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Aim of the work In forensic anthropology, the estimation of age at death is required to establish a biological profile and facilitate individual identification. The pubic symphysis represents one of the most studied skeletal structures due to its late maturation. In this respect, the Suchey-Brooks (SB) system is one of the most commonly used methods of assessment based on the morphological characteristics of the pubic symphysis. However, the SB method has certain drawbacks, including frequently inaccurate estimation for individuals over 40 years old. The main aim of this work was to study the inter-observer agreement in the SB method then to test the errors of estimation by three observers with heterogeneous experience from a computed tomography sample for individuals aged between 15 and 98 years old. Patients and methods We retrospectively studied pubic bones from 50 males and 50 females undergoing clinical multislice computed tomography (MSCT) in a French hospital between November 2017 and April 2018. Results The inter-observer reliabilities, with or without the early and advanced patterns, were excellent between the observers (kappa values between 0.8 and 0.95). By focusing on the first three phases (I–III) versus the last three phases (IV–VI), there was no significant difference between the inter-observer reliabilities (kappa values between 0.44 and 0.85). Conclusion The inaccuracy rose with age, showing a growing underestimation from 40 years old and beyond. Besides, we highlighted a moderate overestimation for younger individuals. These errors of estimation were slightly dependent on the experience of the observer.

Hypothermia is a potentially lethal pathology whose in vivo diagnosis is relatively easy, based on the observation of a body temperature below 35̊C. However, its post mortem diagnosis is much more complex because of a thermal decrease occurring systematically after the death, which renders most often uninterpretable the body temperature as a diagnostic argument for hypothermia. Moreover, none of the macroscopic or microscopic autopsy elements described as suspicious of hypothermia are pathognomonic of a hypothermic death. Currently, this diagnosis arises in the light of an association of concordant arguments including these autopsic and histological elements but also some biomarkers. The aim of this article is to illustrate by a practical case the diagnostic complexity of a death by hypothermia through the evocative elements currently described, by emphasizing the reflection on some biomarkers confirmed or under study.

Resume Introduction La taille est l’un des elements d’identification en medecine legale qui doit etre estime lorsque l’etat du corps n’en permet pas la mesure. La plupart du temps, cette estimation s’appuie sur les equations de Trotter et Gleser (ETG) etablies, il y a 70 ans sur une population americaine a partir de la mesure d’os longs d’individus de taille connue. L’objectif principal de notre etude etait de comparer des mesures scanographiques d’os longs effectuees sur des corps d’individus francais autopsies au modele issu des ETG puis de comparer la taille estimee par ces equations a la taille reelle. Materiel et methode Nous avons inclus l’ensemble des corps ayant beneficie d’une autopsie et d’un scanner a l’institut medicolegal de Tours en 2017. Nous avons mesure les os longs sur les scanners et les avons compares au modele des ETG. La taille estimee a ensuite ete comparee a la taille mesuree. Resultats Au total, 99 hommes et 43 femmes ont ete inclus. Les longueurs effectuees sur le femur etaient a 95,96 % (chez l’homme) et a 100 % (chez la femme) incluses dans l’intervalle de confiance a 95 % de l’ETG. L’estimation de la taille par les ETG tendait a sous-estimer la taille des individus les plus grands et a surestimer la taille des individus les plus petits. Conclusion Ce travail a confirme le femur comme l’os long le plus utile pour estimer la taille. Une etude sur un nombre plus important d’individus permettrait d’adapter les ETG a notre population.

In forensic anthropology, the estimation of age at death is mainly required to establish a biological profile and facilitate individual identification. The Suchey–Brooks (SB) system represents one of the most commonly used and tested methods of assessment based on the morphological characteristics of the pubic symphysis. However, this method has certain drawbacks, including frequently inaccurate estimation for older individuals. The aim of this work was to test the evolution of pubic bone mineral density (BMD) according to age, especially for individuals over 40 years old. We retrospectively studied pubic bones from males (n = 88) and females (n = 113) over 40 years of age undergoing clinical multi-slice computed tomography (MSCT) in a French hospital between November 2017 and April 2018. The results revealed a significant negative correlation between BMD and age for males (R = −0.62) and females (R = −0.55). The intra- and inter-observer reliabilities of the phase allocation were moderate for males (kappa values at 0.72 and 0.65) and strong for females (kappa values at 0.93 and 0.86). Moreover, a significant difference in BMD between stages 6-1 and 6-2 for males was observed. We hypothesize that BMD might help improve the reliability of the SB system for older individuals. In addition to the pubic bone, numerous other anatomical regions such as the area of Ward could represent interesting areas of study in order to relate bone density to age.

Resume Les fistules des arteres coronaires, communiquant soit avec une cavite cardiaque, soit avec un gros vaisseau, sont des entites rares. Elles peuvent etre congenitales ou acquises. Elles sont le plus souvent asymptomatiques, mais peuvent aussi entrainer des symptomes tels qu’une douleur thoracique ou une dyspnee. Des cas de mort subite ont ete decrits dans la litterature. Ces malformations peuvent etre diagnostiquees de maniere fortuite lors d’une coronarographie, ou plus rarement dans le cadre d’une autopsie. Nous rapportons le cas d’un individu qui a presente un malaise avec un trouble du rythme cardiaque aigu, complique d’un arret cardio-respiratoire. Apres ressuscitation et stabilisation de l’individu, une coronarographie a ete realisee, mettant en evidence une fistule entre l’artere interventriculaire anterieure et l’artere pulmonaire. L’evolution clinique a ete pejorative compte tenu des complications anoxo-ischemiques avec un passage en etat de mort encephalique. Un arret therapeutique a donc ete decide. Une autopsie a ete pratiquee confirmant la presence de la fistule entre l’artere interventriculaire anterieure et l’artere pulmonaire. L’imputabilite de cette malformation au deces est ensuite discutee par les auteurs.

Background Survivors of sexual assault are vulnerable to long-term negative psychological and physical health outcomes, but few studies have investigated changes in cognition, emotional processing and brain function in the early stages after sexual assault. We used a multimodal approach to identify the cognitive and emotional correlates associated with sexual assault in women. Methods Twenty-seven female survivors of sexual assault were included within 4 weeks of the traumatic event, and they were compared with 20 age-matched controls. Participants underwent functional MRI while performing cognitive/emotional tasks (n-back, emotional go/no-go, mental imagery). We also measured diurnal salivary cortisol and conducted neuropsychological assessments of attention and memory abilities. Results Relative to the control group, the survivors group had lower levels of morning cortisol and showed attentional deficits. We observed no between-group differences in brain activation during the n-back or mental imagery tasks. During the emotional go/no-go task, however, the survivors group showed a lack of deactivation in the dorsal anterior cingulate cortex when processing emotional material, relative to neutral material. Exploratory analyses in the survivors group indicated that symptom severity was negatively associated with cerebellar activation when positive emotional (happy) content interfered with response inhibition, and positively associated with cerebellar activation when thinking of positive (happy) memories. Limitations The small sample size was the main limitation of this study. Conclusion Dysfunctions in the dorsal anterior cingulate cortex and the cerebellum may represent early functional brain modifications that alter higher cognitive processes when emotional material is involved.

Resume L’evaluation de la maturation osseuse de l’extremite sternale de la clavicule sur un scanner est une des methodes de l’estimation de l’âge chez le sujet vivant. Plusieurs classifications sont utilisees pour cette evaluation. But de l’etude L’objectif etait de savoir si cette analyse etait contributive pour determiner si un individu etait âge de plus ou moins de 18 ans. Patients et methodes Nous avons selectionne retrospectivement tous les patients âges de 15 a 30 ans ayant eu un scanner thoracique et/ou un body scanner dans un CHU francais, entre le 1er janvier 2009 et le 1er juillet 2014, et avons evalue la maturation osseuse de l’extremite sternale des clavicules en utilisant une classification en neuf stades. Resultats Trois cent dix-neuf scanners ont ete inclus. Dans notre echantillon, tous les individus dont la fusion metaphyso-epiphysaire de la clavicule etait superieure a un tiers etaient âges de 18 ans et plus. Discussion Les etudes similaires dans la litterature s’accordent sur le fait que tous les individus dont la clavicule est totalement fusionnee sont âges de 18 ans et plus. Une simplification des classifications existantes pourrait donc etre discutee pour limiter le risque d’erreurs qui augmente avec le nombre de stades.

We report an unusual case of homicidal stab wound of the cervical spinal cord, which illustrates the value of post-mortem computed tomography angiography (PMCTA) in cases of vascular injury. First, we noted a posterior and horizontal trajectory to the neck with complete section of the cervical spinal cord between the first and second cervical vertebrae. This lesion was accompanied by section of the right vertebral and right deep cervical arteries. We also noted an anterior cervical trajectory with an injury to the right internal jugular vein and an anterior right chest wound with a lung trajectory and section of the internal mammary vessels. Cases of spinal cord injuries secondary to stab wounds are rare in the literature. Only one large series has been published from Cape Town. Complete section of the cervical spinal cord accounts for only 4.5% of all cases. Furthermore, lethal cases are rare and classically victims survive and present neurological sequelae. We found only one similar case but despite the transection of the cervical spinal cord the patient survived. Some studies suggest that PMCTA may be very helpful in visualizing vascular system injuries. Our observations are consistent with this proposal. The use of different-time acquisitions was essential for detection of the injured vessels.

Resume But de l’etude Le controle medical est exerce par les medecins-conseils. Ils donnent des avis sur des situations medicales problematiques. La contestation de cet avis par l’assure entraine une expertise medicale de securite sociale selon l’article L. 141-1 du Code de securite sociale. L’epidemiologie de la population des assures concernes par cette procedure a deja ete etudiee, mais pas le profil des individus. Nous avons donc choisi d’etudier les profils individuels d’une telle population. Materiel et methodes Cette etude retrospective a concerne 103 dossiers d’expertises realisees entre juin 2011 et mars 2012 au service medical de la caisse primaire d’assurance maladie d’Indre et Loire (37). Un recueil de donnees a ete effectue afin d’en degager des profils. L’analyse statistique a consiste en une analyse des correspondances multiples suivie d’une classification ascendante hierarchique. Resultats Trois profils ont ete individualises. Le premier concerne des retraites et des professions superieures a qui l’on a refuse le versement d’indemnites journalieres pour une pathologie aigue en risque maladie. Le deuxieme concerne des femmes employees ou exercant une profession intermediaire sans penibilite, victimes d’une pathologie chronique. Enfin, le dernier concerne des ouvriers en arret de travail pour des troubles musculo-squelettiques survenant du fait de la penibilite physique de leur travail. Discussion Ce travail a consiste a completer les travaux preexistants sur la population de personnes expertisees selon l’article L. 141-1 du Code de securite sociale en s’attachant plus a l’individu qu’a la description de la population. Ces profils offrent une vision concrete des situations rencontrees dans la pratique de ce type d’expertise.

Resume L’estimation de l’âge chez le sujet vivant est un sujet important en medecine legale clinique, en raison de l’augmentation des flux migratoires. Des etudes se sont interessees a l’apport de l’imagerie par resonance magnetique (IRM) dans l’evaluation de la maturation osseuse, en raison du caractere non irradiant de cette technique d’imagerie. Le travail recent d’une equipe allemande sur l’analyse d’IRM d’extremite distale du femur a suggere que si un homme presentait une fusion metaphyso-epiphysaire de cette extremite, il etait âge d’au moins 18 ans. Nous avons voulu verifier ce resultat et avons selectionne des IRM de genou de 214 sujets de sexe masculin âges de 14 a 20 ans. Les images ont ete analysees par deux observateurs afin de determiner si la metaphyse et l’epiphyse de l’extremite distale du femur etaient completement fusionnees ou pas. Les resultats confirmaient ceux de la premiere etude, le sujet le plus jeune ayant une fusion complete visible sur les images d’IRM etant âge de 18,1 ans. Ainsi, meme si ces resultats ne concernent que les hommes de deux echantillons composes d’individus originaires de pays dont le niveau de modernisation est eleve, ils suggerent que le genou est une articulation dont l’analyse peut etre contributive dans l’estimation de l’âge et que l’IRM est une technique d’imagerie adaptee a cette evaluation.

Computed tomography (CT) scan of the medial clavicular epiphysis is one of the methods recommended by the Study Group on Forensic Age Diagnostics to estimate the age of living individuals. The aim of our study was to assess the relationship between the skeletal maturation of the sternal end of the clavicle and the chronological age in a sample of French individuals, using a nine-stage classification. We retrospectively reviewed 319 chest CT-scans of individuals aged 15-30 years old (252 males, 67 females). Among males and females, all individuals with a complete fusion, or an ongoing fusion of more than one third of the total surface of the metaphysis were at least 18 years old. Our results were consistent with data in the literature indicating that individuals with a complete fused clavicle were at least 18 years old. Similar studies with the same methods allow for creating a database of samples from different countries to confirm the validity of this method and its excellent results in forensic age estimation of living individuals.

The Suchey-Brooks method is commonly used for pubic symphyseal aging in forensic cases. However, inter-population variability is a problem affected by several factors such as geographical location and secular trends. The aim of our study was to test the reliability of the Suchey-Brooks method on a virtual sample of contemporary French males. We carried out a retrospective study of 680 pubic symphysis from adult males undergoing clinical Multislice Computed Tomography in two hospitals between January 2013 and July 2014 (Toulouse and Tours, France). The reliability of the Suchey-Brooks method was tested by the calculation of inaccuracy and bias between real and estimated ages, and the mean age for each stage and the mean stage for each 10-years age interval were compared. The degree of inaccuracy and bias increased with age and inaccuracy exceeded 20 years for individuals over 65 years of age. The results are consistent with an overestimation of the real age for stages I and II and an underestimation of the real age for stages IV, V and VI. Furthermore, the mean stages of the reference sample were significantly lower for the 14–25 age group and significantly higher for individuals over 35 years old. Age estimation is potentially limited by differential inter-population error rates between geographical locations. Furthermore, the effects of secular trends are also supported by research in European countries showing a reduction in the age of attainment of indicators of biological maturity during the past few decades. The results suggest that the Suchey-Brooks method should be used with caution in France. Our study supports previous findings and in the future, the Suchey-Brooks method could benefit from re-evaluation of the aging standards by the establishment of new virtual reference samples.

The first step in the identification process of bone remains is to determine whether they are of human or nonhuman origin. This issue may arise when only a fragment of bone is available, as the species of origin is usually easily determined on a complete bone. The present study aims to assess the validity of a morphometric method used by French forensic anthropologists to determine the species of origin: the corticomedullary index (CMI), defined by the ratio of the diameter of the medullary cavity to the total diameter of the bone. We studied the constancy of the CMI from measurements made on computed tomography images (CT scans) of different human bones, and compared our measurements with reference values selected in the literature. The measurements obtained on CT scans at three different sites of 30 human femurs, 24 tibias, and 24 fibulas were compared between themselves and with the CMI reference values for humans, pigs, dogs and sheep. Our results differed significantly from these reference values, with three exceptions: the proximal quarter of the femur and mid-fibular measurements for the human CMI, and the proximal quarter of the tibia for the sheep CMI. Mid-tibial, mid-femoral, and mid-fibular measurements also differed significantly between themselves. Only 22.6% of CT scans of human bones were correctly identified as human. We concluded that the CMI is not an effective method for determining the human origin of bone remains.