Search

Objective We evaluated the phrase “Thank God it’s Friday” (TGIF) from a forensic pathologist’s view, i.e. the correlation between the beginning and end of the week in general and Christmas Holidays in particular and the manner of death. Material and methods We retrospectively analyzed 758 consecutive autopsy cases from January 2017 to June 2019. Results There was no correlation between natural deaths and the beginning or the end of the week. One of our main findings in terms of a weekday effect was a profound increase in homicides towards the end of the week. In terms of a Christmas Holiday effect, we sadly observed a profoundly higher rate of suicide cases during Christmas Holidays compared with the rest of the year. Conclusion The TGIF phrase should be modified towards something like “Thank God, it’s Monday” (TGIM). We also should look out for our lonely and mood-susceptible fellow human beings in particular during Christmas Holidays.

Neuroblastoma (NBL) and medulloblastoma (MB) are aggressive pediatric cancers which can benefit from therapies targeting gangliosides. Therefore, we compared the ganglioside profile of 9 MB and 14 NBL samples by thin layer chromatography and mass spectrometry. NBL had the highest expression of GD2 (median 0.54 nmol GD2/mg protein), and also expressed complex gangliosides. GD2-low samples expressed GD1a and were more differentiated. MB mainly expressed GD2 (median 0.032 nmol GD2/mg protein) or GM3. Four sonic hedgehog-activated (SHH) as well as one group 4 and one group 3 MBs were GD2-positive. Two group 3 MB samples were GD2-negative but GM3-positive. N-glycolyl neuraminic acid-containing GM3 was neither detected in NBL nor MB by mass spectrometry. Furthermore, a GD2-phenotype predicting two-gene signature (ST8SIA1 and B4GALNT1) was applied to RNA-Seq datasets, including 86 MBs and validated by qRT-PCR. The signature values were decreased in group 3 and wingless-activated (WNT) compared to SHH and group 4 MBs. These results suggest that while NBL is GD2-positive, only some MB patients can benefit from a GD2-directed therapy. The expression of genes involved in the ganglioside synthesis may allow the identification of GD2-positive MBs. Finally, the ganglioside profile may reflect the differentiation status in NBL and could help to define MB subtypes.

The pattern of gunshot residue (GSR) includes important information about muzzle-target distance since a larger GSR distribution diameter indicates a larger shooting distance. GSR may not be visible to the naked eye when, for example, it is located on dark textiles. In such cases, further procedures need to be performed in order to visualize the pattern of GSR. Besides chemical procedures, an alternative light source or infrared photography can be utilized for non-destructive GSR visualization. In the work presented, these two techniques are compared based on shooting experiments using 26 different dark textiles. Within the range of the alternative light source, the use of a 440-nm light in combination with an orange-colored filter led to the best visualization of GSR in the form of fluorescent particles. Infrared photography, on the other hand, visualized GSR as dark particles, whereas-ideally-the dark textile reflected the infrared light and appeared bright. The comparison of both techniques revealed that the GSR distribution visualized by infrared photography was not identical to the GSR distribution visualized with 440-nm illumination in combination with an orange-colored filter. We concluded that infrared photography visualizes the inner powder soot zone, whereas illumination at 440 nm leads to fluorescence of the outer powder soot zone, which can be visualized using an orange-colored filter. Knowledge of this difference in visualization of the two powder soot zones is important for forensic practitioners assessing firing distances. In the literature, however, this difference is not noted as clearly.

Documenting the existence, size, position and shape of injuries is an important part of medical forensic examinations. In the photography of an injury, the documentation is limited to an approximation of size and position of the injury based on a ruler included in the image. The documentation of injuries can be improved with photogrammetry, which allows the creation of scaled 3D models of an injury that can be used to not only document and visualize the injury but also to match the injury with an injury-causing object. In this paper, the multicamera device “Botscan” was used to perform 3D whole-body documentation and measure the positions of injuries. A major advantage of 3D whole-body documentation compared to photography is that the former can be performed at a later stage of the investigation. This makes the whole-body 3D documentation of injuries an important tool for re-examination. Electronic supplementary material The online version of this article (10.1007/s12024-020-00282-9) contains supplementary material, which is available to authorized users.

Molecular analysis of the RNA transcriptome from a putative tissue fragment should permit assignment to a specific organ since each tissue will exhibit a unique pattern of gene expression. Determination of the organ source of tissues from crime scenes may aid in shooting and stabbing investigations. We have developed a new prototype massively parallel sequencing (MPS) mRNA profiling assay for organ tissue identification, designed to definitively identify 13 organ/tissue types using a targeted panel of 48 mRNA biomarkers. The identifiable organs and tissues include brain, spinal cord, lung, trachea, liver, skeletal muscle, heart, kidney, adipose, intestine, stomach, skin and spleen. The biomarkers were chosen after iterative specificity testing of numerous candidate genes in various tissue types. The assay is very specific with little cross reactivity with non-targeted tissue, and can detect RNA mixtures from different tissues, including two- to five-tissue admixtures. The sensitivity of the assay was evaluated as well as assay reproducibility between library preparations and sequencing runs. We also demonstrate the ability of the assay to successfully identify the tissue source of origin in cadaver samples, tissue samples with varying post mortem intervals (PMI) and mock and bona fide casework samples. We are using the data to train a multivariate statistical model that predicts the tissue type based on the mRNA profile. By considering co-expression of markers the model can recognize distinct expression patterns in each tissue.

Dealing with a refurbished crime scene is a special challenge for forensic investigators. In such cases, a crime scene may not have only been cleaned in order to erase all traces but the walls of an indoor crime scene could also be painted over in order to mask traces of the crime. So far, very few publications have shown that painted-over traces of blood and seminal fluid can be detected using a forensic light source or infrared photography. To date, there have been no systematically executed research studies including guidelines on which settings to use depending on the color of the wall. Moreover, no comparative study has addressed the question of whether it is better to use infrared photography or a forensic light source to visualize painted-over bloodstains. The present study covers the aforementioned gaps and shows that painted-over bloodstains are most easily visualized by infrared photography, while traces of seminal fluid are most easily visualized at 440 nm in combination with a yellow filter-both independent of the color of the wall paint.

Estimating the sex of decomposed bodies and skeletal remains of unknown individuals is one of the first steps in the identification process of a forensic anthropological examination. As postmortem computed tomography (CT) scans are becoming a more common tool in forensic casework, the classical methods would be applied on these images. In this article, we applied the method called ´Purkait's triangle´ for sex estimation on CT scans. We hypothesize that the accuracy of sex estimation will be comparable to the application on dry bones. For this study, we acquired a total of 99 cases of postmortem CT scans from routine cases at the Institute of Forensic Medicine, Zurich, Switzerland. The femora were extracted using segmentation techniques. After this Purkait's method was applied on the segmented bone. Using the equations establish by Purkait we reached an overall accuracy of 67%. Using the method on the total length measurements showed an overall accuracy of 72% additionally a cutoff point could be established using a logistic regression. Despite some limitations, the results obtained by ´Purkait's triangle´ on CT scans for sex estimation in femoral bones showed high accuracies although not as high as applied in the classical way. Further research and testing different segmentation software might improve the result. Nevertheless, we were able to calculate a new cutoff point for a modern swiss population.

Various imaging modalities, including conventional radiography, computed tomography, magnetic resonance, and surface scanning have been applied in the examination of skeletal injuries in the forensic context. Although still not a substitute for a full medico-legal autopsy or the examination of skeletal remains, imaging is now increasingly used as a complementary tool in the postmortem analysis of perimortem skeletal trauma. Facilitated by the progress in general computational capacity, multimodal imaging has been proposed for comprehensive forensic documentation. A major advantage of these imaging approaches is that stored digital or physical 3D models of skeletal injuries can be reviewed at any time by various experts as well as be presented in court as evidence to clarify potentially complex medical and forensic aspects of the case. Due to constant technical progress in imaging techniques and software, continuous education, training, and sharing of expertise among engineers, computer scientists, and forensic experts, including forensic pathologists, anthropologists, and radiologists needs to be warranted to maintain high-quality expertise in the detection and interpretation of traumatic injuries on postmortem imaging. The technical developments and ever-improving user-friendliness of 3D imaging and modeling techniques present an atttactive alternative to traditional forensic approaches, but as long as the techniques have not been sufficiently tested and validated for forensic trauma analysis, and best practice manuals for forensic practice are lacking for both the technical procedures and method selection, the use of imaging techniques needs to be reevaluated on a case-by-case basis. In addition, ethical, legal, and financial aspects of the use of imaging and 3D modeling for forensic purposes need to be well understood by all parties in legal proceedings.

Objectives: Estimating the sex of decomposed corpses and skeletal remains of unknown individuals is one of the first steps in the identification process in forensic contexts. Although various studies have considered the femur for sex estimation, the focus has primarily been on a specific single or a handful of measurements rather than the entire shape of the bone. In this article, we use statistical shape modeling (SSM) for sex estimation. We hypothesize that the accuracy of sex estimation will be improved by using the entire shape. Materials and Methods: For this study, we acquired a total of 61 femora from routine postmortem CT scans at the Institute for Forensic Medicine of the University of Zurich. The femora were extracted using segmentation technique. After building a SSM, we used the linear regression and nonlinear support vector machine technique for classification. Results: Using linear logistic regression and only the first principal component of the SSM, 76% of the femora were correctly classified by sex. Using the first five principal components, this value could be increased to 80%. Using nonlinear support vector machines and the first 20 principal components increased the rate of correctly classified femora to 87%. Discussion: Despite some limitations, the results obtained by using SSM for sex estimation in femur were promising and confirm the findings of other studies. Sex estimation accuracy, however, is not significantly improved over single or multiple linear measurements. Further research might improve the sex determination process in forensic anthropology by using SSM.

We report a case of a contraindicated attachment of a speaking valve to a tracheal tube with an inflated cuff, which rapidly resulted in the patient’s death. The attached one-way valve allowed unrestrained inspiration through the tracheal tube but prevented physiological expiration. The increased pulmonary pressure resulted in alveolar rupture and replaced expiration with a steady release of air into the peribronchial sheaths and the mediastinum, resulting in what is commonly known as the Macklin effect. From the mediastinum, air inflated both pleural cavities, the peritoneum, and the subcutaneous tissue of the entire body. No gas was found in the blood vessels, the brain, the bones, or in the inner organs. The entire air volume was estimated by radiological segmentation to be more than 25 l. This implies continuous inspiration, while expiration turned into an aberrant pulmonary decompression by whole-body gas-enclosure. Death ultimately resulted from asphyxia following bilateral (tension) pneumothorax.

Background Dual-energy computed tomography allows for improved organ characterization by applying two different X-ray energy spectra. Purpose To evaluate the postmortem unenhanced DECT scans of human livers with histologically determined stages of hepatic steatosis; to measure hepatic attenuation, effective atomic number, electron density, fat fraction; to examine whether DECT has an advantage over single-energy CT in distinguishing between steatosis grades. Materials and methods Cases with histologically diagnosed hepatic steatosis were included in this study. Using a standardized DECT scanning protocol, the parameters HU, ρe, Zeff and FF were measured. The diagnostic performance was calculated using the CT-based reference standard of 40HU as the cutoff. In addition, the effect of less strict cutoff values for all measured parameters on diagnostic performance was evaluated. Results 119 cases were included in the study. In histology, mild steatosis was detected in 84 cases, moderate steatosis was detected in 21 cases, and severe steatosis was detected in 14 cases. The reference cutoff value of 40HU led to a high specificity (99%) but limited sensitivity (46%), while the prediction accuracy was 83%. A combination of less strict HU cutoff values with FF improved the sensitivity to 57% and accuracy to 86%. Conclusion This study reported that DECT can improve the diagnostic performance of distinguishing between mild and moderate-to-severe forms of hepatic steatosis by combining HU values with FF. Consequently, DECT is advantageous over single-energy scans.

A case of rapid demise following an undiagnosed stercoral perforation is reported. A 57-year-old woman on chronic opioid replacement therapy presented with constipation and abdominal pain to the hospital. Following an unremarkable abdominal radiograph and admission for laxation and pain therapy, she was found dead only 18 h later. To exclude medical malpractice, a postmortem investigation was ordered. Postmortem computed tomography and autopsy revealed fatal fecal peritonitis based on a stercoral perforation of the rectosigmoid, which had been undiagnosed. This report highlights the need for early cross-sectional imaging and contributes to the data collection concerning this ever-growing, vulnerable group of patients undergoing opioid replacement.

We report a fetal loss following maternal ketoacidosis in a case of cryptic pregnancy. Biochemical analysis of peripheral blood revealed highly elevated levels of beta-hydroxybutyrate (BHB) in the mother (9.2 mmol/l) and the fetus (4.2 mmol/l). Fetal ketoacidosis with hypoxic-ischemic brain damage was determined to be the cause of death. 1H-MRS of the right cerebral hemisphere presented with distinctive resonances of BHB and acetone. Acetoacetate and glucose were not detected. Due to reported chronic abuse of ethanol and a period of fasting, alcoholic ketoacidosis was concluded to be the cause of the metabolic disorder. 1H-MRS is a viable examination for the postmortem detection of ketone bodies and may be a key supplement to noninvasive fetal autopsy for the diagnosis of ketoacidosis.

OBJECTIVE: The purpose was to evaluate the presence of gas in the tissue adjacent to the laryngeal structures, "the gas bubble sign", in cases of hanging as a diagnostic indicator of neck trauma. METHODS: In this study, post-mortem CT (PMCT) scans and autopsies of 35 victims of hanging were examined to reveal age-dependent changes, laryngeal fracture, fracture location and the presence of gas. A matched group with cardiac arrest or intoxication was used as controls (n = 35). An autopsy was performed in each case. RESULTS: Incomplete suspension was the most common method in hanging. The thyroid horns (90.5%) were identified as the most vulnerable location for fractures. Laryngeal deformity and dislocation, which was only detected on PMCT, was observed in 57.1% and was concomitant with fractures in 83.3%. Laryngeal fractures are more common with advanced age (>40 years, 88.9%) and less common in younger subjects (

Suitcases or other containers are occasionally involved in forensic investigations. If there is a suspicion that human remains are hidden inside such a container, medico-legal examinations are required. However, these containers are occasionally locked. Forced opening of a locked suitcase or container may cause damage to its contents. Additionally, the safety of the investigator has to be considered as such containers may be booby-trapped or contain other hazardous material. An overview of the contents before opening is desirable in order to avoid the possibility of encountering a Pandora's box. In forensic medicine, an established approach to examine the inside of a body before opening at autopsy is postmortem computed tomography (CT). However, there may be a reluctance to use this approach for suitcases or containers with metallic components because of the assumption that severe metal artifacts will result in inadequate images. In this article, we present a forensic case in which a CT scan of a metallic suitcase was performed in order to examine its contents. Additionally, we performed an experimental scan of a conventional safe in order to determine if CT is able to reveal the contents of such a highly radiopaque storage box.

False aneurysm of the pulmonary artery complicated by bronchovascular fistula formation represents a rare life threating condition. We report a case of fatal hemoptysis after formation of a bronchial fistula in the late postoperative period after sleeve lobectomy. Cause of death was determined by external postmortem examination, post mortem computed tomography (PMCT) and angiography (PMCTA) without conventional autopsy.

The aorto-esophageal fistula (AEF) is a rare life threatening event, mostly first diagnosed postmortem during the autopsy, although an accurate diagnosis can still be complicated. The postmortem computed tomography (PMCT) including an angiography (PMCTA) is a helpful tool to find the correct diagnosis. This is a case of a fatal gastro-intestinal hemorrhage that occurred due to an aorto-esophageal fistula, diagnosed prior to the conventional autopsy by PMCTA.