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Legal Medicine
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ISSN (Print) 1344-6223
Published by Elsevier Homepage  [3185 journals]
  • An autopsy case of thyroid storm associated with chronic lymphocytic
    • Abstract: Publication date: Available online 5 September 2019Source: Legal MedicineAuthor(s): Motonori Takahashi, Takeshi Kondo, Gentaro Yamasaki, Marie Sugimoto, Azumi Kuse, Mai Morichika, Kanako Nakagawa, Yasuhiro Ueno A Japanese woman in her 30s was found dead on a mattress. She had had fever, cough, and dyspnea for about 2 weeks. Gross examination at autopsy revealed slight enlargement of the thyroid gland and histopathological examination resulted in a diagnosis of chronic lymphocytic thyroiditis. The concentration of triiodothyronine in the cadaveric blood was extraordinarily high, whereas that of thyroid stimulating hormone was below the detection limit. Autoimmune antibodies against thyroid tissue were positive. The cause of death was assumed to be congestive heart failure caused by thyroid storm associated with chronic lymphocytic thyroiditis. Systemic histopathological examination of tissues and postmortem biochemistry can enable a diagnosis in medicolegal autopsies.
  • Bongkrekic acid poisoning: Severe liver function damage combined with
           multiple organ failure caused by eating spoiled food
    • Abstract: Publication date: Available online 27 August 2019Source: Legal MedicineAuthor(s): Ruijuan Shi, Chaoyang Long, Yunda Dai, Qiong Huang, Yuzhen Gao, Nengpei Zhang, Yanchang Chen, Shuiping Liu, Qianqian Ma, Li Quan, Yonghui Zhang, Bin Luo Bongkrekic acid(BA) poisoning can be caused by eating spoiled or fermented foods contaminated with pseudomonas cocovenenans. Although some in vitro studies have been reported on the use of purified BA to interfere with cell metabolism, few clinical or pathological data of BA poisoning on human due to food-borne factors are available for forensic appraisal. For the first time, we retrospectively report five cases of food-borne poisoning caused by eating rice noodles, a popular traditional food in Guangdong, China, and three of the victims died. All five victims were hospitalized with gastrointestinal symptoms such as nausea, vomiting and diarrhea and were treated with admission diagnosis of liver failure and acute kidney damage. Certain concentrations of BA were detected in the victims' peripheral blood serums at the hospitalization (ranging from 70∼345μg/L) and the suspected poisonous foods (0∼810 ng/g) with LC-MS/MS technique. The results of forensic pathological examination showed that all three deceased had severe liver and kidney damage, accompanied by multiple organ congestion and edema, which were consistent with clinical diagnosis. Combined with the clinical records, we found that the difference in blood glucose between the deceased and survivors of the five victims may be an indication of the severity of the disease. In addition, we compared BA poisoning with other diseases that can cause acute liver function damage in terms of pathological characteristics and clinical manifestations, which has important reference significance for the diagnosis and forensic appraisal of this food-borne poisoning.
  • Utility of the Ion S5™ and MiSeq FGx™ sequencing platforms to
           characterize challenging human remains
    • Abstract: Publication date: Available online 14 August 2019Source: Legal MedicineAuthor(s): Kyleen Elwick, Magdalena M. Bus, Jonathan L. King, Joseph Chang, Sheree Hughes-Stamm, Bruce Budowle Often in missing persons’ and mass disaster cases the samples remaining for analysis are hard tissues such as bones, teeth, nails, and hair. These remains may have been exposed to harsh environmental conditions, which pose challenges for downstream genotyping. Short tandem repeat analysis (STR) via capillary electrophoresis (CE) is still the gold standard for DNA typing; however, a newer technology known as massively parallel sequencing (MPS) could improve upon our current techniques by typing different and more markers in a single analysis, and consequently improving the power of discrimination.In this study, bone and tooth samples exposed to a variety of DNA insults (cremation, embalming, decomposition, thermal degradation, and fire) were assessed and sequenced using the Precision ID chemistry and a custom AmpliSeq™ STR and iiSNP panel on the Ion S5™ System, and the ForenSeq DNA Signature Prep Kit on the MiSeq FGx™ system, as well as the GlobalFiler™ PCR Amplification Kit on the 3500™ Genetic Analyzer.The results demonstrated that using traditional CE-based genotyping performed as expected, producing a partial or full DNA profile for all samples, and that both sequencing chemistries and platforms were able to recover sufficient STR and SNP information from a majority of the same challenging samples. Run metrics including profile completeness and mean read depth produced good results with each system, considering the degree of damage of some samples. Most sample insults (except decomposed) produced similar numbers of alleles for both MPS systems. Comparable markers produced full concordance between the two platforms.
  • Causes of Death Shortly after Delivery and Medical Malpractice Claims in
           Congenital High Airway Obstruction Syndrome: Review of the Literature
    • Abstract: Publication date: Available online 9 August 2019Source: Legal MedicineAuthor(s): Francesco Lupariello, Emilio Nuzzolese, Giancarlo Di Vella Congenital High Airway Obstruction Syndrome is a rare pathology that may conduct the baby to death shortly after delivery. This outcome may cause emotional distress in the parents but it may also generate expensive medical malpractice claims about the reasons why the syndrome was not identified and/or correctly treated. The authors conducted a review of the cases in which Congenital High Airway Obstruction Syndrome caused death of the baby shortly after delivery. Then, they pointed out these ultrasonographic and anatomical reasons why the syndrome may be not identified and/or correctly treated: negative prenatal ultrasonography, recurrence of non-specific findings at prenatal ultrasonography, connection of respiratory and gastrointestinal tracts, tracheal agenesis or atresia, parent’s refuse of post-partum therapeutic procedures, multiple malformations of the fetus/child. In conclusion, the authors highlighted that death shortly after delivery is usually caused by specific conditions that are not influenced by healthcare team’s practice.
  • Correspondence on: “Sequence and time course of depletion of cardiac
           cellular proteins and accumulation of plasma proteins in rat early
           ischemic myocardium”
    • Abstract: Publication date: Available online 9 August 2019Source: Legal MedicineAuthor(s): Man Liang, Yu-Jia Zhai, Na Zheng
  • Euthanasia and other end of life in patients suffering from dementia
    • Abstract: Publication date: Available online 22 July 2019Source: Legal MedicineAuthor(s): Gabriele Cipriani, Mario Di Fiorino Medicine aims to relieve patient suffering and cure illness. To relieve suffering is the heart of what doctors do. However, respect for individual autonomy and self-determination are fundamental principles in Western medical ethics and decision-making, often expressed as a desire for control over the timing and manner of death. Patients who become demented often formulate advance euthanasia and assisted suicide directives. Dealing with such request is quite complex because of the specific medical and conflicting ethical questions they raise. Some specific medical and ethical issues arise regarding these substantive requirements when evaluating the euthanasia request of a person suffering from dementia. In jurisdictions that allow euthanasia, the most fundamental prerequisite for a person to make autonomous decisions is capacity. Whether anyone with moderate or severe dementia, and even some with mild dementia, could be deemed to be competent by these criteria is debatable, but during the course of their disease people with dementia sooner or later lose their capacity to make self-determined decisions.
  • The medico-legal assessment of aesthetic damage. A correlation analysis
           between experts and an operative proposal
    • Abstract: Publication date: Available online 22 July 2019Source: Legal MedicineAuthor(s): Marianna Russo, Matteo Bolcato, Valeria Sabadin, Anna Aprile Aesthetic damage, defined as any detrimental modification of the individual morpho-functional exterior attributes, is difficult to assess, since the perception of its entity is rather subjective. This study aims to provide a medico-legal contribution to the assessment of this kind of damage.60 photographic images, representing stabilized aesthetic damage, were collected and showed to 16 expert evaluators, who were required to exclusively quantify the objective component of the aesthetic impairment. The inter-observer agreement for the assessments was calculated using the Intraclass Correlation Coefficient (ICC). Looking into specific characteristics of both the injury and the damaged subject, the assessors were more consistent in quantifying the damage in male subjects (ICC 0.68) and in subjects aged over 50 years (ICC 0.81) as well as in assessing extensive damages (ICC 0.61) than those of mild severity (ICC 0.41). The assessment of impairments located in the facial area resulted in a high level of concordance (ICC 0.73), while damages located the head and neck regions presented the lowest concordance (ICC 0.35). The evaluators were more consistent in assessing the outcomes of burns (ICC 0.70). Regardless the various reasons underlying the different degree of concordance, these results and the high degree of the overall concordance (ICC 0.63) point out the skillfulness of medicolegal professionals to formulate a complex judgment as more objectively as possible. Finally, an operative proposal was outlined to guide medico-legal professionals or interns in evaluating the aesthetic damage as more objectively as possible.
  • Forensic - Pathological SEM/EDX Analysis in Prosecution of Medical
    • Abstract: Publication date: Available online 22 July 2019Source: Legal MedicineAuthor(s): Arnaldo Stanislao Migliorini, Paolo Bailo, Michele Boracchi, Graziano Domenico Luigi Crudele, Guendalina Gentile, Riccardo Zoja The retention of gauze within the mediastinum is considered an exceptional finding. We are presenting the case of a woman, affected by aorto-mitral valvulopathy, in whose mediastinum was found, during the autopsy, a gauzome without signs of active phlogosis, which had been “forgotten” in a previous surgery, acted 14 years before the death.A 39 y.o. woman had received surgical treatment of double aorto-mitral valve substitution and tricuspid plastic. At age 53, she successfully received surgery once again at a different hospital; she then started rehabilitation therapy, during which she deceased due to sudden hematemesis with infectious multi organ failure. During the autopsy, a 5 cm long surgical gauze was found in the mediastinum. A SEM/EDX (Scanning Electron Microscopy with Energy Dispersive X-ray spectroscopy) exam was ran on the foreign body and a sample of the same gauze used in the cardiac-surgical department of the hospital the victim had passed away in, to act a comparison between the two kinds of material. The exam showed a morphological difference between exogenous fibers incorporated within the gauzome and the control gauze.This case highlights the diagnostic and interpretative challenges in finding a foreign body within the mediastinum without signs of active phlogosis. SEM/EDX investigations executed on the gauzome and a “control gauze” allowed the attribution of malpractice to the first hospital the victim had been operated in 14 years before the exitus. The SEM/EDX exam confirms its importance in correctly identifying the case, which becomes an example for similar happenings.
  • Forensic age estimation based on the pigmentation in the costal cartilage
           from human mortal remains
    • Abstract: Publication date: Available online 16 July 2019Source: Legal MedicineAuthor(s): Hang Meng, Mingchang Zhang, Bi Xiao, Xin Chen, Jianjun Yan, Ziqin Zhao, Kaijun Ma, Yiwen Shen, Jianhui Xie Age estimation is considered a crucial and challenging issue in forensic casework. Costal cartilage appears a potential mortal remain in age-at-death estimation attributable to its correlative alteration in color based on pigment accumulation with the advancing age. In this study, samples from the second costal cartilage were collected in a Chinese Han population, and the cross sections were subsequently scanned and digitalized in a standard way. Color change was quantified using mean gray value (MGV), which was measured by Photoshop CS5. After the exclusion of samples with factors which could impair the quality of images and the accuracy of values, a high correlation was demonstrated between age and MGV in samples. A linear regression model (AGE=173.425-0.755*aveMGV) was established for age prediction, with its performance evaluated using both samples from the training set and the blind test set, in which a mean absolute deviation of 4.42 years and 3.57 years was obtained, respectively. Altogether, MGV could be reckoned as a precise quantification of pigmentation in costal cartilage and an excellent indicator of age prediction in the age interval from 20 to 60 years. Moreover, our strategy appears more user-friendly and accurate, thus exceedingly practical for age estimation in forensic anthropology.
  • Forensic age estimation of 85 male child laborers and 31 rescued female
           commercial sex workers from hyderabad in south india
    • Abstract: Publication date: Available online 15 July 2019Source: Legal MedicineAuthor(s): Sudheer B. Balla, Parinita Bontala, Ivan Galic, Lakshmi Shravani, P. Sri Laxmi Manasa, Jayasurya Kondapaneni, R. Sudha Age estimation in living individuals has attained importance in forensic sciences from legal proceedings and has been a frequent request from concerned authorities to ascertain whether the person in question has reached the age of imputability and legal responsibility.The purpose of age estimation is not just limited to juvenile or sub-adult delinquents but also required in situations like a violation of child rights such as child employment, commercial sexual exploitation involving minor girls. Indian Law strictly forbids any employment of the children under the age of 14 and sexual exploitation of minor girls (
  • Prediction of nasal morphology in facial reconstruction: validation and
           recalibration of the Rynn method
    • Abstract: Publication date: Available online 15 July 2019Source: Legal MedicineAuthor(s): Ozgur Bulut, Ching-Yiu Jessica Liu, Safa Gurcan, Baki Hekimoglu BackgroundPrediction of the nose from the skull remains an important issue in forensic facial approximation. In 2010, Rynn et al. published a method of predicting nose projection from the skull. With this method, three craniometric measurements (x, y, z) are taken, and these are then used in regression formulae to estimate the nasal dimensions.AimThe purpose of this study was to examine and test the accuracy of the Rynn et al. method and if necessary to adapt the formulae for this population.Subjects and methods: A sample of 90 CT scans of Turkish adults was used in the study. The actual and predicted dimensions were compared using t-test. The age of the individuals ranged from 20 to 40 years by sex.ResultsThe descriptive statistics and correlations were calculated, and the actual and predicted measurements were compared. The differences between the actual and predicted values were statistically significant (p
  • Body mass estimation from dimensions of the fourth lumbar vertebra in
           middle-aged Finns
    • Abstract: Publication date: Available online 29 June 2019Source: Legal MedicineAuthor(s): Niina Korpinen, Asla Keisu, Jaakko Niinimäki, Jaro Karppinen, Markku Niskanen, Juho-Antti Junno, Petteri Oura Although body mass is not a stable trait over the lifespan, information regarding body size assists the forensic identification of unknown individuals. In this study, we aimed to study the potential of using the fourth lumbar vertebra (L4) for body mass estimation among contemporary Finns. Our sample comprised 1158 individuals from the Northern Finland Birth Cohort 1966 who had undergone measurements of body mass at age 31 and 46 and lumbar magnetic resonance imaging (MRI) at age 46. MRI scans were used to measure the maximum and minimum widths, depths, and heights of the L4 body. Their means and sum were calculated together with vertebral cross-sectional area (CSA) and volume. Ordinary least squares (OLS) and reduced major axis (RMA) regression was used to produce equations for body mass among the full sample (n = 1158) and among normal-weight individuals (n = 420). In our data, body mass was associated with all the L4 size parameters (R = 0.093–0.582, p ≤ 0.019 among the full sample; R = 0.243–0.696, p ≤ 0.002 among the normal-weight sample). RMA regression models seemed to fit the data better than OLS, with vertebral CSA having the highest predictive value in body mass estimation. In the full sample, the lowest standard errors were 6.1% (95% prediction interval ±9.6 kg) and 7.1% (±9.1 kg) among men and women, respectively. In the normal-weight sample, the lowest errors were 4.9% (±6.9 kg) and 4.7% (±5.7 kg) among men and women, respectively. Our results indicate that L4 dimensions are potentially useful in body mass estimation, especially in cases with only the axial skeleton available.
  • CLEIA of humor vitreous in a case of suicidal insulin overdose
    • Abstract: Publication date: Available online 25 June 2019Source: Legal MedicineAuthor(s): Valentina Bugelli, Carlo Pietro Campobasso, Amalia Angelino, Martina Focardi, Vilma Pinchi Insulin overdoses have been mostly described in literature as accidental and suicidal deaths, especially in diabetic patients. The present case study deals with a 68 years old male found dead in his bedroom. The victim worked as health care professional in a rescue team, suffering from depression for several years. At the death scene, two ampoules of soluble insulin were recovered close to the body, one of which was empty. At autopsy, no signs of trauma and no injection marks were found at common sub-cutaneous or intravenous injection sites. No other remarkable findings, but hemorrhagic pulmonary edema along with astrogliosis and neuronal degeneration/necrosis in the subcortical regions and corpus callosum were observed. The blood specimen was inadequate due to hemolysis, since it was not centrifugated soon after sampling. Biochemical analysis was performed on bilateral samples of vitreous humor by using electro-chemiluminescence immunoassay (CLEIA). The insulin concentration was 61.11 mU/L in the right vitreous humor and 74.23 mU/L in the left one; the C-peptide concentration was 0.166 ng/mL in right vitreous and 0.157 ng/mL in the left one. The results are in agreement with levels of insulin and C-peptide detected in previous case studies. Based on these findings the cause of death was determined as suicidal insulin overdoses probably by sublingual administration. This way of self-administration was a diagnosis for exclusion as it has been demonstrated that sublingual human insulin has hypoglycemic effects similar to insulin injected.The case study emphasizes the potential role of vitreous humor as reliable alternative substrate for biochemical analysis compared to post-mortem serum or blood samples in cases of fatal insulin intoxication. Furthermore, the CLEIA is an encouraging analytical method to be considered in such cases, although still not validated to perform quantitative analysis of post-mortem fluids.
  • Cardiac Rupture with Intact Pericardium: a report of four cases and short
           review of the literature
    • Abstract: Publication date: Available online 22 June 2019Source: Legal MedicineAuthor(s): Bin Lv, Mingjie Qiu, Jiao Mu, Jing Ma, Jiayan Wu, Hongmei Dong Cardiac rupture with intact pericardium is a dangerous lesion due to high and rapid mortality. Its most common etiologies are blunt chest trauma and myocardial infarction. In forensic practice, this type of rupture can involve a complex relationship between trauma and cardiac disease, so clarifying the main cause of rupture is critical. Herein, we present four cases of cardiac rupture with intact pericardium, which were due to trauma, pathology or both. We propose several diagnostic pointers to analyze this uncommon lesion. Furthermore, the possibility of cardiac rupture induced by cardiopulmonary resuscitation should also be discriminated in such cases.
  • Genetic characterization of 21 autosomal STR loci of Goldeneye™ DNA ID
           22NC Kit in Chinese She group
    • Abstract: Publication date: July 2019Source: Legal Medicine, Volume 39Author(s): Jingyi Zhang, Zihao Yang, Xiaochun Zhang, Ruiyang Tao, Jiashuo Zhang, Chong Chen, Suhua Zhang, Chengtao Li Genetic polymorphism of 21 autosomal STR loci included in Goldeneye™ DNA ID 22NC Kit (D19S253, D6S477, D22GATA198B05, D15S659, D8S1132, D3S1358, D3S3045, D14S608, D17S1290, D3S1744, D2S411, D18S535, D13S325, D7S1517, D10S1435, D11S2368, D4S2366, D1S1656, D7S3048, D10S1248 and D5S2500) was studied in 297 unrelated She individuals. Allele frequencies and forensic efficiency parameters such as, observed and expected heterozygosity (Ho & He), matching probability (MP), power of discrimination (PD), polymorphism information content (PIC), power of exclusion (PE), typical paternity index (TPI) was calculated for the loci. The combined PD and PE for all 21 STR loci were calculated to be 0.999999999999999999999999324094 and 0.999999996182425, respectively. The dataset indicated the usefulness of these loci in personal identification, parentage testing and complex kinship analysis in She population. The MDS plots and neighbor-joining tree were constructed based on pair-wise Nei’s genetic distance by comparing allele frequency data for the 21 loci with ten other populations. The analysis showed that She population lies closer to a clade consisting Southern Han, Hainan Han and Li populations.
  • Brain death of an infant caused by a penetrating air gun injury
    • Abstract: Publication date: Available online 10 June 2019Source: Legal MedicineAuthor(s): Gábor Simon, Veronika Heckmann, Dénes Tóth, Zsolt Kozma Air guns are shooting projectiles (pellets) from the expansion of compressed air without involving any chemical reactions. Air guns are often regarded as harmless by the public, but these weapons can produce severe, sometimes lethal injuries, especially in children. A case of a penetrating head injury of an eleven-month-old infant, caused by an ordinary air gun pellet, is presented. The air gun pellet created an exceptionally severe brain injury, and brain death. The factors influencing the severity of air gun injuries – muzzle velocity, muzzle energy, skull thickness - are discussed.
  • Genetic polymorphisms in 16 X-STR loci analyzed in the She population from
           Zhejiang Province, China
    • Abstract: Publication date: July 2019Source: Legal Medicine, Volume 39Author(s): Zihao Yang, Chong Chen, Jingyi Zhang, Ruiyang Tao, Ruocheng Xia, Xiaochun Zhang, Jiashuo Zhang, Linsheng Yu, Suhua Zhang, Chengtao Li Allele frequencies for 16 X-chromosomal STR (X-STR) loci (DXS6795, DXS9902, DXS8378, HPRTB, GATA165B12, DXS7132, DXS7424, DXS6807, DXS6803, GATA172D05, DXS6800, DXS10134, GATA31E08, DXS6810, DXS6789, and DXS10159) were obtained from a sample set of 296 unrelated individuals from the Zhejiang She population in China. We observed a total of 117 alleles in the group, with allele frequencies ranging from 0.0022 to 0.8143. The most informative marker for the studied population was DXS10134, with a polymorphism information content (PIC) of 0.8547, and the least polymorphic locus was DXS6800 (PIC = 0.3071). The power of discrimination (PD) varied from 0.3244 (DXS6800) to 0.8680 (DXS10134) in males and from 0.5263 (DXS6800) to 0.9693 (DXS10134) in females. The combined PDM and PDF was 0.999999996987156 and 0.999999999999993, respectively. The combined MECD and MECT was 0.999993100252466 and 0.999999973583357, respectively. In the population comparisons, a close relationship between the Zhejiang She and Eastern Han populations was observed. In general, the present findings indicate that the 16 X-STR loci examined are highly genetically polymorphic in the She population of Zhejiang, providing useful information on She for forensic science and population genetic studies.
  • New Regression Models for Dental Age Estimation in Children Using Third
           Molar Maturity Index: A Preliminary Analysis Testing ITS Usefulness As
           Reliable Age Marker
    • Abstract: Publication date: Available online 6 June 2019Source: Legal MedicineAuthor(s): Sudheer B. Balla, Sudhashree Lingam, Kotra Alekhya, P. Hima Ranjana, P. Karunakar, N. Naga Madhuri, Roberto Cameriere This paper concerns a method to estimate age in children using third molar maturity index (I3M) as independent variable and age as the dependent variable. Total of 1283 digital orthopantomograms (OPTs) of south Indian children aged between 7 and 22 years was included. Training sample of 933 OPTs was used to derive regression formulae, and validation sample of 350 OPTs used to verify accuracy of newly derived regression models. Regression analysis performed revealed that cubic function gave the best correlation between the studied variables. The models exhibited a high correlation coefficient for third molar development in both sexes (0.81 for boys and 0.84 for girls). When new models were verified, slight overestimation of dental age i.e., 0.2 years in boys and 0.13 years in girls was observed. Therefore, we conclude by recommending newly derived regression models as they provided better age predicting performances.
  • Comparative Analysis of Four Morphometric Methods for Sex Estimation: A
           Study Conducted on Human Skulls
    • Abstract: Publication date: Available online 3 June 2019Source: Legal MedicineAuthor(s): Patrícia Anaya Sinhorini, Igor Arthur Parron Costa, Thais Torralbo Lopez-Capp, Maria Gabriela Haye Biazevic, Luiz Airton Saavedra de Paiva The pelvis and skull are the regions of the human skeleton that most clearly show sexual dimorphism, with the pelvis being superior to the skull for sex estimation owing to reproductive and hormonal factors. However, as many skeletons are found incomplete, it is important to be able to determine sex from analyzing the skull as well as the pelvis. This study was aimed at validating and evaluating the effectiveness of four morphometric methods for sex estimation using the human skull. One hundred human Brazilian skulls belonging to identified but unclaimed skeletons were used after all legal and administrative requirements for exhumation were satisfied. Four dimensions were analyzed: the facial triangle; the bimastoid triangle; the mastoid triangle; and finally, the occipital triangle. These dimensions were used to calculate the triangle areas. Descriptive analysis was used to verify the mean, standard deviation, and confidence interval of all variables and discriminant analysis with cross-validation was used to verify the percentage of correctness of the sex estimation methods. Individual analysis of the areas of the facial, right mastoid, left mastoid, bimastoid, and occipital triangles, and sum of the mastoid triangle areas, produced average accuracies of 63.0%, 81.8%, 77.8%, 71.4%, 64.0%, and 80.8%, respectively. Combinations of triangles resulted in higher mean accuracy percentages, with only 75.6% accuracy recorded when the left and right mastoid triangle areas were removed. All average values of analyzed triangles were higher in males than in females. Analyses of the cranial triangles were useful for sex estimation in the population studied.
  • Evaluation of Using Scoring Systems of Epiphyseal Union at Knee Joint to
           Assess Chronological Age among a Sample of Egyptians
    • Abstract: Publication date: Available online 27 May 2019Source: Legal MedicineAuthor(s): Mona M. Ghonem, Marwa M. Shahin, Mohammed H. Elrefaey
  • Three-dimensional image analysis of developing mandibular third molars
           apices for age estimation: A study using CBCT data enhanced with Mimics &
           3-Matics software
    • Abstract: Publication date: Available online 27 May 2019Source: Legal MedicineAuthor(s): Muhammad Khan Asif, Phrabhakaran Nambiar, Norliza Ibrahim, Samah M. Al-Amery, Iqra Muhammad Khan Three-dimensional imaging has improved the method of analysis in many forensic science investigations. The study aimed to derive regression equation for age estimation by investigating the relationship between chronological age and surface area of the developing mandibular 3rd molars apices. Furthermore, other predictor variables: ethnicity (Malay and Chinese), gender and status of the root development completion (open/closed apices) were also investigated in terms of fit to the age estimation model. One hundred and twenty eight training and 55 validation samples of intact mandibular 3rd molars were selected from 183 CBCT scans. The samples comprised of 93 Malays and 90 Chinese, ranging in age from 13 to 24 years. Three-dimensional image modeling and surface area analysis of the developing mandibular 3rd molars apices were performed using Mimics and 3-Matics software. Multiple linear regression analysis was used to derive age estimation model using chronological age as a dependent variable and surface area of the apices, ethnicity, gender and status of the root development completion (open/closed apices) as predictor variables. A strong inverse correlation (r = 0.95, SD = 1.144) was observed between chronological age and all the predictor variables. The results showed that 89.6% of the variation in age can be explained by the predictor variables. Mean absolute error (MAE) value of 0.8223 was observed when the derived regression equation was tested on the independent validation sample. In conclusion, three-dimensional surface area analysis of the developing mandibular 3rd molars apices can be used as a reliable method for age estimation.
  • Determining the time of death by morphological and immunohistochemical
           evaluation of collagen fibers in postmortem gingival tissues
    • Abstract: Publication date: Available online 7 May 2019Source: Legal MedicineAuthor(s): M.C. Mazzotti, P. Fais, C. Palazzo, F. Fersini, A. Ruggeri, M. Falconi, S. Pelotti, G. Teti The estimation of the post mortem interval (PMI) is still one of the most challenging variables to determine and the different approaches currently used in its estimation generally yield to large post mortem windows.In the present study we combined morphological and immunohistochemical analysis in order to reach a more detailed knowledge on tissue organization and degradation after death. Ultrastructural cellular changes and the extracellular matrix of gingival tissues, collected at different post mortem intervals, were observed by a Transmission Electron Microscopy (TEM), in combination with the immunohistochemical detection of extracellular matrix proteins (i.e. collagen type I and collagen type III) as potential post mortem biochemical markers. The final goal was to find a correlation between morphological modifications, biomarkers expression and the time of death.Samples of gingival tissues obtained from 10 cadavers at different post mortem intervals (short post mortem interval, 1–3 days; mid post mortem interval, 4-6 days; long post mortem interval, 7-9 days) were processed for light microscopy and TEM and they were also immunostained with anti-collagen type I and type III antibodies.Results showed gradual degradation of extracellular matrix in the suboral connective tissue in relation to the different time of death. Moreover PMI was related to an increase of nuclear chromatin condensation and cytoplasmic vacuolization both in epithelial and connective tissues.In conclusion, in addition to traditional forensic approaches to estimate PMI, the combined analyses of cellular morphology, ultrastructure and immunohistochemical expression of collagen proteins allow to better infer the PMI.
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