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Postmortem detection of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) after the exhumation of a corpse can become important, e.g. in the case of subsequent medical malpractice allegations. To date, data on possible detection periods [e.g. by reverse transcription polymerase chain reaction (RT-PCR)] or on the potential infectivity of the virus after an exhumation are rare. In the present study, these parameters were examined in two cases with a time span of approximately 4 months between day of death and exhumation. Using SARS-CoV-2 RT-PCR on swabs of both lungs and the oropharynx detection was possible with cycle threshold (Ct) values of about 30 despite signs of beginning decay. RT-PCR testing of perioral and perinasal swabs and swabs collected from the inside of the body bag, taken to estimate the risk of infection of those involved in the exhumation, was negative. Cell culture-based infectivity testing was negative for both, lung and oropharyngeal swabs. In one case, RT-PCR testing at the day of death of an oropharyngeal swab showed almost identical Ct values as postmortem testing of an oropharyngeal swab, impressively demonstrating the stability of viral RNA in the intact corpse. However, favorable climatic conditions in the grave have to be taken into account, as it was wintertime with constant low temperatures. Nevertheless, it was possible to demonstrate successful postmortem detection of SARS-CoV-2 infection following exhumation even after months in an earth grave.

Hintergrund: In Frankfurt am Main (~750.000 Einwohner) wird die erste Leichenschau im Auftrag der Polizei tagsüber durch einen dafür eingerichteten rechtsmedizinischen Dienst vorgenommen. Nachts und am Wochenende führen diese Tätigkeit Ärzte des ärztlichen Bereitschaftsdienstes (ÄBD) der kassenärztlichen Vereinigung durch. Material und Methoden: Für das Jahr 2019 wurden die im Rahmen dieser ersten Leichenschauen ausgestellten Leichenschauscheine hinsichtlich der attestierten Todesart ausgewertet und die Ergebnisse mit denen einer ggf. im Nachgang durchgeführten Sektion, inklusive Zusatzuntersuchungen, verglichen. Von den Ärzten des ÄBD konnten 461 Leichenschauen in die Auswertung eingeschlossen werden, davon erfolgte in 76 Fällen eine Obduktion. Im Nachgang der 364 rechtsmedizinischen Leichenschauen wurden 78 Obduktionen durchgeführt. Ergebnisse: Veränderungen in der Todesart nach Sektion ergaben sich für die Leichenschauen des ÄBD in 57, bei den rechtsmedizinischen Leichenschauen in 49 Fällen, wobei insbesondere eine bei Leichenschau attestierte ungeklärte Todesart in einen natürlichen Tod spezifiziert werden konnte. Nach der Obduktion fanden sich bei den rechtsmedizinischen Leichenschauen 8 Fälle, bei denen des ÄBD 19 Fälle eines nichtnatürlichen (statt weiterhin ungeklärten) Todes. Bei den rechtsmedizinisch beschauten Fällen änderte sich zudem nach der Sektion in einem Fall die Todesart von natürlich zu nichtnatürlich, bei denen des ÄBD kam es in einem Fall zu einer Änderung von nichtnatürlich zu natürlich. Diskussion: Die Veränderung bzw. Spezifizierung der Todesart nach der Sektion beider Kollektive verdeutlicht, wie wichtig eine Steigerung der Sektionsrate wäre, und dass auch bei professioneller Durchführung der Leichenschau das Erkennen der Todesart Probleme bereitet. Background: In Frankfurt am Main (~750,000 inhabitants) first postmortem external examinations are carried out by two institutions at the request of the police. During daytime the medical team of the Institute of Forensic Medicine performs first postmortem external examinations, whereas during nights and weekends, the examinations are carried out by physicians of the medical emergency service (ÄBD). Material and methods: For the year 2019 both examiner groups were evaluated with respect to the certification of the manner of death during the first postmortem external examination. Evaluation results were then compared with those of a subsequent autopsy. For the ÄBD group 461 examinations resulting in 76 autopsies were included in this study, whereas for the forensic medicine group 364 examinations were included, which resulted in 78 autopsies. Results: In 57 cases of the ÄBD the manner of death had to be changed based on the autopsy findings (49 cases in the forensic medicine group). This fraction of cases mainly consisted of a change from an undetermined to a natural manner of death. In 19 cases of the ÄBD and 8 cases of the forensic medicine group the manner of death was changed from undetermined to unnatural death. In one case of the forensic medicine group the manner of death had to be changed from natural to unnatural, 1 case from the ÄBD changed from unnatural to natural. Discussion: The necessity for changing manners of death after performing a medicolegal autopsy in a relatively high percentage of examinations in both subgroups stresses the need for an increase of the autopsy rate. Furthermore, the data showed that even with a professionalized approach using forensic experts for first postmortem external examinations, special case constellations pose great challenges on the medical examiner.

Zusammenfassung Einleitung Funde von Knochen(fragmenten) können von Interesse für Strafverfolgungs- oder Denkmalbehörden sein. Die forensisch-osteologische Begutachtung kann zur Einordnung der Bedeutung des Fundes beitragen. Ziel der Studie war, durch eine Auswertung von am Institut für Rechtsmedizin Gießen begutachteten Knochenfunden einen Überblick über Umstände und Art der Funde sowie Umfang und Ergebnisse der Begutachtungen zu erhalten. Material und Methoden Für den Zeitraum von 2005 bis 2019 wurden im Institut archivierte osteologische Gutachten analysiert und Daten zu Fundort, -umständen, Humanspezifität, postmortalem Intervall, Spuren von Gewalteinwirkungen und die Ergebnisse weiterführender Untersuchungen ausgewertet. Ergebnisse Von 172 begutachteten Knochenfunden wurden 40 % in Wald- und Wiesengebieten aufgefunden. In 58 % enthielten die Funde menschliche Knochen, davon wurde in 32 % eine forensisch relevante Liegezeit nicht ausgeschlossen. Zeichen perimortaler Gewalteinwirkung fanden sich in 6 % menschlicher Knochenfunde. Ergänzende DNA-Untersuchungen wurden in 20 % aller Funde durchgeführt; davon verlief in 62 % die Typisierung humaner STR erfolgreich, und in 41 % gelang die Zuordnung zu einem antemortalen Profil. Bei den zur Begutachtung übersandten nichtmenschlichen Knochen handelte es sich am häufigsten um Knochen von Hirsch bzw. Reh (32 %), Schwein (29 %) und Rind (14 %). Diskussion Die Begutachtung von Knochenfunden soll Behörden ermöglichen, die (straf-)rechtliche Relevanz eines Fundes einzuordnen. Die makroskopische Untersuchung ist dafür von großer Bedeutung. Für die Identifizierung menschlicher Knochen besitzen DNA-Vergleichsuntersuchungen einen großen Stellenwert. Sie waren für 81 % der erfolgreichen Identifizierungen der Fälle mit menschlichen Knochen verantwortlich.

Background Burn wound progression is a significant problem as burns initially thought to be superficial can actually become full thickness over time. Cooling is an efficient method to reduce burn wound conversion. However, if the cooling agent is below room temperature, depending on the wound size the patient is at risk of hypothermia. Additionally, tissue perfusion is reduced leading to an aggravation of burn wound progression. We investigated if wound dressings based on non-pre-cooled bacterial nanocellulose (BNC) with a high water content cool a burn just by evaporation and reduce the intradermal damages in the skin. Material and methods In a human ex-vivo model, skin explants underwent contact burns using a 100 °C hot steel block. The burned areas were divided into two groups of which one was cooled with a BNC-based wound dressing. Intradermal temperature probes measured temperature in cooled and uncooled burn sites over 24 h. For histological assessments of the burned areas biopsies were taken at different time points. High mobility group box-1 (HMBG1) staining served as marker for cell vitality and necrosis in the different skin layers. Results Intradermal temperature measurement showed that application of the BNC-based wound dressing reduced temperature significantly in burned skin. This cooling effect resulted in a maximum temperature difference of 6.4 ± 1.9 °C and a significant mean reduction of the area under the curve in the first hour after burn of 62% (p Conclusion Based on our results, BNC-based wound dressings cool a burn. Intradermal temperature as well as thermal damage of the tissue was reduced. The tested BNC-based wound dressing can be used without pre-cooling to cool a burn as well as to reduce the burn BNC-based wound progression through its evaporation cooling effect.

Background Bacterial nanocellulose (BNC) is considered a promising carrier for various substances and novel approaches using BNC in combination with antiseptics are well documented. However, the difference in the molecular weight of these molecules influences their uptake by and release from BNC. Analysing the diffusion of standard molecules with different weight, e.g. dextrans, offers the possibility to investigate the mobility of various molecules. We aimed to test the use of BNC regarding uptake and release of different standard molecules as well as two commercially available antiseptics for possible applications in future wound dressings. Material and methods Diffusion profiles, uptake and release of three FITC-dextran molecules differing in weight as well as octenidine (Octenisept®) and povidone-iodine (Betaisodona®)-based antiseptics were tested with BNC-based wound dressings. Furthermore, the antiseptic efficacy of BNC in combination with antiseptics against Staphylococcus aureus was tested. Results Uptake and release capacity for FITC-dextran molecules showed a molecular weight-dependent mobility from BNC into an agarose gel. The loading capacity of BNC was also inversely proportional to the molecular weight of the antiseptics. The release test for octenidine showed a sustained and prolonged delivery into a solid matrix, whereas povidone-iodine was released faster. Both antiseptic solutions combined with BNC showed a good dose-dependent efficacy against S. aureus. Conclusion Results obtained from the mobility of FITC-dextran molecules in the BNC matrix could open possible applications for the combination of BNC with other molecules for medical applications. Combination of both tested antiseptics with BNC showed to be an efficient approach to control bacterial infections.

Purpose To investigate the most peripheral corneal nerve plexus using high-resolution micro-optical coherence tomography (µOCT) imaging and to assess µOCT's clinical potential as a screening tool for corneal and systemic diseases. Methods An experimental high-resolution (1.5 × 1.5 × 1 µm) µOCT setup was applied for three-dimensional imaging of the subbasal nerve plexus in nonhuman primates (NHPs) and swine within 3 hours postmortem. Morphologic features of subbasal nerves in µOCT were compared to β3 tubulin-stained fluorescence confocal microscopy (FCM). Parameters such as nerve density, nerve distribution, and imaging repeatability were evaluated, using semiautomatic image analysis in form of a custom corneal surface segmentation algorithm and NeuronJ. Results Swine and NHP corneas showed the species-specific nerve morphology in both imaging modalities. Most fibers showed a linear course, forming a highly parallel pattern, converging in a vortex with overall nerve densities varying between 9.51 and 24.24 mm/mm2. The repeatability of nerve density quantification of the µOCT scans as approximately 88% in multiple image recordings of the same cornea. Conclusions Compared to the current gold standard of FCM, µOCT's larger field of view of currently 1 × 1 mm increases the conclusiveness of density measurements, which, coupled with µOCT's feature of not requiring direct contact, shows promise for future clinical application. The nerve density quantification may be relevant for screening for systemic disease (e.g., peripheral neuropathy). Translational Relevance Technological advances in OCT technology may enable a quick assessment of corneal nerve density, which could be valuable evaluating ophthalmic and systemic peripheral innervation.

Background and objectives A recent generation of 5,500 nm wavelength carbon monoxide (CO) lasers could serve as a novel tool for applications in medicine and surgery. At this wavelength, the optical penetration depth is about three times higher than that of the 10,600 nm wavelength carbon dioxide (CO2 ) laser. As the amount of ablation and coagulation is strongly influenced by the wavelength, we anticipated that CO lasers would provide extended coagulation zones, which could be beneficial for several medical applications, such as tissue tightening effects after laser skin resurfacing. Until now, the 1,940 nm wavelength thulium fiber (Tm:fiber) laser is primarily known as a non-ablative laser with an optical penetration depth that is eight times higher than that of the CO2 laser. The advantage of lasers with shorter wavelengths is the ability to create smaller spot sizes, which has a determining influence on the ablation outcome. In this study, the ablation and coagulation characteristics of a novel CO laser and a high power Tm:fiber laser were investigated to evaluate their potential application for fractional ablation of the skin. Study design/materials and methods Laser-tissue exposures were performed using a novel CO laser, a modified, pulse-width-modulated CO2 laser, and a Tm:fiber laser. We used discarded ex vivo human skin obtained from abdominoplasty as tissue samples. Similar exposure parameters, such as spot size (108-120 μm), pulse duration (2 milliseconds), and pulse energy (~10-200 mJ) were adjusted for the different laser systems with comparable temporal pulse structures. Laser effects were quantified by histology. Results At radiant exposures 10-fold higher than the ablation threshold, the CO laser ablation depth was almost two times deeper than that of the CO2 laser. At 40-fold of the ablation threshold, the CO laser ablation was 47% deeper. The ablation craters produced by the CO laser exhibited about two times larger coagulation zones when compared with the CO2 laser. In contrast, the Tm:fiber laser exhibited superficial ablation craters with massive thermal damage. Conclusions The tissue ablation using the Tm:fiber laser was very superficial in contrast to the CO laser and the CO2 laser. However, higher etch depths should be obtainable when the radiant exposure is increased by using higher pulse energies and/or smaller spot sizes. At radiant exposures normalized to the ablation threshold, the CO laser was capable of generating deeper ablation craters with extended coagulation zones compared with the CO2 laser, which is possibly desirable depending on the clinical goal. The effect of deep ablation combined with additional thermal damage on dermal remodeling needs to be further confirmed with in vivo studies. Lasers Surg. Med. © 2020 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Continuous subcutaneous insulin infusion (CSII) is a widely used treatment for diabetes patients. Insulin infusion sets (CSII-catheters) are continuously optimized regarding size, handling and safety, but recurring dysfunction (kinking or occlusion), due to different user situations, behavior or chain of events, demand new ways to improve the functionality and safety in patients experiencing these issues. A novel CSII-catheter design (Lantern) features additional lateral perforations, which guarantee functionality even in case of kinking or occlusion. This study aimed to compare functionality, insulin distribution, and failure rate of Lantern and standard catheters using excised human adipose tissue samples. Novel Lantern CSII-catheters (open and artificially occluded) and commercially available standard CSII-catheters were inserted into adipose tissue samples. A mixture of insulin and contrast agent was infused as single bolus (7 IU) with an insulin infusion pump at highest flow rate (1 IU/s). Microtomography images and surface-to-volume ratios were used to assess insulin distribution and depot volume indicating the functionality of CSII-catheters. Failure rate was measured by flow-stop alerts of the pump. We found no difference in the volume of insulin depots compared with the nominal volume of 70 μL. Surface-to-volume ratios showed no significant difference among CSII-catheters. None of the catheters triggered any flow-stop alarm. The novel Lantern CSII-catheter design achieved similar insulin distribution as commercially available CSII-catheters. Moreover, functionality of Lantern CSII-catheters was guaranteed during occlusion, which is an improvement compared with standard CSII-catheters. We conclude that the novel CSII-catheter design has the potential to provide a valuable contribution to patient well-being and safety.

Background/objectives Standard optical coherence tomography angiography (OCTA) has been limited to imaging blood vessels actively undergoing perfusion, providing a temporary picture of surface microvasculature. Capillary perfusion in the skin is dynamic and changes in response to the surrounding tissue's respiratory, nutritional, and thermoregulatory needs. Hence, OCTA often represents a given perfusion state without depicting the actual extent of the vascular network. Here we present a method for obtaining a more accurate anatomic representation of the surface capillary network in human skin using OCTA, along with proposing a new parameter, the Relative Capillary Capacity (RCC), a quantifiable proxy for assessing capillary dilation potential and permeability. Methods OCTA images were captured at baseline and after compression of the skin. Baseline images display ambient capillary perfusion, while images taken upon capillary refill display the network of existing capillaries at full capacity. An optimization-based automated vessel segmentation method was used to automatically analyze and compare OCTA image sequences obtained from two volunteers. RCC was then compared with visual impressions of capillary viability. Results Our OCTA imaging sequence provides a method for mapping cutaneous capillary networks independent of ambient perfusion. Differences between baseline and refill images clearly demonstrate the shortcomings of standard OCTA imaging and produce the RCC biometric as a quantifiable proxy for assessing capillary dilation potential and permeability. Conclusion Future dermatological OCTA diagnostic studies should implement the Capillary Refill Methods over standard imaging techniques and further explore the relevance of RCC to differential diagnosis and dermatopathology. Lasers Surg. Med. © The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals, Inc.

Arztinnen und Arzte werden im Rahmen ihrer Berufsausubung zunehmend mit rechtlichen Fragen konfrontiert. Aufgrund einer Starkung der Patientenrechte durch die Vorschriften zum Behandlungsvertrag (§§ 630a ff. BGB), aber auch einer umfangreichen Rechtsprechung, Gesetzen oder Leitlinien ist eine starke Reglementierung der Medizin zu beobachten. Die arztliche Approbationsordnung erwahnt Rechtsfragen der arztlichen Berufsausubung als Unterrichtsgegenstand. Eine verbindliche Regelung uber den Umfang und Inhalt medizinrechtlichen Unterrichts existiert nicht. Der Nationale Lernzielkatalog fur Mediziner (NLKM) greift diese Problematik auf und beschreibt Lernziele, welche die ethischen und rechtlichen Kenntnisse, Fahigkeiten und Fertigkeiten definieren, die Medizinstudierenden im Verlauf ihres Studiums vermittelt werden sollen. Der NKLM entfaltet jedoch gegenuber den medizinischen Fakultaten keine Bindungswirkung. Erstmals wurden Studierende im praktischen Jahr (PJ) an 18 medizinischen Fakultaten mittels eines standardisierten Fragebogens nach ihrer Einschatzung der Bedeutung des Medizinrechts insgesamt und auch zu medizinrechtlichen Einzelthemen befragt. Von den befragten Studierenden sah die ganz grose Mehrheit die Vermittlung von Rechtskenntnissen als sehr wichtig bzw. als auserordentlich wichtig an. Uberwiegend wurde die Etablierung einer eigenstandigen Lehrveranstaltung zum Medizinrecht mit einer Verankerung in der arztlichen Approbationsordnung fur sinnvoll erachtet. Die Relevanz einzelner Themen wurde unterschiedlich beurteilt. So wurden u. a. die Themen Aufklarung und Einwilligung, Rechtsfragen bei Verdacht auf Kindesmisshandlung, Verhalten bei einem Behandlungsfehlervorwurf, arztliche Schweigepflicht und Dokumentationspflichten des Arztes als relevant eingestuft. Als weniger wichtig werden z. B. gesehen: Rechtsfragen der Komplementarmedizin, der Reproduktionsmedizin, ethisch-religios-weltanschauliche Konflikte, einschlieslich Sterbehilfe, oder die Rolle von Ethikkommissionen. Die Studierenden zeigen sich gegenuber Fragen des Medizinrechts grundsatzlich offen und sehen die Relevanz zahlreicher konkreter Rechtsfragen. Dies sollte bei der weiteren Diskussion zum NKLM, aber auch von den medizinischen Fakultaten und den in der Lehre Tatigen starker berucksichtigt werden. Sinnvoll erscheint die Bereitstellung eines Lehrbeauftragten fur Medizinrecht.

The agenesis of one or both upper thyroid horns (UTH) cannot be considered rare with an incidence ranging between 0.8–9.4%. Studies so far have mostly described frequencies, yet surveys on its morphology and traumatology are missing. It is unknown to what extent this anatomical variant impacts the overall symmetry of the larynx. For the trauma reconstruction after cervical trauma this knowledge is required as an asymmetric larynx can show a different fracture pattern. In this investigation, larynxes with unilateral (n = 21)/bilateral (n = 5) agenesis of the upper thyroid horn(s) and a control group with regular larynxes (n = 23) were juxtaposed. Various measurements were taken after μ-CT scanning. In total 10 distances/angles for the thyroid cartilage and 8 for the cricoid cartilage were compared. Using intra-individual and matched pair comparisons the symmetry was assessed. The results of this investigation showed significant differences in the intra-individual and pairwise comparison for the opening angle and the length of the thyroid alae although the lateral inclination of the thyroid alae showed no significant difference. Combining these three parameters into one symmetry score, the comparison was not significant. This research demonstrates that neither unilateral nor bilateral agenesis of the UTH is related to a structural disbalance of the larynx. Thus, different fracture patterns or vulnerabilities are not to be expected.

Der Schadel stellt haufig das Ziel interpersoneller Gewalt dar und weist infolge von schweren (todlichen) Unfallen nicht selten Verletzungen auf. Bestimmte Frakturmuster des Gehirnschadels lassen sich unter rekonstruktiven Gesichtspunkten interpretieren. Publikationen hierzu thematisieren diesbezuglich jedoch eher Frakturen des Schadeldachs als jene der Schadelbasis. Ein aktueller Sektionsfall, bei dem es durch ein disloziertes Mandibulakopfchen zu einer Lochfraktur der Schadelbasis gekommen war, gab Anlass zu einer retrospektiven Auswertung von Obduktionsfallen aus den Instituten fur Rechtsmedizin in Frankfurt am Main, Giesen und Homburg (Saar) in einem Zehnjahreszeitraum. Daruber hinaus erfolgte eine Literaturrecherche uber die Metadatenbank PubMed. Im Auswertungszeitraum von 2009 bis 2018 wurden in den genannten rechtsmedizinischen Instituten 10.733 gerichtliche Obduktionen durchgefuhrt. Es fanden sich lediglich 2 Falle von Lochfrakturen der Schadelbasis, bei denen jeweils das intakte Unterkieferkopfchen im Sinne einer zentralen Kiefergelenkluxation in die mittlere Schadelgrube eingedrungen war. Bei beiden Verstorbenen war ein Sturzgeschehen ursachlich, die Lochfraktur, fur sich betrachtet, jedoch nicht todesursachlich. Die Literaturrecherche erbrachte mehrere klinische Fallberichte, systematisch aufgearbeitete Fallserien und Ubersichtsarbeiten sowie eine rechtsmedizinische Kasuistik. Als Hauptursache der superioren bzw. zentralen Kiefergelenkluxationen werden Verkehrsunfalle angesehen. Die in der klinischen Fachliteratur beschriebenen, mit dieser Fraktur einhergehenden typischen Symptome (Malokklusion mit einem unilateral offenen und kontralateralen Kreuzbiss, fixierte Mandibulastellung) konnen postmortal durch Rigor mortis und Dunsung der Gesichtsweichteile uberlagert werden und fallen somit bei der auseren Leichenschau ggf. nicht auf. Bei dieser besonderen Lochfraktur der Schadelbasis handelt es sich um eine auserst seltene Verletzung, die – analog zur Schadelbasisringfraktur – als Sonderform einer Biegungsfraktur der Schadelbasis betrachtet werden kann. Ihr Auftreten lasst rekonstruktive Aussagen zum Unfall- bzw. Tatgeschehen zu. Als Verletzungsmechanismus ist die Fortleitung einer von vorn unten auf das Kinn einwirkenden stumpfen Gewalteinwirkung anzusehen.

Background Trisomy 21 is the most common human chromosomal abnormality. Its manifestation includes intellectual impairment and more or less typical anatomical malformations and functional deficiencies that can cause sudden or unexpected deaths. Typical medicolegal questions at autopsy are related to medical malpractice, improper care, neglect, or abuse, and, depending on the cause of death, whether the death might have been avoidable. The aim of this study was to examine whether the causes of death in individuals with trisomy 21 were linked to the known health risks for this condition and to consider how these deaths might have been prevented. Material and methods A retrospective study was performed at the Institutes for Legal Medicine in Giessen and Frankfurt am Main, Hesse, Germany. All records for forensic autopsy cases within a 20-year period from 1998 to 2017 were reviewed for the diagnosis trisomy 21”, respectively, “Down’s syndrome”. Results Twenty-three cases complied with the inclusion criteria trisomy 21 and autopsy. The age of the deceased ranged from 23 days to 61 years. Infectious diseases, mainly respiratory, were the leading cause of death, followed by accidental deaths. Conclusion The medicolegal relevance of the known health risks in Down’s syndrome could be illustrated by the autopsy findings and the results of the additional examinations. The known high susceptibility to infections, with an increased risk of a rapid course and lethal outcome, in individuals with Down’s syndrome could be confirmed in our study. A sound knowledge of the risks and abnormalities associated with trisomy 21 are helpful in medicolegal assessments, particularly, in relation to medical malpractice charges.

Eicosanoids are lipid-mediator molecules with key roles in inflammatory skin diseases, such as psoriasis. Eicosanoids are released close to the source of inflammation, where they elicit local pleiotropic effects and dysregulations. Monitoring inflammatory mediators directly in skin lesions could provide new insights and therapeutic possibilities. Here, we analyzed dermal interstitial fluid samples obtained by dermal open-flow microperfusion in a rat model of skin inflammation. We developed a solid-phase extraction ultra-HPLC/MS/MS method to reliably and precisely analyze small-volume samples and quantified 11 eicosanoids [thromboxane B(2), prostaglandin (PG) E(2), PGD(2), PGF(2α), leukotriene B(4), 15-HETE, 12-HETE, 5-HETE, 12-hydroxyeicosapentaenoic acid, 13-HODE, and 17-hydroxydocosahexaenoic acid]. Our method achieved a median intraday precision of approximately 5% and interday precision of approximately 8%. All calibration curves showed excellent linearity between 0.01 and 50 ng/ml (R(2) > 0.980). In the rat model, eicosanoids were significantly increased in imiquimod-treated inflamed skin sites compared with untreated control sites. Oral treatment with an anti-inflammatory glucocorticoid decreased eicosanoid concentrations. These results show that a combination of tissue-specific sampling with LC/MS analytics is well suited for analyzing small sample volumes from minimally invasive sampling methods such as open-flow microperfusion or microdialysis to study local inflammation and the effect of treatments in skin diseases.

Zusammenfassung Misshandlung und sexueller Missbrauch von Kindern hinterlassen u.a. physische Verletzungen. Diese können bei zeitnaher Dokumentation entscheidend sein für eine Beweisführung u.a. vor Gericht. Dabei werden körperliche Untersuchungen von verschiedenen Institutionen in Auftrag gegeben (Jugendamt, Polizei, Staatsanwaltschaft, Gericht) und es werden Gewaltformen unterschieden: stumpfe Gewalt (z.B. Schläge), thermische Gewalt (z.B. Verbrennen durch eine Zigarette), scharfe Gewalt (z.B. durch ein Messer). Hinzu kommen spezielle Formen der Kindesmisshandlung: u.a. das Schütteltrauma-Syndrom und das Münchhausen-Syndrom by proxy.

Die Untersuchung der Ossifikation des Schildknorpels ist nicht nur in Form von anatomischer und morphologischer Grundlagenforschung, sondern auch fur rechtsmedizinische Uberlegungen von Belang. Ziel war es, einen Geschlechts- und Alterspolymorphismus mittels Mikro-Computertomographie (µCT) nachzuweisen. An 53 autoptisch asservierten Kehlkopfpraparaten wurde eine mikrocomputertomographische Bildgebung durchgefuhrt. Die µCT eignet sich durch ihre hohe raumliche Auflosung und das nichtdestruktive Erschaffen dreidimensionaler Volumendatensatze zur quantitativen Analytik von Knochenstrukturparametern und zur Visualisierung von Unterschieden und Veranderungen der trabekularen Knochenstruktur. Dabei wurden u. a. Parameter bestimmt wie z. B. die Knochendichte, das Knochen- und Gesamtvolumen und ein eigens entwickelter Score fur die Art der Verknocherung. Sowohl ein Alters- als auch ein Geschlechtspolymorphismus konnten nachgewiesen werden. Die mannlichen und die alteren Schildknorpel sind deutlich starker trabekular und vollstandiger verknochert und weisen ein groseres Knochen- und Gesamtvolumen auf als die jungeren und die weiblichen Schildknorpel. Damit lasst sich ein Nutzen fur die Rechtsmedizin aufzeigen, mit dem Schildknorpel als Pradiktor fur das Geschlecht und das Alter eines Knochen- bzw. Leichenfundes.

Introduction The estimation of age-at-death of unidentified cadavers is a central aspect of the identification process. With increasing age, the incidence of glomerulosclerosis and the thickness of the carotid wall have been observed to also increase. This correlation has been demonstrated in various international histological studies. The aim of our study was to assess whether these correlations also apply to a Western European population. Methodology In this retrospective observational study, kidney and common carotid artery samples from 216 cases autopsied at the Institute of Legal Medicine at the Justus-Liebig University in Giessen, Germany, were examined. Only cases with available tissue samples from both body sides were included. Exclusion criteria were poor sample quality and an age younger than 21 years. After histological processing, the tissue samples were assessed and digitally evaluated. Regression and classification analyses were used to investigate the correlation between age-at-death and intima-media thickness and age-at-death and the incidence of renal glomerular sclerosis. Results Of the 216 autopsy cases, 183 were included for evaluation. Analysis of the carotid artery segments showed a strong correlation (Pearson correlation coefficient r = 0.887) between the intima-media-complex thickness and chronological age. Classification of the glomerulosclerotic incidence showed a correlation of 37.7–43.1% with the predicted age group. Discussion Both the intima-media thickness and the proportion of sclerotic glomeruli can be used to estimate age in Western European cadavers. On the basis of these results, both methods are suited to supplement other already established methods for age-at-death estimation in the identification of an unknown cadaver.

The treatment of macular diseases requires frequent monitoring by optical coherence tomography (OCT). Home monitoring would reduce the burden of frequent clinical visits and increase therapy adherence. In a pilot study with 47 patients having different macular diseases we tested a proprietary self-examination low-cost full-field OCT (SELFF-OCT). For comparison, scans with a standard clinical spectral domain OCT were taken. Data was graded by a reading center. Patients were able to successfully acquire images that were clinically gradable for 85% of the included eyes. The sensitivity and specificity for an anti-VEGF treatment decision based on the SELFF-OCT was 0.94 and 0.95, respectively.

Burn injuries initiate numerous processes such as heat shock response, inflammation and tissue regeneration. Reliable burn models are needed to elucidate the exact sequence of local events to be able to better predict when local inflammation triggers systemic inflammatory processes. In contrast to other ex vivo skin culture approaches, we used fresh abdominal skin explants to introduce contact burn injuries. Histological and ultrastructural analyses confirmed a partial-thickness burn pathology. Gene expression patterns and cytokine production profiles of key mediators of the local inflammation, heat shock response, and tissue regeneration were analyzed for 24 h after burn injury. We found significantly increased expression of factors involved in tissue regeneration and inflammation soon after burn injury. To investigate purely inflammation-mediated reactions we injected lipopolysaccharide into the dermis. In comparison to burn injury, lipopolysaccharide injection initiated an inflammatory response while expression patterns of heat shock and tissue regeneration genes were unaffected for the duration of the experiment. This novel ex vivo human skin model is suitable to study the local, early responses to skin injuries such as burns while maintaining an intact overall tissue structure and it gives valuable insights into local mechanisms at the very beginning of the wound healing process after burn injuries.

To investigate the difference in clinical efficacy in AD patients between two topical PDE4 inhibitors using dermal open flow microperfusion and cAMP as a pharmacodynamic read-out in fresh human skin explants. Clinical formulations were applied to intact or barrier disrupted human skin explants and both skin biopsy samples and dermal interstitial fluid was sampled for measuring drug concentration. Furthermore, cAMP levels were determined in the skin biopsies as a measure of target engagement. Elevated cAMP levels were observed with LEO 29102 while no evidence of target engagement was obtained with LEO 39652. In barrier impaired skin the dISF concentration of LEO 29102 was 2100 nM while only 33 nM for LEO 39652. For both compounds the concentrations measured in skin punch biopsies were 7–33-fold higher than the dISF concentrations. Low unbound drug concentration in dISF in combination with minimal target engagement of LEO 39652 in barrier impaired human skin explants supports that lack of clinical efficacy of LEO 39652 in AD patients is likely due to insufficient drug availability at the target. We conclude that dOFM together with a pharmacodynamic target engagement biomarker are strong techniques for establishing skin PK/PD relations and that skin biopsies should be used with caution.

Purpose Dermal open flow microperfusion (dOFM) has previously demonstrated its utility to assess the bioequivalence (BE) of topical drug products in a clinical study. We aimed to characterize the sources of variability in the dermal pharmacokinetic data from that study. Methods Exploratory statistical analyses were performed with multivariate data from a clinical dOFM-study in 20 healthy adults evaluating the BE, or lack thereof, of Austrian test (T) and U.S. reference (R) acyclovir cream, 5% products. Results The overall variability of logAUC values (CV: 39% for R and 45% for T) was dominated by inter-subject variability (R: 82%, T: 91%) which correlated best with the subject’s skin conductance. Intra-subject variability was 18% (R) and 9% (T) of the overall variability; skin treatment sites or methodological factors did not significantly contribute to that variability. Conclusions Inter-subject variability was the major component of overall variability for acyclovir, and treatment site location did not significantly influence intra-subject variability. These results support a dOFM BE study design with T and R products assessed simultaneously on the same subject, where T and R treatment sites do not necessarily need to be next to each other. Localized variation in skin microstructure may be primarily responsible for intra-subject variability.

The identification of unknown bodies is the fulfilment of a moral obligation towards the deceased, serves to maintain legal security within a society, and gives families the certainty they need to mourn. Taking into account respective local conditions, the aim should always be to achieve a secure and quick identification. To achieve this goal, a functioning cooperation between investigating authorities and forensic sciences is essential. The main objective of this study was to clarify the potential role of tattoos in the identification process of unknown deceased persons in the state of Jalisco, Mexico. Post-mortem data of 2045 bodies from the Instituto Jaliscience de Ciencias Forenses in Guadalajara were evaluated. Of the deceased 46% were tattooed (male: 47%, female: 39%), with 29% of all bodies (male: 29%, female: 26%) showing tattoos at body locations usually visible in everyday life (i.e. head and neck, forearms and hands). The male bodies were most frequently tattooed on the shoulders and upper arms, followed by the forearms and hands and the torso. Female bodies mostly showed tattoos on the forearms and hands, followed by the torso and legs. Taking local tattooing habits into account, the authors developed a classification for tattoo motives. With decreasing frequency, the following keywords could be assigned to the motives: letters and/or numbers, human, symbol (other), plant, symbol (religious), animal, object, tribal/ornament/geometry, fantasy/demon/comic, other. Results of the study indicate the great importance of tattoos as a possible mean of identification in Jalisco, Mexico – either as a stand-alone identification method, as a complementary tool or for planning and prioritizing subsequent investigations. Die Identifizierung unbekannter Verstorbener stellt die Erfüllung einer moralischen Verpflichtung gegenüber dem Verstorbenen dar, dient der Wahrung der Rechtssicherheit innerhalb einer Gesellschaft und gibt Familien Gewissheit, um Abschied nehmen zu können. Hauptziel der vorgestellten Studie war es, die mögliche Rolle von Tätowierungen im Identifizierungsprozess unbekannter Verstorbener unter den aktuell herrschenden Bedingungen im mexikanischen Bundesstaat Jalisco zu klären. Hierfür wurden postmortale Daten von 2045 Verstorbenen aus dem Instituto Jaliscience de Ciencias Forenses in Guadalajara ausgewertet. Von den Verstorbenen waren 46 % tätowiert (männlich: 47 %, weiblich: 39 %), wobei 29 % aller Verstorbenen (männlich: 29 %, weiblich: 26 %) Tätowierungen an im Alltag üblicherweise sichtbaren Körperlokalisationen (Kopf, Hals, Unterarme, Hände) aufwiesen. Männliche Verstorbene waren am häufigsten an den Schultern und Oberarmen, Unterarmen und Händen und am Rumpf tätowiert. Die weiblichen Verstorbenen wiesen zumeist Tätowierungen an den Unterarmen und Händen, am Rumpf und den Beinen auf. Unter Berücksichtigung der lokalen Tätowiergewohnheiten entwickelten die Autoren eine Klassifizierung für Tätowiermotive. Mit abnehmender Häufigkeit konnten den Motiven folgende Schlüsselwörter zugeordnet werden: Buchstaben und/oder Zahlen, human, Symbol (andere), Pflanze, Symbol (religiös), Tier, Objekt, Tribal/Ornament/Geometrie, Fantasie/Dämon/Comic, andere. Die Ergebnisse der Studie deuten auf eine große Bedeutung von Tätowierungen als mögliches Mittel zur Identifizierung im Bundesstaat Jalisco, Mexiko, hin – als eigenständige Identifizierungsmethode, als ergänzendes Werkzeug oder zur Planung und Priorisierung nachfolgender Untersuchungen.

Purpose To image, track and map the nerve fiber distribution in excised rabbit corneas over the entire stromal thickness using micro-optical coherence tomography (µOCT) to develop a screening tool for early peripheral neuropathy. Methods Excised rabbit corneas were consecutively imaged by a custom-designed µOCT prototype and a commercial laser scanning fluorescence confocal microscope. The µOCT images with a field of view of approximately 1 × 1 mm were recorded with axial and transverse resolutions of approximately 1 µm and approximately 4 µm, respectively. In the volumetric µOCT image data, network maps of hyper-reflective, branched structures traversing different stromal compartments were segmented using semiautomatic image processing algorithms. Furthermore, the same corneas received βIII-tubulin antibody immunostaining before digital confocal microscopy, and a comparison between µOCT image data and immunohistochemistry analysis was performed to validate the nerval origin of the tracked network structures. Results Semiautomatic tracing of the nerves with a high range of different thicknesses was possible through the whole corneal volumes, creating a skeleton of the traced nerves. There was a good conformity between the hyper-reflective structures in the µOCT data and the stained nerval structures in the immunohistochemistry data. Conclusions This article demonstrates nerval imaging and tracking as well as a spatial correlation between µOCT and a fluorescence corneal nerve standard for larger nerves throughout the full thickness of the cornea ex vivo. Translational relevance Owing to its advantageous properties, µOCT may become useful as a noncontact method for assessing nerval structures in humans to screen for early peripheral neuropathy.

Background: Optical coherence tomography (OCT) is indispensable for studying the progression of age-related macular degeneration (AMD), since it can show quantitatively morphological changes of the retina. However, current OCT devices can only be used in clinical settings and do not provide functional[for full text, please go to the a.m. URL], 7th International Symposium on AMD: Age-related Macular Degeneration - Understanding Pathogenetic Mechanisms of Disease

Nach todlich verlaufenen Fallen eines Schutteltraumas mussen Befunde, die die entsprechende Gewalteinwirkung belegen, im Rahmen der Obduktion und durch nachfolgende histologische Untersuchungen erhoben werden. Dies gilt v. a. fur jene Schutteltraumaopfer, bei denen zu Lebzeiten keine klinische Diagnostik mehr erfolgen konnte. Aber auch ein antemortal bekannter Verdacht auf ein Schutteltrauma mit klassischen Befunden, wie z. B. einem subduralen Hamatom und retinalen Blutungen, gelegentlich auch mit paravertebralen Rippenfrakturen und subkutanen Einblutungen (Thorax, Oberarme), bedarf der autoptischen Beweissicherung. Wurde das Schutteltrauma zunachst uberlebt, konnen Fragen der Altersbestimmung von Verletzungen relevant werden.

BACKGROUND Traditionally, fractional laser treatments are performed with focused laser sources operating at a fixed wavelength. Using a tunable laser in the mid-infrared wavelength range, wavelength-dependent absorption properties on the ablation process and thermal damage formation were assessed with the goal to obtain customizable tissue ablations to provide guidance in finding optimized laser exposure parameters for clinical applications. METHODS Laser tissue experiments were carried out on full thickness ex vivo human abdominal skin using a mid-infrared tunable chromium-doped zinc selenide/sulfide chalcogenide laser. The laser has two independent channels: a continuous wave (CW) output channel which covers a spectrum ranging from 2.4 μm to 3.0 μm with up to 9.2 W output power, and a pulsed output channel which ranges from 2.35 μm to 2.95 μm. The maximum pulse energy of the pulsed channel goes up to 2.8 mJ at 100 Hz to 1,000 Hz repetition rate with wavelength-dependent pulse durations of 4-7 ns. RESULTS Total ablation depth, ablation efficiency, and coagulation zone thickness were highly correlated to wavelength, pulse width, and pulse energy. Using the same total radiant exposure at 2.85 μm wavelength resulted in 10-times smaller coagulation zones and 5-times deeper ablation craters for one hundred 6 ns pulses compared to one 100 ms pulse. For a fixed pulse duration of 6 ns and a total radiant exposure of 2.25 kJ/cm2 the ablation depth increased with longer wavelengths. CONCLUSION The tunable laser system provides a useful research tool to investigate specific laser parameters such as wavelength on lesion shape, ablation depth and thermal tissue damage. It also allows for customization of the characteristics of laser lesions and therefore facilitates the selection of suitable laser parameters for optimized fractional laser treatments. Lasers Surg. Med. 50:961-972, 2018.© 2018 Wiley Periodicals, Inc.

Hautzeichen bei akuter hamorrhagischer und nekrotisierender Pankreatitis wie das Cullen-, das Grey-Turner- oder das Fox-Zeichen (benannt nach den Erstbeschreibern) werden klinisch selten beobachtet. Die Pankreatitis ist aber nicht die einzige innere Ursache der Hauterscheinungen, die auch bei diversen anderen intraabdominellen Prozessen gefunden werden. In dieser Ubersicht werden die verschiedenen Hautzeichen vorgestellt und im Hinblick auf ihre Entstehung rekapituliert. Ziel der Studie war es, anhand von Autopsiefallen zu uberprufen, ob und wie haufig die Hautzeichen bei akuter Pankreatitis vorkommen. Nicht immer gelingt eine Abgrenzung der Hautzeichen aus innerer Ursache zu Hamatomen als Folge stumpfer Gewalteinwirkung oder nach medizinischer Nadelpunktion zweifelsfrei.

Defects in autophagy and the resulting deposition of protein aggregates have been implicated in aging and neurodegenerative diseases. While gene targeting in the mouse has facilitated the characterization of these processes in different types of neurons, potential roles of autophagy and accumulation of protein substrates in neuroepithelial cells have remained elusive. Here we report that Atg7f/f Tyr-Cre mice, in which autophagy-related 7 (Atg7) is conditionally deleted under the control of the tyrosinase promoter, are a model for accumulations of the autophagy adapter and substrate sequestosome-1/p62 in both neuronal and neuroepithelial cells. In the brain of Atg7f/f Tyr-Cre but not of fully autophagy competent control mice, p62 aggregates were present in sporadic neurons in the cortex and other brain regions as well in epithelial cells of the choroid plexus and the ependyma. Western blot analysis confirmed a dramatic increase of p62 abundance and formation of high-molecular weight species of p62 in the brain of Atg7f/f Tyr-Cre mice relative to Atg7f/f controls. Immuno-electron microscopy showed that p62 formed filamentous aggregates in neurons and ependymal cells. p62 aggregates were also highly abundant in the ciliary body in the eye. Atg7f/f Tyr-Cre mice reached an age of more than 2 years although neurological defects manifesting in abnormal hindlimb clasping reflexes were evident in old mice. These results show that p62 filaments form in response to impaired autophagy in vivo and suggest that Atg7f/f Tyr-Cre mice are a model useful to study the long-term effects of autophagy deficiency on the homeostasis of different neuroectoderm-derived cells. Electronic supplementary material The online version of this article (10.1007/s12035-018-0996-x) contains supplementary material, which is available to authorized users.

Technological innovations are rapidly driving the development of forensic medicine. Imaging techniques are used not only to diagnose but also to provide causal interpretations for a chain of events in criminal investigations. This paper argues the necessity of upgrading the forensic toolkit with modern digital imaging technology. The possibilities and limitations of identifying evidential content in images are elucidated using the example of the special role of color and the special methods with which new imaging techniques in the discipline are evaluated are discussed. The aspect of reliability is exemplified by the results from two experiments that tested interrater agreement in the assessment of classification stages from radiographs. The results of these two experiments illustrate that an element of uncertainty remains between information contained in imaging data and individual diagnostic interpretation of these data depending on experience that can be influenced by other factors. Various underlying reasons are discussed along with the various types of errors that can occur using imaging techniques. In forensic examinations visual findings cannot be evaluated, interpreted, or integrated simply by transferring skills and proficiencies from other disciplines. The techniques applied need to be constantly adapted and developed. Specifically, this means that acquiring modern image generating equipment is not enough and practitioners also must learn how to use the technology to evaluate the visual data generated from a forensic aspect.

Die Identifizierung unbekannter Verstorbener stellt eine wichtige Aufgabe der Rechtsmedizin dar. Gewalteinwirkung oder eine langere Leichenliegezeit konnen diese prima vista im Einzelfall unmoglich machen, sodass weiterfuhrende Untersuchungen zur Identitatssicherung notig sind. Eine retrospektive Auswertung von im Institut fur Rechtsmedizin der Justus-Liebig-Universitat Giesen zwischen 2007 und 2016 bearbeiteten Identifizierungen ergab 194 Falle, bei denen die Identitat unbekannter Verstorbener mithilfe molekulargenetischer Untersuchungen gesichert wurde. In mehr als der Halfte der Falle handelte es sich um faulnisveranderte Leichen, gefolgt von Verstorbenen mit groben, entstellenden Verletzungen. Die Erstellung eines postmortalen DNA-Musters gelang in mehr als zwei Drittel der Falle aus dem Blut der Verstorbenen; bei starken Faulnisveranderungen erwiesen sich Finger- und Fusnagel als geeignetes Untersuchungsmaterial. Antemortale Vergleichsmuster wurden in etwa zwei Drittel der Falle aus Gegenstanden der Korperpflege (Zahnburste, Rasierer, Haarburste) erstellt, in gut einem Funftel der Falle von biologischen Verwandten. Bei sog. Wohnungsleichen erfolgte in einem Funftel der Falle ein Abgleich mit in polizeilichen Datenbanken einstehenden Mustern. In mehr als zwei Drittel der 194 Falle wurde zusatzlich zu den molekulargenetischen Untersuchungen eine Obduktion des Leichnams durchgefuhrt. Allerdings war die Obduktionsrate stark abhangig von den ermittlungsseitig angenommenen Todesumstanden und den sich daraus ergebenden Verdachtsmomenten fur eine strafrechtliche Relevanz des Todesfalls.

Frakturen des Gehirnschadels als Folge stumpfer Gewalteinwirkung konnen Schadeldach und -basis betreffen. Grundsatzlich werden bei Frakturen der Schadelkalotte Biegungs- und Berstungsfrakturen sowie Bruchsysteme unterschieden. Zudem kann eine Klassifizierung hinsichtlich direkter und indirekter Frakturen erfolgen. Biegungsbruche resultieren aus eher kleinflachigen und geformten Gewalteinwirkungen mit kurzen Stoszeiten. Berstungsfrakturen entstehen durch Komprimierung des Schadels in einer Achse bzw. Verformung des gesamten Schadels durch eher grosflachige und ungeformte Gewalteinwirkungen mit langen Stoszeiten. Treten Belastungen weit oberhalb der Bruchgrenze auf, kommt es zu Trummerfrakturen. Schadelbasisfrakturen stellen meistens Berstungsbruche infolge allgemeiner Schadelverformungen dar. Hierbei gilt, dass Querdruck Schadelbasisquer- und Langsdruck Schadelbasislangsfrakturen verursachen. Eine Besonderheit stellen zirkular um das Foramen magnum lokalisierte Ringfrakturen dar.

The demographic development in Germany shows a steady increase to senior citizens. The driving suitability of older road-users is of large social and political concern, because awareness and reactivity can be influenced by age-related diseases and potential medication, particularly in combination with the consumption of alcohol. This study provides an overview of senior road-users under the influence of alcohol. Therefore, 404 cases of drunken-driving by road-users aged 70 and over within the purview of the Institute of Legal Medicine at Justus-Liebig-University, Giessen, from the years 2009-2013 were evaluated in retrospect. The vast majority of the drivers were male (88.4% of the cases). Distribution of the blood alcohol concentrations were almost equally in male and female drivers with 62.8% of all cases showing a blood alcohol concentration (BAC) of more than 1.1‰ and 10.9% a BAC of more than 2.0‰. In 48.5% of the cases, drunk driving was associated with an accident. 54.5% of the drivers stated suffering from at least one disease and 60% admitted a regular medication or an intake prior to the incident. Moreover, the collected data includes aspects such as the kind of traffic participation as well as neurological and physiological deficits of the road-users. If accidents were caused by drunk driving, the external circumstances and consequences of these accidents were analyzed, too. The evaluation revealed, that the standard medical examination protocol proved to be improbable to cover polypharmacy and multimorbidity of older alcoholized drivers. So, an evaluation and adaptation of the common medical examination protocol must be considered.

Korpermodifikationen erfreuen sich zunehmender Beliebtheit und sozialer Akzeptanz und sind Bestandteil der heutigen Gesellschaft geworden. Sie werden immer offener getragen, und neben dem Tatowieren und Piercen haben sich weitere Formen entwickelt, die den Tragern den Wunsch nach Aufmerksamkeit und Individualisierung erfullen sollen. Im vorliegenden Beitrag werden die Besonderheiten und moglichen Komplikationen der unterschiedlichen und mehr oder weniger haufigen und auffalligen Korpermodifikationen dargestellt sowie deren Variabilitat und teils szenetypische Terminologie vermittelt. Zahlen zu Haufigkeiten von Korpermodifikationen in der Bevolkerung werden genannt und die Ergebnisse einer retrospektiven Auswertung des Obduktionsregisters des Instituts fur Rechtsmedizin Giesen dargestellt. Fur die Rechtsmedizin von besonderer Bedeutung ist die Nutzung von Korpermodifikationen als identitatssicherndes oder auf die Identitat hinweisendes Merkmal z. B. im Rahmen von Straf- oder Todesermittlungsverfahren. Daneben konnen sich zivilrechtliche Gutachtenauftrage zur Bewertung eingetretener Komplikationen ergeben.

Previous studies have demonstrated that filled intervals are perceived as being longer than empty intervals of the same duration (i.e., the filled - duration illusion). In the present study, we asked whether the motor actions involved in filled and empty reproductions (a single continuous key press vs. two discrete key presses) would affect time estimates in a similar way. We hypothesized that reproductions of intervals of the same duration should be shorter for filled than empty reproductions (i.e., a filled - reproduction illusion). In two experiments, participants reproduced filled and empty intervals (ranging from 400 to 1,600 ms) using filled and empty reproductions. The results provided evidence for both kinds of illusions, even though the evidence was clearer for the filled - duration than for the filled - reproduction illusion. The present study demonstrates that in a situation in which both illusions work in concert, reproductions of the same interval can vary dramatically depending on the combination of interval and reproduction type.

Morbus Osler (hereditare hamorrhagische Teleangiektasie, HHT) bezeichnet eine erbliche Erkrankung der Blutgefase, bei der es zu Teleangiektasien und vaskularen Malformationen kommen kann. Insbesondere pulmonale arteriovenose Malformationen konnen mit lebensbedrohlichen oder letalen Komplikationen einhergehen. Vorgestellt wird der Todesfall einer 13-Jahrigen, bei der es plotzlich und unerwartet zur Ruptur einer bis dahin unbekannten vaskularen Malformation der linken Lunge gekommen ist. Histologisch wies die etwa 1 cm durchmessende Gefasveranderung eine unterschiedlich dicke Gefaswand und Unterbrechungen der Lamina elastica interna, passend zu einer arteriovenosen Malformation, auf.

In forensic case work, blood stain pattern analysis frequently aids in deducing the chain of actions or parts thereof taking place during an event leading to blood loss. Wiped single blood stains and/or groups of blood stains are seen at a majority of complex crime scenes. The appearance of wiped blood stains depends on droplet volume and stain age (as a function of blood viscosity and the degree of stain skeletonization) and characteristics of the stained surface (i.e., texture, temperature). Furthermore, based on the biochemical and biophysical properties of blood, not only the drying processes, but also complex coagulation cascades are relevant to the assessment of wiped blood stains. This study was designed to determine if anticoagulation therapies markedly affect the wipeability of blood stains over times elapsed since deposition and the overall drying process. A total of 813 blood stains, originating from donors being treated with acetylsalicylic acid (ASA), clopidogrel + ASA, low-molecular-weight heparin, or rivaroxaban, were dropped on common household tiles. Wipeability at an ambient temperature of 20 °C was tested for 22 time periods (1, 2, 3, 5, 10, 15…105 min since deposition). Whereas stains consisting of untreated blood were dried within 55 min, wipeability of all droplets originating from donors with prior anticoagulation treatment showed pronounced delays compared with the control, ranging from 20 min (ASA and clopidogrel + ASA) to 45 min (rivaroxaban). This pronounced effect was not seen in earlier studies, which might be explained by the higher volume of droplets used in this study, which resulted in a shift in relevance from drying to clotting processes. Significant differences between the drying times of the various anticoagulation regimes might be attributed to anticoagulant activity against different targets in the coagulation cascades. In conclusion, anticoagulation treatment prior to blood loss significantly affected the wipeability of blood stains. Anticoagulation therapy should therefore be taken into account in the analysis of blood stain patterns.

Background Following the legal provisions on the termination of pregnancies in Art. 13 of the SFHG (Law on the Assistance for Pregnant Women and Families, passed on 27.07.1992, BGBl. I, p. 1398) the so-called embryopathic indication for termination was abandoned. Since then, sec. 218a para. 2 of the German Criminal Code (StGB) states that for late terminations, i.e., terminations after the 12th week of gestation post conception, the pregnant woman must be in exceptional distress “according to medical opinion”. Method Between 01.05.2012 and 25.07.2016, a total of 160 pregnancy terminations were carried out in Giesen University Hospital under sec. 218a para. 2 StGB. The following data were obtained from the patientsʼ files: age of the pregnant woman, number of pregnancies, type of fetal disease or malformation, time of diagnosis, medical and psychosocial counseling given to the pregnant woman, time of termination or delivery, type of termination, fetal gender. Results 160 pregnant women (mean age: 31.6 years) underwent termination of pregnancy between the 13th – 37th week of gestation. Chromosomal anomalies were diagnosed prenatally in 60 cases, and anomalies were diagnosed on ultrasonography in 100 cases, with the preponderance of cases presenting with developmental disorders of the central nervous system and cardiovascular system. Conclusion In addition to recording intrauterine fetal disorders, when pregnancies are terminated under sec. 218a para. 2 StGB, treating physicians are expected to give plausible reasons why “according to medical opinion” the pregnancy represents a danger to the life of the pregnant woman or of grave injury to her physical or mental health and enter these reasons in the patientʼs medical records.

Introduction Cooling of burn injuries is most important, not only to reduce pain but also to reduce the intradermal damage as well as the burn wound conversion. Studies have shown that cooling for about 20 to 30 minutes using only plain tap water at moderate temperature is most efficient resulting in least intradermal damage. However, many burn injuries reach the hospital without any pre-clinical cooling, possibly due to the lack of a cooling agent. After a pilot study, we investigated if a bacterial nanocellulose (BNC)-based wound dressing containing about 95% water can cool a burn injury and if so the effect suffices to reduce the damage in the skin. Methods Skin explants from human donors were burned with inflicted a contact burn injury, of which half were treated with a BNC-based wound dressing and a paraffin gauze dressing. Intradermal temperature sensors measured the temperature changes in the dermis over the course of 24 hours. Biopsies were taken for histological evaluation at different time points. Results The intradermal measurements show high temperature spikes at the moment of the burn injuries. After the application of a BNC-based wound dressing the intradermal skin temperature was significantly reduced. The area under the curve in the treated group was significantly less than the untreated. The histological assessment showed according results with less damage in the treated group in comparison to the untreated. Conclusions Bacterial nanocellulose-based wound dressings with high water content significantly lower the intradermal temperature after a contact burn and reduce the thermal damage inflicted to the skin. A secondary dressing that permits the water to evaporate slower additionally prolongs the cooling effect. The use of such a wound dressing could find use in a preclinical setting where other cooling options are not available. Applicability of Research to Practice The findings of this experiment should be tested in an in-vivo setting prior to clinical use to investigate the possibility of inducing hypothermia with this treatment.

Einleitung: Das Kühlen von Verbrennungen ist wichtig, nicht nur um Schmerzen zu lindern, sondern auch um die intradermalen Schäden sowie das Nachbrennen zu verringern. Studien haben gezeigt, dass das Kühlen für etwa 20 bis 30 Minuten mit mäßig warmen Leitungswasser am effizientesten[zum vollständigen Text gelangen Sie über die oben angegebene URL], 38. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV 2020)

Einleitung: Verbrennungen zählen weltweit zu den häufigsten und schwersten Verletzungsformen und sind oft mit einer hohen Morbidität und Mortalität verbunden. Obwohl sich im Bereich der Grundlagenforschung in den letzten Jahren auch im Bereich der „Verbrennungsforschung“[zum vollständigen Text gelangen Sie über die oben angegebene URL], 38. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV 2020)

Einleitung: Bakterielle Nanocellulose (BNC) ist eine relativ neue Verbandsmatrix, die zu fast 95% aus Wasser besteht. Diese Eigenschaft ermöglicht es dieser Wundauflage, wässrige Substanzen wie Antiseptika zu absorbieren und wieder freizusetzen. Wir untersuchten, wie gut bakterielle Nanocellulose[zum vollständigen Text gelangen Sie über die oben angegebene URL], 38. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV 2020)

Einleitung: Entzündung ist Teil der physiologischen Phasen der Wundheilung. Ziel ist es, verschiedene Immunzellen anzulocken, um die Wunde von Keimen und Zellteilen zu befreien und eine ideale Umgebung zu schaffen, in der Fibroblasten und Keratinozyten differenzieren, wandern und sich teilen können,[zum vollständigen Text gelangen Sie über die oben angegebene URL], 38. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV 2020)

PURPOSE: To evaluate a new non-ablative and adjustable procedure for laser ablative refractive corneal surgery in hyperopia using the injection of a biocompatible liquid filler material into a stromal pocket. METHODS: A total of 120 stromal pockets were created using a clinical femtosecond laser system in 96 rabbit corneoscleral discs and 24 whole globes. Pockets were cut at a depth of 120 or 250 µm below the epithelial surface. Hyaluronic acid was injected manually into the pocket. To determine the refractive changes, three-dimensional optical coherence tomography images and a specifically developed picture recognition Matlab (The Mathworks) routine were used. RESULTS: After injection, a steepening of the anterior and flattening of the posterior corneal surface was observed, which led to hyperopic correction. The two main factors determining the amount of correction were the pocket depth and the injected volume. After the pocket was homogeneously filled, an initial refractive increase was observed, followed by a linear relation between the injected volume and the refraction increase. CONCLUSIONS: This possible clinical protocol for controlled refraction correction of hyperopia suggests a potential readjustable clinical application. [ J Refract Surg . 2020;36(6):406–414.]