to help evaluating possible contributing factors and the most probable cause of death in ARD., (Copyright © 2020 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Conducted electrical weapons (CEW) are ubiquitous in law enforcement given their unique ability to physically incapacitate violently resisting subjects. Early use of animal models to study CEW incapacitation effectiveness (e.g. porcine model with 4-limb strain gauges) proved to be poorly predictive of human incapacitation effectiveness. In a previously published human study, we developed a methodology for the prospective assessment of the incapacitation effectiveness of CEWs in highly motivated human subjects. Here we use this methodology in Part 1 to compare the incapacitation effectiveness of the newly released Axon® (formerly TASER® International) T(ASER) 7 to the TASER X26E, the "gold standard", and the TASER X2, a current model. The T7 has a new "adaptive cross-connect" technology that may improve incapacitation effectiveness in the scenario of small spreads between probe pairs, a common cause of weapon "failure" in the field. In Part 2, we use our methodology to test the functionality of the T7 cross-connect technology by comparing different bay and probe configurations. This is the first published study in the literature comparing different CEW models using this human model. For Part 1, 29 subjects completed the study and had data available for analysis. For Part 2, 21 subjects completed the study and had data available for analysis. The subjects were motivated to complete the task of reaching a suspended martial arts dummy 3.4 m (11 ft) away while being exposed "under power" to the CEW. In Part 1, subjects were assigned to 1 of 6 groups with probe spreads of 10, 20, and 30 cm (4, 8, 12 in). Subjects were exposed to a "control" CEW (either the X2 or X26E) and the T7 on alternating sides. Exposures with the X2 and T7 included 2 bay-exposures. In Part 2, 21 subjects were assigned to 1 of 5 groups of different T7 bay and probe configurations all with a theoretical effective spread of 30 cm (12 in). Subjects were rated on their progress towards successfully reaching the dummy and on the extent of limb incapacitation using a quasi-blinded expert-observer scoring panel based on high-speed video review. In Part 1, all CEW models achieved maximal or near-maximal subject control with the 30 cm probe spread. With probe spreads of 10 and 20 cm the pooled data showed the T7 to be superior to the X2 for goal achievement (p < 0.001) and limb incapacitation (p = 0.002) mostly driven by differences seen with the 10 cm spread (2-bay exposures). The T7 was non-inferior to the X26E. In Part 2, there was no statistical significance between the limb capture scores, but there was a statistically significant difference in goal scores. The results overall validate that the T7 CEW cross-connect feature performed as expected. The T7 adaptive cross-connect feature with two simultaneous deployed probe pairs demonstrated a significant improvement in incapacitation effectiveness compared to the current X2 CEW with two simultaneously deployed probe pairs. Small probe spreads are a common reason for limited incapacitation effectiveness in the field and this study suggests the T7 may offer an improvement in this scenario. The T7, with single-bay exposures, was non-inferior to the single-bay X26E.

Axon Enterprise, Inc. (Axon) released its newest generation conducted electrical weapon (CEW), the T7, in October 2018. In order to compare the effects of this new CEW to prior generations, we used our previously described methodology to study the physiologic effects of CEWs on human volunteers at rest. This was a prospective, observational study of human subjects consisting of two parts. Part 1 was testing a single cartridge (2-probe) exposure. Subjects received a 10-s exposure from the T7 to the back with a 30 cm (12 in.) spread between the two probes. Part 2 was testing a simultaneous two-cartridge (4-probe) exposure. Subjects received a 10-s exposure from the T7 to the back with two cartridges with a 10 cm (4 in.) spread between each probe pair. The probe pairs were arranged cephalad to caudal such that the distance between the top probe of the first cartridge and the bottom probe of the second cartridge was 30 cm (12 in.). Vital signs were measured immediately before and after the exposure. Continuous spirometry was performed. ECG monitoring was performed immediately before and after the exposure. Venous pH, lactate, potassium, CK, catecholamines, and troponin were measured before and immediately after the exposure, at 1-h post-exposure, and again at 24 h. 11 subjects completed part 1 of the study. 9 subjects completed part 2 of the study. No subjects had a dysrhythmia or morphology change in the surface ECG. There were no statistical changes in vital signs pre- and post-exposure. While subjects did not have a statistical change in spirometry parameters pre-exposure to exposure except for a small drop in PETCO 2 , there was an increase in minute ventilation after the exposure that could have several explanations. A similar pattern was seen with prior generation weapons. No subject had elevated troponin levels. Other blood parameters including venous pH, lactate, potassium, CK, and catecholamines had changes similar to prior generation weapons. Comparison of the data for the single-cartridge exposures against the simultaneous two-cartridge exposures yielded no difference in vital signs, but the minute ventilation was higher for the two-cartridge exposures. The blood data, where there was a difference, was mixed. In our study, the physiologic effects of the Axon T7 are modest, consistent with the electrically-induced motor nerve-driven muscle contraction, and were similar to prior generation weapons.

Cases of combined blunt and sharp force trauma to the head caused by one striking tool are rare. When beer steins are used as an assault weapon, they can cause blunt traumas upon initial contact phase. If the impact force exceeds the mechanical stability of the beer stein, it breaks into several sharp-edged pieces, which then can cause sharp force trauma injuries due to the interaction between the head and the stein fragments.We present a case of a 43-year old man, who suffered from blunt and sharp force head traumas due to one single blow with a 1-l beer stein. A forensic-biomechanical analysis of the event, together with witness testimony evaluation and experimental comparison helped to reconstruct the most probable chain of events. Based on these findings as well as on the medical diagnoses and treatment, the assault was assessed as a nonacute life-threatening, but potentially fatal offence. The case was indicted as grievous bodily harm.

Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Background: There have been case reports following the use of a conducted electrical weapon (CEW) suggesting that these devices might affect coagulation or thrombosis in at-risk individuals. The aim of this manuscript therefore is firstly to explore this hypothesis by reviewing each of these cases and secondly to report the results of a prospective study exploring a priori the effects of electrical weapons on hematocytes in a group of human volunteers., Methods: First, we systematically reviewed all cases of adverse outcomes following CEW discharge that could be due to an effect on coagulation or thrombosis, with particular focus on the clinical scenario and its relationship with the weapon discharge. Second, we assessed hematocyte levels in venous blood from 29 volunteers before, 5 min after, and 24 h after receiving a full-trunk 5-s TASER® X26(E) CEW exposure., Results: Following extensive review of the literature, we found 3 relevant case reports of possible vascular thromboembolic clinical events after CEW exposure, specifically a case of ischemic stroke, and 2 cases of ST-segment elevation myocardial infarctions. Review of these published cases failed to establish a plausible linkage to the CEW beyond a temporal association with significant emotional and physiological stress from a violent struggle. Our prospective study of biomarker change following CEW discharge revealed acutely increased values for WBC (white blood cells), specifically lymphocytes and monocytes, and a raised platelet count. Neutrophil levels decreased as a percentage of WBC. While these changes were statistically significant at 5 min, all results remained within established reference ranges. At 24 h, all values had returned to baseline except total WBC which decreased to slightly below baseline but was still within the normal reference range., Conclusions: A review of clinical cases, of ischemic or thrombotic events revealed no direct association with the CEW discharge. A full-trunk electrical weapon exposure did not lead to hematocyte changes beyond normal clinically expected variations in similar acute response scenarios. The case report and biomarker data do not support the hypothesis that a CEW discharge is associated with changes likely to promote coagulation or thrombus formation., Competing Interests: Declaration of competing interest MWK is a member of Axon’s Scientific and Medical Advisory Board (SMAB) and corporate board. RML is a SMAB member and consultant to Axon. SNK is a SMAB member. KKW and JCC declare no conflicts. MWK and RML have served as litigation or inquest experts in multiple countries., (Copyright © 2020. Published by Elsevier Ltd.)

A clinical as well as forensic autopsy is a uniform medical investigation of the deceased, which mainly serves to verify the plausibility of information on the cause, mode and mechanism of death provided by the police and/or medical personnel. Despite its importance in the context of a conclusive assessment of a person's medical history and in detecting any criminal correlation or malpractice, a significant decline in autopsies is evident in Iceland. This article gives an overview on autopsy rates in Iceland and compares the situation with European countries.

Regionalization, which emphasizes matching patient needs with the capabilities of the hospital in which care is provided, has long been a recommended approach to reducing neonatal morbidity and mortality. Over the past decade, research methods surrounding the measurement and evaluation of such programs have improved, thus strengthening arguments for implementation of these strategies. However, regionalization policies vary widely across regions and between countries, with potential impacts on neonatal outcomes as well as costs of care. It is important to account for geographic and other regional differences when determining the feasibility of regionalization for a specific region, as certain areas and populations may need particular consideration in order for regionalization policies to be successful., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Intense blunt compression trauma to the neck can result in subcutaneous, intramuscular or laryngeal mucosa bleedings of different intensity. While these findings can easily be detected through a layer-wise dissection of the neck muscles and soft tissue during autopsy, it can be difficult to distinguish between peri-/post- and ante mortem hemorrhages solely based on macroscopic findings. Especially when an initial preliminary diagnosis is required, possible artifacts have to be excluded. The study at hand examines possible peri- and post mortem hemorrhages in the anterior neck after NorMors™ chin-collar application. In routine clinical and forensic autopsy cases, where such a chin-collar has been placed around the neck of the deceased in close proximity after death, focus was directed to the soft tissue and muscles of the neck. The results of our analysis could prove that the use of chin-collar shortly within the first 1 ½ hours after death applies just enough pressure to the neck to be able to cause superficial hemorrhages within the surface of the sternocleidomastoid muscles, which can mimic vital compression trauma injuries. Based on location, morphological outlines and intensity of the injuries, it is possible to correlate them with the position of the applied collar. Together with histological analyses, asphyxia by a second party involvement can be excluded. However, the application of chin-collars should be prohibited in any case, where an autopsy might be performed., (Copyright © 2019 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Injuries resulting from blows with beer steins are a frequent occurrence during annual autumn fairs or at beer halls in South Germany and Austria. The majority of these cases are tried in court and thus being assessed by a forensic medicine expert. The article at hand gives a short overview on the injury potential of one-litre beer steins and explains the key variables to consider when analyzing beer stein injuries. On the basis of representative cases, which were assessed by specialists from the Institute of Legal Medicine of the Munich University over the last 5 years, the main biomechanical aspects and resulting injuries of one-litre beer stein assaults are discussed. Several severe and potentially life-threatening injuries have been observed after an assault with a one-litre beer stein. There is a discrepancy between the mechanical stability of brand new and used steins and the corresponding injuries, which can be explained by a decrease in impact tolerance of the steins with their use. In general, a blow with a one-litre glass or stonework beer stein to the head can cause severe and even life-threatening blunt as well as sharp trauma injuries.

The variety and high number of published research articles on conducted electrical weapons (CEW) provides a detailed, yet in some parts inconclusive overview of medical aspects of CEW. Due to different research approaches and the use of dissimilar test subjects, an assessment of possible health risks of CEW is limited. The present work provides a brief on CEW safety based on currently available animal, computer and human research data. Using the medical database PubMed, articles published on this topic are critically evaluated and compared with each other. Special focuses are the differences and similarities of human and animal research as well as computer simulation programs. The authors explain why some studies are more reliable than others and give their expert opinion on the safety of CEW. The body of data that have been reviewed provides reasonable support for the safety of CEW.

Up to 20% of newborn infants retro-transferred to a lower level of care require readmission to a higher-level facility. In this study, we developed and validated a prediction rule (The Rule for Elective Transfer between Units for Recovering Neonates [RETURN]) to identify clinical characteristics of infants at risk for failing retro-transfer., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: Electronic control with the CEW (conducted electrical weapon) has gained widespread acceptance as the preferred force option due to its significant injury reduction. However, a CEW application does stress the human body. In the case of the CEW, the human body response is similar to the challenge of physical exercise combined with emotional stress over a very short time interval. There has been concern whether the tension of the skeletal-muscle system together with the emotional stress of being exposed to the effects of a CEW, can lead to severe metabolic dysfunction., Methods: A systematic and careful search of the MedLine database was performed to find publications describing pathophysiological effects of CEWs. Additional publications were collected through a manual search of reference lists in retrieved articles. After preliminary exclusions, we carefully reviewed the remaining publications and found 24 papers reporting prospective human clinical research data on adrenergic, ventilation, or metabolic effects. Where there were multiple studies on the same endpoints, we performed meta-analyses., Results: A CEW exposure provides a clinically insignificant increase in heart rate (7.5 BPM) and a drop in both systolic and diastolic blood pressure. Alpha-amylase goes down but cortisol levels increase-both epinephrine and norepinephrine levels are increased by levels similar to mild exercise. A CEW exposure increases ventilation but does not appear to interfere with gas exchange. Lactate is increased slightly while the pH is decreased slightly with changes equivalent to mild exercise. The lactate and pH changes appear quickly and do not appear to be affected by increasing the exposure duration from 5 to 30 s., Conclusions: Thorough review and meta-analyses show that electrical weapon exposures have mixed and mild adrenergic effects. Ventilation is increased and there are metabolic changes similar to mild exercise.

Conducted Electrical Weapons (CEWs) are being used as the preferred non-lethal force option for police and special forces worldwide. This new technology challenges an exposed opponent similarly to the way they would be challenged by physical exercise combined with emotional stress. While adrenergic and metabolic effects have been meta-analyzed and reviewed, there has been no systematic review of the effects of CEWs on skeletal and cardiac muscle. A systematic and careful search of the MedLine database was performed to find publications describing pathophysiological cardiac and skeletal muscle effects of CEWs. For skeletal muscle effects, we analyzed all publications providing changes in creatine kinase, myoglobin and potassium. For cardiac effects, we analyzed reported troponin changes and arrhythmias related to short dart-to-heart-distances. Conducted electrical weapons satisfy all relevant electrical safety standards and there are, to date, no proven electrocution incidents caused by CEWs. A potential cardiovascular risk has been recognized by some of the experimental animal data. The effects on the heart appear to be limited to instances when there is a short dart-to-heart-distance. The effect on the skeletal muscle system appears to be negligible. A responsible use of a CEW on a healthy adult, within the guidelines proposed by the manufacturer, does not imply a significant health risk for that healthy adult.

Cases of intoxication in combination with extreme agitation, physical exertion and restraint are mainly associated with restraint-related deaths (RRD) in the context of police use of force. In these cases, the mechanism of death usually mentioned is RRD associated with drug-induced excited delirium. To the best of our knowledge, there are no cases published on RRD that occurred during a physical encounter among civilians. We present a case of a 39-year old man, who died during a struggle with another person while being chokehold in a prone position with a knee on his back. Detailed witness testimonies as well as reliable blood parameters, which were taken immediately after his death, helped to define a most probable diagnosis. The deceased suffered from schizophrenia, consumed amphetamine and bupropion. He showed typical symptoms of an agitated delirious state, most likely induced by bupropion intoxication. The cause of death was restraint asphyxia by a second party on the basis of an excited delirium. The manner of death was concluded to be manslaughter., (Copyright © 2018 Elsevier B.V. All rights reserved.)

This study has evaluated the action of flavonoid hesperidin on the neurotoxic effects caused by the intake of iron (Fe) in Drosophila melanogaster. Male adult flies, aged 1-3 days, have been divided into four groups of 50 each: (1) control, (2) Hsd 10 μM, (3) Fe 20 mM (4) Hsd 10 μM + Fe 20 mM. During the exposure protocol, the flies have been exposed to a diet containing Hsd and/or Fe for 48 h. The survival and behavioral analyses have been carried out in vivo, and ex vivo. The analyses involved acetylcholinesterase (AChE) activity and Fe levels in the flies' heads and bodies and determination of dopaminergic levels, cellular and mitochondrial viability, activities of superoxide dismutase (SOD), catalase (CAT), glutathione-S-transferase (GST), reactive species levels (RS), thiobarbituric acid reactive substances (TBARS) and contents of total thiols and non-proteic thiols (NPSH) in the flies' heads. A significant negative correlation between Fe levels in the head of the flies and the survival, dopamine levels and antioxidant enzymes in the head of the flies has been found. Additionally, significant positive correlation between Fe levels in the head of the flies with negative geotaxis RS and AChE activity in the head of the flies has been found. It demonstrates that the flies which had higher levels of Fe in their heads have demonstrated more susceptibility to neurotoxicity. An important result from our study is that Hsd treatment promotes a decrease in Fe concentration in the head, restores dopamine levels and cholinergic activity of the flies and improves motor function caused by Fe. Hsd also ameliorates Fe induced mortality, oxidative stress and mitochondrial dysfunction. Our results have demonstrated the neuroprotective effect of Hsd and it suggests that flavonoid acts in different ways to protect against the Parkinson disease caused by Fe exposure such as the direct scavenging of RS and activation of antioxidant enzymes., (Copyright © 2017 Elsevier B.V. All rights reserved.)

The differentiation between a non-accidental injury and injuries resulting from accidents, such as falls to the ground or onto various objects, is a challenge not only for forensic experts but also for all clinicians caring for children. The forensic-biomechanical analysis of accidents in infants aims at the assessment of the loading characteristics based on the reconstruction of the particular incident. It includes an evidence-based analytical comparison between the actual injuries presented and the injuries that should be expected as a result of the proclaimed accident. With the help of kinematical and dynamical parameters of the described actions and the resulting loading situations, the forensic-biomechanical analysis can assess the plausibility of the proclaimed course of the event and thus contribute to the differentiation between accidental and non-accidental injuries. The quality of such a forensic-biomechanical expert opinion depends on the accuracy and quantity of available data regarding biomechanical tolerance of tissues, organs, and body parts. Case-specific measurements can contribute significantly to the insight of the kinematics and dynamics of the proclaimed event, its feasibility, etc. The present article demonstrates, based on one case report, the potential as well as the limits of such an analysis of proclaimed accidental fall injuries.

Background: In recent years, tourism has become the number one account for foreign exchange income in Iceland, overtaking the fisheries industry and aluminium production. The rise of tourism has strongly affected Icelandic society in various sectors. With the increase of tourists visiting Iceland, the number of foreign citizens that died and were autopsied also rose., Method: Data were collected from the Department of Forensic Pathology at Landspitali University Hospital in Reykjavik for the period January 2006 - December 2016., Result: During this time there were 109 autopsies performed on foreign citizens of which 58 died from natural causes, 49 were injury deaths and in 2 cases no certain cause of death could be determined. Most represented were citizens from North America, United Kingdom and Germany (each 11%). The main causes of death were cardiovascular events (41%) followed by unintentional injuries (34%)., Conclusion: The research at hand shows the significant influence of tourism on Forensic Medicine and provides an update on deaths of overseas travellers. Furthermore this study points out variable risks of travel-related injuries and deaths in Iceland., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: The objectives of this study are to use network analysis to describe the pattern of neonatal transfers in California, to compare empirical sub-networks with established referral regions and to determine factors associated with transport outside the originating sub-network., Study Design: This cross-sectional database study included 6546 infants <28 days old transported within California in 2012. After generating a graph representing acute transfers between hospitals (n=6696), we used community detection techniques to identify more tightly connected sub-networks. These empirically derived sub-networks were compared with state-defined regional referral networks. Reasons for transfer between empirical sub-networks were assessed using logistic regression., Results: Empirical sub-networks showed significant overlap with regulatory regions (P<0.001). Transfer outside the empirical sub-network was associated with major congenital anomalies (P<0.001), need for surgery (P=0.01) and insurance as the reason for transfer (P<0.001)., Conclusion: Network analysis accurately reflected empirical neonatal transfer patterns, potentially facilitating quantitative, rather than qualitative, analysis of regionalized health care delivery systems.

The location of a gunshot entrance wound as well as the wound path trajectory are the main findings that help to determine the position from which a weapon was fired and thus distinguish firearm suicides from homicides and accidents. We present a case of a 28-year old man, who was found dead in his car. Because of an unusual position of the firearm, which was clamped into the steering wheel, and an unclear entrance/exit wound, an autopsy was performed. The deceased showed typical signs of a contact shotgun wound to the head with an entrance wound in the right temporal region and an exit wound in the midface. With the help of gunpowder attachments and a muzzle imprint at the entrance site, a wound channel from the right lower posterior part of the temporal region to the left anterior part of the mid-facial region could be reconstructed. The stellate wound in the midface was assessed as an atypical exit wound. The cause of death was a contact shotgun shot to the right temple with a consequent central regulatory failure due to extensive brain injury. The manner of death was concluded to be a suicide., (Copyright © 2017 Elsevier B.V. All rights reserved.)

During a bloodstain pattern analysis, one of the essential tasks is to distinguish between different kinds of applied forces as well as to estimate their level of intensity. In this study, high-speed digital imaging has been used to analyze the formation of cast-off patterns generated by a simulated backswing with a blood-bearing object. For this purpose, 0.5 mL blood was applied evenly over the last 5 cm of a blade simulant. Bloodstains were created through the controlled acceleration of a backswing at different speed levels between 1.1 m/sec and 3.8 m/sec. The flight dynamics of blood droplets were captured with an Olympus ® i-Speed 3 high-speed digital camera with a Nikon ® AF Nikkor 50 mm f/1.8 D lens and analyzed using the Olympus i-Speed 3 Viewer software. The video analysis showed that, during the backswing, blood droplets would move toward the lower end of the knifepoint and would be tangentially thrown off. These droplets impacted on the horizontal surface according to the arc of the swing. An increase in velocity led to longer cast-off patterns with distinct morphological characteristics. Under laboratory conditions, bloodstain pattern analysis allows certain conclusions about the intensity of a backswing and provides instructions on the position of the offender. However, due to the number of unknown variables at a crime scene, such interpretation of cast-off patterns is extremely limited and should be performed with extreme caution., (© 2016 American Academy of Forensic Sciences.)

Aims: Aluminum (Al) is an important environmental contaminant; however, there are not enough evidences of Al-induced cardiovascular dysfunction. We investigated the effects of acute exposure to aluminum chloride (AlCl 3 ) on blood pressure, vascular reactivity and oxidative stress., Methods and Results: Male Wistar rats were divided into two groups: Untreated: vehicle (ultrapure water, ip) and AlCl 3 : single dose of AlCl 3 (100mg/kg,ip). Concentration-response curves to phenylephrine in the absence and presence of endothelium, the nitric oxide synthase inhibitor l-NAME, the potassium channel blocker tetraethylammonium, and the NADPH oxidase inhibitor apocynin were performed in segments from aortic and mesenteric resistance arteries. NO released was assessed in aorta and reactive oxygen species (ROS), malondialdehyde, non-protein thiol levels, antioxidant capacity and enzymatic antioxidant activities were investigated in plasma, aorta and/or mesenteric arteries. After one hour of AlCl 3 exposure serum Al levels attained 147.7±25.0μg/L. Al treatment: 1) did not affect blood pressure, heart rate and vasodilator responses induced by acetylcholine or sodium nitroprusside; 2) decreased phenylephrine-induced vasoconstrictor responses; 3) increased endothelial modulation of contractile responses, NO release and vascular ROS production from NADPH oxidase; 4) increased plasmatic, aortic and mesenteric malondialdehyde and ROS production, and 5) decreased antioxidant capacity and affected the antioxidant biomarkers non-protein thiol levels, glutathione peroxidase, glutathione-S-transferase, superoxide dismutase and catalase enzymatic activities., Conclusion: AlCl 3 -acute exposure reduces vascular reactivity. This effect is associated with increased NO production, probably acting on K + channels, which seems to occur as a compensatory mechanism against Al-induced oxidative stress. Our results suggest that Al exerts toxic effects to the vascular system., (Copyright © 2016 Elsevier Inc. All rights reserved.)

We report a rare case of homicide by hanging. The postmortem examination resulted in a verdict of death by suicidal hanging and the Public Prosecutor's Office released the body for burial. After intervention by the relatives police investigations were resumed. Based on evidence impossible to reconcile with the results of the postmortem examination and requiring further clarification, an autopsy was ordered. The results of the postmortem could not be brought in line with a suicidal hanging and were further substantiated by DNA analysis. The scenario put forward by the defense claiming a secondary transfer of trace evidence onto the ligature and the victim's clothes was excluded because of the distribution pattern and the trace evidence ratio. The defendant was sentenced to 20 years of prison for homicide. The verdict was confirmed by the Supreme Court and commuted to 18 years., (Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Parental refusal of a recommended treatment is not an uncommon scenario in the neonatal intensive care unit. These refusals may be based upon the parents' perceptions of their child's projected quality of life. The inherent subjectivity of quality of life assessments, however, can exacerbate disagreement between parents and healthcare providers. We present a case of parental refusal of surgical intervention for necrotizing enterocolitis in an infant with Bartter syndrome and develop an ethical framework in which to consider the appropriateness of parental refusal based upon an infant's projected quality of life., (Copyright 2015 The Journal of Clinical Ethics. All rights reserved.)

Contact and close-range gunshot injuries can produce bloodstains on the shooting hand and weapon. In this study, backspatter was analyzed in experimental horizontal pistol shots into blood-filled sponges. The shooting distances were set between 0 and 45 cm. With increasing shooting distance, there was a significant decrease in the degree of backspatter. Microspatter could be detected on the weapon and shooting hand up to a shooting distance of 40 cm. They were predominantly located on thumb and index finger as well as the radial dorsal aspects of the hand. Fine spray of microspatter combined with elongated droplets in the shape of exclamation marks was found at contact and 2-cm distance shots. An angular calculation based on the shape of the bloodstains was possible up to a shooting distance of 2 cm. No bloodstains were detected beyond 45 cm., (© 2014 American Academy of Forensic Sciences.)

Transcatheter aortic valve implantation via transarterial or transapical access is an alternative therapy to treat high-risk patients with severe symptomatic aortic stenosis. Despite growing experience, procedural complications may still occur. We herein report an 86-year-old female patient with fatal left ventricular rupture after transapical transcatheter aortic valve implantation with an Edwards Sapien prosthesis due to severe cardiac amyloidosis., (© 2014 Wiley Periodicals, Inc.)

Electronic control devices (ECDs) deliver high-voltage, low-current energy pulses temporarily paralyzing a person. For the ECD-human interaction, we have developed a computer model using the SEMCAD program within which to simulate the electrical effects throughout the body resulting from the imposition of an ECD pulse at a particular point on the body surface. Our human body models were based on cross-sectional MRIs and CT scans, with the dielectric properties of the various tissues assigned based on previously published values. We simulated the application of a single ECD pulse and calculated the resulting electric field strength and current and charge densities at different body locations. The results were compared with corresponding values obtained by other researchers in similar simulations. Furthermore, we simulated an application of a pulse of 20-millisecond duration equal to the European household current of 50 Hz and to the ventricular fibrillation threshold. The resulting current level indicated at the heart muscle was 1/5 the level considered the threshold for triggering ventricular fibrillation., (© 2014 American Academy of Forensic Sciences.)

When it comes to firearm fatalities, the main goal of forensic analysis is to distinguish firearm suicides from homicides and accidents. Apart from the location of the entrance wound, wound path trajectory and gunshot residue, blood stain pattern analysis of gunshot-related backspatter on the hands of the victim can be an essential tool not only to determine which hand was holding the firearm, but also to reconstruct the position from which a weapon was fired. We present a case of a 90-year-old man, who was found dead in his house. Because of unclear circumstances and an unusual position of the deceased with a gunshot entrance wound to the right temporal region and a firearm found on the left side of his body, an autopsy was performed. Due to the unusual bloodspatter stains on the hands and the firearm, it was possible to deduce the position and orientation of the hands and the firearm of the deceased. We could reconstruct that the man held the weapon in his right hand, using the left hand to stabilise the firearm and the right thumb to pull the trigger. A contact shot to the right temple led to central regulatory failure due to extensive brain injury. The manner of death was concluded to be a suicide., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background/purpose: Gastroschisis is the most common congenital abdominal wall defect. Despite advances in the surgical closure of gastroschisis, consensus is lacking as to which method results in the best patient outcomes. The purpose of this meta-analysis was to compare short-term outcomes associated with primary fascial closure and staged repair with a silo in patients with gastroschisis., Methods: We reviewed Medline citations, as well as the Cochrane Database of Systematic Reviews, between January 1, 1996 and June 1, 2012. Articles were identified using the search term "gastroschisis" and [("treatment outcome" or "prognosis") or randomized controlled trials]. Case reports, reviews, letters, abstracts only, non-English abstracts, and studies that did not address at least one of the outcomes of interest were excluded from the meta-analysis. Two independent reviewers identified relevant articles for final inclusion. A standard data collection form created by the authors was used to extract study information, including study design, patient characteristics, and reported patient outcomes. The data were analyzed using standard meta-analytic techniques., Results: Twenty studies were included in the meta-analysis. In the five studies that selected closure method randomly or as a temporal shift in practice, silo was associated with better outcomes, with a significant reduction in ventilator days (p<0.0001), time to first feed (p=0.04), and infection rates (p=0.03). When all studies were included, primary closure was associated with improved outcomes., Conclusions: Silo closure is associated with better clinical outcomes in the studies with the least selection bias. Larger prospective studies are needed to definitively determine the best closure technique., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: Histological evaluation of porcine posterior cervical muscles after a forceful translational and extensional head retraction simulating high-speed rear end impact., Methods: Four anesthetized pigs were exposed to a cervical spine distortion (CSD)-like motion in a lying position. After 2 different survival times of 4 and 6 h (posttrauma), the pigs were euthanized and tissue sampling of posterior cervical muscles was performed. A standard histological staining method involving paraffin-embedded sections was used to analyze the muscles, focusing on injury signs like hemorrhage and inflammatory cell reaction. A pig that was not subjected to impact was used as a control pig and was subjected to the same procedure to exclude any potential artifacts from the autopsy., Results: The differentiation of 8 different posterior neck muscles in the dissection process was successful in more than 50 percent for each muscle of interest. Staining and valid analysis was possible from all extracted samples. Muscle injuries to the deepest posterior neck muscles could be found, especially in the musculus obliquus samples, which showed laminar bleedings in 4 out of 4 samples. In addition, in 4 out of 4 samples we were able to see increased cellular reactions. The splenius muscle also showed bleeding in all 4 samples. All animals showed muscle injury signs in more than three quarters of analyzed neck muscles. Differences between survival times of 4 and 6 h in terms of muscular injury were not of primary interest and could not be found., Conclusions: By simulating a CSD-like motion we were able to confirm injuries in the posterior cervical muscles under severe loading conditions. Further studies need to be conducted to determine whether these muscle injuries also occur under lower exposure forces.