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Legal Medicine
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  • The relationship between positional asphyxia and increasing body mass
           index
    • Abstract: Publication date: Available online 16 January 2020Source: Legal MedicineAuthor(s): Roger W. ByardAbstractReview of the files of the Pathology section of XXXX over 18yrs (January 2003-December 2019) revealed 32 adult cases of positional asphyxia (age range 18-87 years; average 49 years – m:f ratio 3:1). Predisposing/causative conditions were accidents, N=8, alcohol intoxication N=7, neurological disease N=7, drug intoxication N=5, morbid obesity N=2, combinations of factors N=2, and a single homicide N=1. There was one case with below normal weight (BMI 17.9), with 6 cases having normal weights (BMI range 18.9-24.6, average 22.3), 9 being overweight (BMI range 25.3-29.5, average 27.9), and 16 being obese (BMI range 30-66.2, average 40.9). Only 7 cases (22%) had either under/normal weight compared to 25 (78%) who were overweight/obese (p
       
  • Population genetics, diversity, forensic characteristics of four Chinese
           populations inferred from X-chromosomal short tandem repeats
    • Abstract: Publication date: Available online 16 January 2020Source: Legal MedicineAuthor(s): Guanglin He, Xing Zou, Mengge Wang, Jing Liu, Fei Wang, Yiping Hou, Zheng WangAbstractWe genotyped 19 X-STRs included in the AGCU X19 kit in 712 unrelated Chinese individuals from four populations (Li, Hui, Tibetan, and Han) and then merged with 4,156 previously genotyped subjects from 19 populations to investigate genetic relationships and population structure, as well as the association between the genetic affinity and language classification. The combined mean paternity exclusion chances and the combined probabilities of discrimination based on single allele frequencies of 19-X-STRs and haplotype frequencies of seven linkage groups were high, indicating that this set of markers was very polymorphic in the four populations studied. Therefore, this panel can complement autosomal or uniparental markers in kinship analysis and complex deficient paternity testing. Subsequently, population differentiation analyses among 23 populations based on 19 STRs and 15 populations based on over 62 million single nucleotide polymorphisms consistently demonstrated that genetic stratifications exist between the different language-speaking populations, especially Tibeto-Burman-speaking, Tungusic and Turkic-speaking populations. Our newly studied populations are genetically close to ethnolinguistically adjacent populations. Our datasets can and should be used as an allele and haplotype frequencies reference database to facilitate the use of 19-X-STRs panel in routine forensic practice.
       
  • Publisher's Note
    • Abstract: Publication date: Available online 9 January 2020Source: Legal MedicineAuthor(s):
       
  • Efficacy of “Touch” DNA Recovery and Room-Temperature Storage from
           Assault Rifle Magazines
    • Abstract: Publication date: Available online 9 January 2020Source: Legal MedicineAuthor(s): Esiri Tasker, Madeline G. Roman, Mary Akosile, Carrie Mayes, Sheree Hughes-Stamm, Bobby LaRueAbstractCrimes committed with assault rifles are becoming increasingly prevalent in the United States. In the absence of other evidence, DNA analysis can often provide informative leads. Unfortunately, any DNA transferred to rifle components left behind at a crime scene is likely to be low in quantity and/or quality. Furthermore, collected evidence is unlikely to be processed immediately and may require storage. Long-term storage can subject DNA to damage and degradation, which ultimately affects DNA profile interpretation and may prevent the identification of potential suspects.This study assessed the ability of a new swab storage device, the SwabSaver®, to preserve “touch” DNA from AR-15 magazine rifles using three different collection devices. Three volunteers loaded bullet cartridges into plastic polymer and aluminum AR-15 magazines. DNA was collected with traditional cotton swabs, layered cotton paper swabs, or nylon-flocked swabs. Collection devices were then stored at room-temperature for up to two months in either the SwabSaver® device or an empty centrifuge tube. The results suggest that substrate and swab type had less of an effect on profile completeness than storage type. Furthermore, SwabSaver® storage yielded DNA quantities comparable to “touch” DNA extracted after 24 hours.
       
  • Facial average soft tissue depth variation based on skeletal classes in
           Indonesian adult population: a retrospective lateral cephalometric study
    • Abstract: Publication date: Available online 7 January 2020Source: Legal MedicineAuthor(s): Erli Sarilita, Christopher Rynn, Peter A Mossey, Sue Black, Fahmi OscandarAbstractObjectiveTo understand the influence of three types of skeletal classes (Class I, Class II and Class III) on midline average soft tissue depth (ASTD).MethodsLateral cephalograms of 335 pre-treatment orthodontic patients were obtained from the archive of Radiology Clinic Universitas Padjadjaran Dental Hospital Bandung Indonesia. The linear measurements of 10 midline facial landmarks ASTD and angular measurement of ANB were extracted and analysed statistically.ResultsA database of ASTD grouped by skeletal classes, specific for the Indonesian population, within the South East Asian ancestry group was obtained.ConclusionsA generic pattern of deeper upper lip than lower lip in class III compared to class II and conversely, deeper lower lip than upper lip in class II compared to class III, was visible in both male and female groups.
       
  • Genetic polymorphisms and haplotypic structure analysis of the Guizhou
           Gelao ethnic group based on 35 Y-STR loci
    • Abstract: Publication date: Available online 7 January 2020Source: Legal MedicineAuthor(s): Xiaojuan Wang, Li Jiang, Enfang Qian, Fei Long, Wei Cui, Anquan Ji, Fangshun Zhang, Kang Zou, Jiang Huang, Caixia LiAbstractIn this research, 35 Y-chromosomal short tandem repeat (Y-STR) loci were analyzed in 286 unrelated healthy Gelao male individuals from Guizhou Province, China. Allelic and haplotype frequencies, haplotype diversity (HD), haplotype match probability (HMP), and discrimination capacity (DC) values were computed. Pairwise Rst values were assessed by AMOVA analysis and visualized through multidimensional scaling and neighbor-joining tree construction. A total of 609 alleles were detected at the 35 Y-STR loci, and the allelic frequencies ranged from 0.0035 to 0.8322. The HD, HMP, and DC were 0.9999, 0.0036, and 0.9825, respectively. A total of 281 haplotypes were found at 35 loci in the 286 Gelao individuals, 98.25% of which were unique. Related forensic parameters revealed that this panel of 35 loci had a high level of genetic polymorphisms in the Gelao group. However, the use of multi-copy and rapidly mutating Y-STR loci could significantly increase the discrimination power of a common Y-STR panel. Analyses of population differentiation with the same set of common Y-STR loci demonstrated that the Gelao group has a closer genetic relationship with the Guizhou Han and Guizhou Miao groups than other groups.
       
  • Genetic analysis of 27 Y-chromosomal STR loci in a Zimbabwean Shona ethnic
           group
    • Abstract: Publication date: March 2020Source: Legal Medicine, Volume 43Author(s): Mandipa Shonhai, Tamuka Nhiwatiwa, Tshifhiwa Nangammbi, Sungai MazandoAbstractBuccal swabs from 200 unrelated Zimbabwean males were collected from voluntary participants located in Harare province. The 5-dye SureID® 27Y Human STR Identification Kit was used to perform multiplex polymerase chain reactions (PCR) and generate Y-chromosomal DNA profiles. This kit targets markers DYS456, DYS576, DYS570, DYS481, DYF387S1, DYS627, DYS393, DYS391, DYS390, DYS635, DYS449, DYS533, DYS438, DYS389I, DYS448, DYS389II, DYS19, GATA_H4, DYS518, DYS458, DYS460, DYS437, DYS439, DYS392, and DYS385, similar to the Yfiler® Plus Amplification Kit. A total of 161 haplotypes were generated with the PowerPlex® Y system, whereas 159 complete haplotypes were generated for the Yfiler® Plus system. Haplotype Discrimination Capacity (DC) with the Yfiler® Plus system was determined to be 0.9686, while the Genetic Diversity (GD) of the targeted loci ranged from 0.03748 at DYS392 to 0.867239 at DYS449. One haplotype contained the triallelic pattern 37, 38, and 39 at DYS387S1. In addition, marker DYS387S1 and marker DYS385 had 13 counts of microvariant alleles overall, while 9 null allele counts were noted at marker DYS448. Genetic distances between our population data and 22 other data sets from African countries and people of African descent were estimated and results showed significant genetic variation.
       
  • Thallium toxicity due to audultered infusion with thallium sulfate in
           eight members belonging to the same family nucleus: Autopsy findings and
           ICP-MS analysis (inductively coupled plasma mass spectrometry) in a triple
           homicide
    • Abstract: Publication date: February 2020Source: Legal Medicine, Volume 42Author(s): Domenico Di Candia, Enrico Muccino, Alessio Battistini, Michele Boracchi, Guendalina Gentile, Riccardo ZojaThe banning of the heavy metal thallium (Tl) in many Countries, because of its toxicity, led to a remarkable reduction of the number of cases of poisoning both accidental and homicidal forcing us to better study the pharmacokinetics of this poison using new technologies. The
      Authors , in this work, are reporting the case of a collective thallium toxicosis caused by voluntary adulteration of an infusion with thallium sulfate, occurred in 8 members of the same familial nucleus; the administration of Prussian Blu resulted to be ineffective for 3 of these members that died at a later time.The most peculiar aspects of this rare manner of poisoning are discussed; the analytical procedures used, Inductively Coupled Plasma Mass Spectrometry (ICP-MS) in particular, resulted to be fundamental in the forensic diagnosis process of acute poisoning cause by thallium.
       
  • Validation of the third molar maturity index cut-off value of
    • Abstract: Publication date: February 2020Source: Legal Medicine, Volume 42Author(s): Parul Khare, Jiang Li, Luz Andrea Velandia Palacio, Ivan Galić, Luigi Ferrante, Roberto CameriereAbstractHaving a reliable, inexpensive and simple method to estimate 18 years of age would be of help in the forensic field. This study aimed to test the accuracy of the third molar maturity index (I3M) in indicating the legal adult age of 18 years. This retrospective cross-sectional study analysed 450 digital panoramic images of Eastern Chinese children and young adults (226 females and 224 males) aged between 14 and 22 years. A cut-off value of I3M 
       
  • Experience of an Italian Hospital Claims Management Committee: A tool for
           extrajudicial litigations resolution
    • Abstract: Publication date: February 2020Source: Legal Medicine, Volume 42Author(s): Patrizia Gualniera, Cristina Mondello, Serena Scurria, Antonio Oliva, Simone Grassi, Jacopo Pizzicannella, Angela Alibrandi, Daniela Sapienza, Alessio AsmundoAbstractLitigation related to medical liability has a great impact on Italian healthcare expenditure. Recently, many Italian Regions have adopted a “self-insurance system” and, in Sicilian Hospitals, were established the Claims Management Committees (CMC) to provide the direct management of claims.Here the experience of a Sicilian University Hospital CMC was described to analyze the claims features and their outcomes providing evidence on CMC usefulness. The analysis involved claims for compensation received during 4 years, using data obtained by a retrospective analysis of claims database created by Forensic Medicine Service. Claims data, obtained from the insurance broker, were used to perform the statistical comparison. During the examined period a total of 377 claims were received by CMC, respectively 63.6% for professional liability and 36.4% for other causes (damages not related to medical malpractice). The prevalence of complaints about malpractice regarded surgery. The CMC had expressed an opinion on 120 claims related to malpractice with the percentages of admission or rejection of liability respectively of 55% and 45%. The statistical analysis revealed a greater number of lawsuits in the Insurance system and, moreover, the CMC higher probability to reach the amicable settlement of litigations.CMC provides specific data on claims trend and economic expenditure, demonstrating its usefulness for analysis and monitoring the causes of patients/people damage. It is a tool for medical malpractice risk assessment and prevention. It can encourage the amicable settlement and prevention of civil action. It seems to be an efficient system to reduce the health liability costs.
       
  • Acute myocardial infarction in a young woman: Unexpected findings of a
           coronary occlusion
    • Abstract: Publication date: February 2020Source: Legal Medicine, Volume 42Author(s): Shuquan Zhao, Longlong Zhu, Lopsong Tinzin, Fang Huang, Longda Ma, Yiwu ZhouAbstractIn clinical and forensic practice, the cause of death is often attributed to acute myocardial infarction, among which the coronary atherosclerosis being the Captain of the Men of Death. However, other reasons such as coronary septic embolization with neutrophilic granulocyte myocarditis although rare, can also cause sudden unexpected death. This paper reports a case with this rare cause—a 21-year-old woman diagnosed with “acute gastroenteritis” who died 4 days later. A forensic autopsy revealed an inflammatory polypous embolic located at 1.0 cm from the left anterior descending branch (LAD) with serve neutrophilic granulocyte myocarditis, which resulted in embolic at the opening of the left main coronary artery, acute myocardial infarction and eventually leading to her death. Histopathological examination showed large amounts of neutrophilic granulocyte infiltration in the arterial layer forming the septic embolic and eventually resulting in coronary occlusion. To find the real cause of septic embolic, myocarditis, bacterial, fungal, protozoan and virus detection was performed through RT-PCR, with negative findings. Septic embolic leading coronary occlusion in left main coronary artery and LAD is rarely reported in forensic practice, we hope this report can pave the way on understanding this rare disease to make correct diagnosis in medical practice.
       
  • Blast injuries found on the exhumed remains of Polish postwar partisans
           killed by the Polish security service in 1946
    • Abstract: Publication date: February 2020Source: Legal Medicine, Volume 42Author(s): Łukasz Szleszkowski, Agata Thannhäuser, Krzysztof Szwagrzyk, Maciej Kuliczkowski, Tomasz JurekAbstractExhumed, badly decomposed human remains constitute very difficult research material. It requires a great deal of caution and critical judgment to analyze the nature of injuries, especially those resulting from an explosion. Scientific publications in the field of traumatology concerning injuries caused by the action of explosives mainly focus on the effects of contemporary terrorist or military activities. The results of this research regard mainly clinical medicine and the organization of healthcare. This article discusses the problems and solutions of determining the presence of injuries caused by explosions on badly decomposed human remains exhumed 70 years after death. To obtain optimal results in valuable injures estimation it is vital to apply efficient work methods i.e.: forensic team composed of experienced pathologist and anthropologist, archeological methodology and doubled examination and description of the remains (in the field and next in the autopsy room), detailed photographical documentation and protocol. The results of forensic examinations of the remains (58 fragments forming anatomical wholes), derived from not fewer than 30 individuals (MNI = 30), confirmed, despite the presence of severe taphonomic changes, the presence of injuries caused by an explosion. Forensic examination of the remains revealed a characteristic pattern of injuries resulting from the dismembering the bodies. We discovered typical traumatic amputation of the limbs, which corresponds to the aforementioned mechanism of injury. The findings confirm the thesis that in the area of the former Luftwaffe airport near Stary Grodków (Opole province, Poland), in September 1946, a group of Polish postwar partisans was liquidated.
       
  • Will different sagittal and vertical skeletal types relate the soft tissue
           thickness: A study in Chinese female adults
    • Abstract: Publication date: February 2020Source: Legal Medicine, Volume 42Author(s): Guang Chu, Meng-qi Han, Ling-ling Ji, Mu-jia Li, Hong Zhou, Teng Chen, Yu-cheng GuoAbstractFacial reconstruction is a classical technique in forensic anthropology to reestablish the contours of the soft tissues over the skull. The accurate facial soft tissue data plays an essential role in forensic facial reconstruction. However, according to previous studies, various skeletal types might relate to different thickness in facial soft tissue. Until now, there are few publications focusing on the relationship between facial soft tissue thickness (FSTT) and different skeletal types, and none of them analyze the FSTT according to various sagittal and vertical skeletal types. The aim of this study was to testify the possible existence of correlations between FSTT and different skeletal types. In order to exclude interference from age, sex, ethnicity and body mass index (BMI) factors, we collected lateral projection X-rays data of 270 Chinese female aged 19–26 years with nomal BMI and divided them into various skeletal groups. Soft tissue thickness measurements were mainly based on 10 anthropological landmarks of the skull and statistics were analyzed on the basis of different skeletal types. The greatest differences were observed in the upper lip region of maxilla and the mental region of mandible. The concave and hypodivergent skull types showed the thickest soft tissue in maxillary region, and the convex and hypedivergent skull types showed the thickest soft tissue in the mental region. This study provided a database for FSTT according to various skeletal types in Chinese female population, and our current studies demonstrated that considering various skeletal types will improve the accuracy of facial reconstruction.
       
  • The postmortem examination prior to cremation: still a necessary safety
           measure'
    • Abstract: Publication date: Available online 19 December 2019Source: Legal MedicineAuthor(s): Lisa Marie Behrens, Jan-Peter Sperhake, Klaus Püschel, Ann Sophie SchröderAbstractBackgroundThe postmortem external examination has repeatedly been the subject of political and medicolegal disputes. This study was performed to examine whether the postmortem external examination at the crematory provides additional benefits and to determine whether any differences in the quality of medical death certificates exist between hospital and non-hospital postmortem external examinations.Material and MethodsAll cases of death that had been examined within the context of a second postmortem external examination at crematories performed by medicolegal specialists from the Hamburg Department of Legal Medicine were analyzed during a 6-month investigation period.ResultsA second postmortem external examination was carried out on 9,981 decedents prior to cremation during the investigation period. In the interim, the second postmortem medical examiner did not release 474 bodies (4.7%) for cremation. Suspicion of death caused by trauma was the most frequent cause for delaying the release of the body. The quality of information stated on the medical death certificate was good in 112 certificates issued by clinicians (48.9%, n=229) and in 51 issued by general practitioners (31.3%, n=163).DiscussionThis study verified deficiencies in the initial postmortem external examination. A postmortem external examination prior to cremation by a medical professional specialized in this field is currently an indispensable component for quality assurance.
       
  • Age estimation from ossification of sternum and true ribs using 3D
           post-mortem CT images in a japanese population
    • Abstract: Publication date: Available online 19 December 2019Source: Legal MedicineAuthor(s): Tawachai Monum, Yohsuke Makino, Sukon Prasitwattanaseree, Daisuke Yajima, Fumiko Chiba, Suguru Torimitsu, Yumi Hoshioka, Maiko Yoshida, Shumari Urabe, Yukiko Oya, Hirotaro IwaseAbstractAge estimation of cadavers from post-mortem “chest plate” using conventional radiography, which involves radiographic assessment of ossification around the sternum and rib ends, has been evaluated without fruitful results. This study examined the value of images of the chest plate obtained by three-dimensional post-mortem CT for estimation of age at time of death in a Japanese population. Five chest plate ossification scores were evaluated in 320 subjects, including ossification of the first costal cartilage (OF), ossification of the second to seventh costal cartilages at the rib (OR) and sternal (OS) ends, fusion of the manubriosternal joint (FM), and fusion of the xiphisternal joint (FX). OS was found to have the highest correlation with age while FM had no significant correlation. The best composite score for age estimation was the summative score for both sides of the OS and the right side of the OF and FX, for which the coefficient of determination (R2) and the standard error of estimation (SEE) were 0.608 and 12.44 years, respectively, for men and 0.590 and 14.65 years for women. The accuracy of the model was tested in a further 26 male and 24 female subjects, and the accuracy rate within the first SEE was 57.69% and 70.83%, respectively. This rapid and non-invasive method of age estimation in the chest plate area is superior to conventional methods and could be useful for estimation of age at time of death in the Japanese population.
       
  • Expanded CODIS STR allele frequencies - evidence for the irrelevance of
           race-based DNA databases
    • Abstract: Publication date: Available online 16 November 2019Source: Legal MedicineAuthor(s): Robert F. Oldt, Sreetharan KanthaswamyAbstractThe US Federal Bureau of Investigation’s (FBI) core Combined DNA Index System (CODIS) short tandem repeat (STR) panel is required for the calculations of random match probabilities (RMPs) in forensic DNA analysis. Current practice dictates that RMPs should be generated across appropriate reference STR allele frequency databases, including African American, Asian, Caucasian, Hispanic, and Native American, when the suspect’s race is unknown. Should the suspect declare their race, a specific reference database that pertains to that designation is used. This practice is based on the presumption that racial population group is relevant for calculating conservative RMPs that favor the defendant. The core CODIS panel has been expanded to 20 STRs, however, the relationship between RMP and race has not been re-evaluated.Genetic structure analyses and Bayesian-based population assignment of expanded CODIS profiles from one race-neutral and five race-specific reference databases revealed that STR data could not distinguish races as distinct biological clusters. For instance, while the average race-specific RMPs for Hispanic or Caucasian profiles were almost equally-conservative when calculated from either population's reference database, the Hispanic profiles closely affined with the Native American population. Race-neutral RMPs computed with a correction factor (θ) of 0.03 favor the defendant as much as race-specific RMPs based on a θ of 0.01. Insufficient genetic differentiation observed among the US racial populations as well as inconsequential differences between race-specific and race-neutral RMPs undermine the value of using “race” in the context of forensic DNA analysis and support the argument that forensic databases should be race-neutral.
       
  • Analyzing genetic polymorphism and mutation of 44 Y-STRs in a Chinese Han
           population of Southern China
    • Abstract: Publication date: Available online 14 November 2019Source: Legal MedicineAuthor(s): Hanguang Lin, Qiansu Ye, Peizhi Tang, Tian Mo, Xin Yu, Jianpin TangAbstractShort tandem repeat on the non-recombining part of chromosome Y with paternally inheritable capability is a valuable tool in the studies of forensic genetics, population genetics and anthropology. The mutation rate of Y-STR is an important parameter in the applications. A total of 629 haplotypes at 44 Y-STR markers were found in 629 unrelated males of our population. Mutation rates at 44 Y-STR loci ranged from 0 (CI: 0-5.70×10-3) to 40.63×10-3 (25.90×10-3-57.2×10-3) in our population. A higher mutation rate was noted at DYS612, DYS449, DYS547, DYS518, DYS576, DYS627, DYF403S1b, DYF387S1, DYS385a/b, DYS527a/b, DYF404S1, DYF403S1a and DYF399S1 in this population. The Y-STR set showed a higher discrimination capacity in forensic applications, and the present study provided reference data for the application of forensic and population genetics.
       
  • Assessment of nasal profiles for forensic facial approximation in a modern
           Korean population of known age and sex
    • Abstract: Publication date: Available online 14 November 2019Source: Legal MedicineAuthor(s): U-Young Lee, Hankyu Kim, Jin-Kyoung Song, Dong-Ho Kim, Kook-Jin Ahn, Yi-Suk KimAbstractThe nose is a valuable facial feature for facial recognition and approximation. We propose the use of regression functions to predict nasal profiles comprising the structures around the piriform aperture using CT-based 3D models. We examined craniofacial reconstruction models acquired from computed tomographic images of Korean adults (188 males and 201 females). Eighteen measurements using 16 craniometric landmarks were measured on 3D craniofacial models. We conducted a descriptive analysis with comparisons according to sex, and simple linear regression analyses to obtain regression functions. Using multiple regression analyses with sex and age as independent variables, multiple regression equations were developed with coefficient of determination R2 ranging from 0.314 and 0.724, meaning that the equations for known sex and age were better for the prediction of nasal profiles than equations that assumed only known sex. These equations are useful and practical for reconstructing nasal profiles in forensic analyses.
       
  • Possible applications of reflected UV photography in forensic odontology:
           food for thought
    • Abstract: Publication date: Available online 14 November 2019Source: Legal MedicineAuthor(s): Danilo De Angelis, Giulia Mapelli, Filippo Lupo Mazzullo, Maria Teresa Lorenz, Cristina CattaneoAbstractUsually, in forensic sciences, ultraviolet (UV) light is used to induce fluorescence on many samples to identify and evaluate proofs (ex. fibers, gunshot residue, biologic fluids, pigments, inks and fingerprints) and different wavelength are used to better enhance the material characteristics. On the contrary, the potential use of absorbed and reflected UV has not been deeply investigated, especially in forensic odontology. The aim of this study is to evaluate the forensic potential of dental materials UV absorption and reflection and to investigate if different dental tissues and materials interact in different ways with UV radiation. A digital camera modified so to be UV sensible only and a modified flashlight were used to produce images of absorbed/reflected UV radiation of different dental materials. First results show the promising potentials of the technique in detecting dental composite resin materials, in enhancing image contrast between dentin and enamel, in enhancing enamel infractions and in possible age estimation future applications.
       
  • Rapid death following undiagnosed stercoral perforation in a chronic
           opioid user
    • Abstract: Publication date: Available online 14 November 2019Source: Legal MedicineAuthor(s): Jakob Heimer, Carlo Tappero, Barbara Fliss, Eva MeixnerAbstractA 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 hours 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.
       
  • Sex Determination from Talus in Chinese Population by Three-dimensional
           Measurement Approach
    • Abstract: Publication date: Available online 14 November 2019Source: Legal MedicineAuthor(s): Yang Liu, Qing Han, Weihuang Yin, Chenyu Wang, Bingpeng Chen, Naichao Wu, Aobo Zhang, Jincheng WangAbstractObjectiveThe determination of sex is an essential part of building the biological profile for unknown human remains. Sex determination from talus in Chinese population has been rarely reported. The aim of this study was to determine sex by discriminant function analysis through talus measurement in Chinese population.Methods48 male and 47 female Chinese northeast subjects were taken in this research. The ankle joints of these subjects were scanned by CT. In total, thirteen indexes were measured through Mimics and Magics software. Length and breadth indexes of total talus, trochlea, talar head, medial and lateral malleolus articular surface were mainly selected. Nine of them were measured through Mimics software. The other four indexes were measured through Magics software. All data were analyzed by independent-samples t-test in SPSS and Stata software. Discriminant function equations were generated for sex determination.ResultsAll the indexes were normally distributed. No significant difference between left and right talus in either males or females was identified (P> 0.05). All results showed significant sexual difference (P < 0.05) except posterior breadth of trochlea. The average accuracy of sex determination ranged from 95.85% to 98.45% in the direct method and 98.95% in the stepwise method.ConclusionsLength indexes showed higher accuracy rate than breadth ones. Length of lateral malleolus articular surface was the best discriminator of sexual dimorphism. Talus was proved effective for sex determination in Chinese population. This study provided a remarkable reference for sex determination in forensic science.
       
  • A case of intoxication with a new cathinone derivative α-PiHP – A
           presentation of concentrations in biological specimens
    • Abstract: Publication date: Available online 12 November 2019Source: Legal MedicineAuthor(s): Piotr Adamowicz, Agnieszka Jurczyk, Dominika Gil, Szymon SzustowskiAbstractIntroductionCathinones are currently the second largest and the second most frequently seized group of new psychoactive substances (NPS). One of the most recent synthetic cathinones that has appeared on the ‘legal highs’ market is alpha-pyrrolidinoisohexanophenone (α-PiHP).Case historyAn 18-year-old man was found dead in an apartment. The autopsy materials were collected for toxicological analyses.MethodsThe quantitative analyses were carried out by LC-MS/MS.Resultsα-PiHP was detected and quantified in all post-mortem materials except the hair. The determined concentrations of the compound in the blood, urine and bile were 69 ng/mL, 2072 ng/mL, and 341 ng/mL respectively. The concentrations of α-PiHP in solid tissues were in the range of 7–478 ng/g. 4-Chloromethcathinone (4-CMC), n-ethylhexedrone, benzoylecgonine and 3,4-methylenedioxymethamphetamine (MDMA) were also detected in some materials.DiscussionNo cases presenting concentrations of α-PiHP in biological materials have been reported so far. Due to the similarity of structures and the reported dosages, an attempt to compare the concentrations of α-PVP and α-PHP has been made. In the described case, functional death through intoxication of α-PiHP was accepted as the final cause of death. The other detected substances did not contribute to death due to their very likely distant administration.Conclusionα-PiHP is another new synthetic cathinone that is a danger to the life of users. The described fatal intoxication case presents the concentrations of α-PiHP in post-mortem materials. This data could be valuable for further interpretation of other results from toxicological analyses in cases where the use of α-PiHP is suspected.
       
  • An investigative strategy for assessment of injuries in forensic
           anthropology
    • Abstract: Publication date: Available online 11 November 2019Source: Legal MedicineAuthor(s): Filippo Scianò, Barbara Bramanti, Vanessa Samantha Manzon, Emanuela Gualdi-RussoAbstractIn a forensic context, identification of skeletal injuries’ and traumas’ timing may be of fundamental relevance to understand the events related to the life and death of an individual. In this study, we propose a new evaluation form to facilitate the detection of traumas and interpret them as ante-, peri- or post-mortem injuries. We describe the use of this form with the analysis of two skeletonized individuals. Bone injuries on their skeletons were caused by diverse sharp weapons and differed for the timing they have occurred, as revealed by macroscopic, radiographic and microscopic assays. Thanks to its completeness and user-friendly approach, the evaluation form here proposed may greatly facilitate the analysis and interpretation of injuries found on skeletons under forensic investigation.
       
  • Major cerebral hypoperfusion on an internal carotid loop during an
           otologic surgery : a case report
    • Abstract: Publication date: Available online 11 November 2019Source: Legal MedicineAuthor(s): Florent Carsuzaa, Xavier Dufour, Tyffanie Houpert, Jean-Claude Ferrié, Michel Sapanet, Alexia DelbreilAbstractAn aberrant course of the internal carotid artery, such as a carotid loop or kinking, is a rare type of malformation. These malformations are typically asymptomatic, their occurrence is unpredictable, and they can exacerbate clinical disorders such as heart failure. We report the case of a seven-year-old child who died consecutively to cardiac arrest during otologic surgery for a cholesteatoma. After rapid and effective cardiorespiratory resuscitation, the child was transferred to a paediatric intensive care unit. In the following days, pronounced cerebral hypoperfusion led to the death of the child. The autopsy revealed a right carotid loop and a left carotid kink that presumably led to the cerebral hypoperfusion.
       
  • Comparative assessment to determine the accuracy of Demirjian and DARLInG
           methods of dental age estimation in western Indian children
    • Abstract: Publication date: Available online 11 November 2019Source: Legal MedicineAuthor(s): Pooja Balgi, Farhin Katge, Shishir Singh, Jayakumar Jayaraman
       
  • Aerobic Microbe Community And Necrophagous Insects Associated With
           Decomposition Of Pig Carrion Poisoned With Lead
    • Abstract: Publication date: Available online 11 November 2019Source: Legal MedicineAuthor(s): Aneyo Idowu, Alafia Oyindamola, Doherty Funmilayo, Udoma Roseline, Balogun Bukola, Adeola AbdullahiAbstractThis study investigated the effects of pig feed contaminated with lead (Pb) on the decomposition rate of pig carrion, identified the aerobic microorganisms and necrophagous insects associated with decomposing pig (Sus scrofa) carrion (above ground), and explored their potential use in the determination of post-mortem interval (PMI). The study profiled the decomposition of Sus scrofa carrion over a period of 40 days to record the effects of lead during decomposition. Fungi were identified by sub-culturing on prepared solidified potato dextrose agar and microbial identification was carried out using biochemical characterization. The decomposition rate of pigs fed with lead-contaminated feed (0.18 and 0.2 ppm) attracted insects and increased the rate of hair fall, hence at day 35, these carrion were skeletonized. The aerobic bacterial communities identified were Staphylococcus aureus, Bacillus sp. and Salmonella paratyphiwhereas the fungi identified include Fusarium sp., Cylindrocladium sp Cephalosporium sp., Scopolariopsis sp., Aspergillus sp, Mucor sp., Circinella sp., Pythium sp., Penicillium sp., Trichoderma sp., Geotrichum sp., Phytophthora sp., and Saccharomyces sp. The necrophagous insects collected consisted of three orders: Coleoptera, Diptera, and Hymenoptera which included insects like Chrysomya chloropyga Wiedemann, 1818, Musca domestica Linnaeus, 1758, Sarcophaga exuberans Pandelle, 1896, Necrobia rufipes De Geer, 1775, Dermestes maculatus De Geer, 1774, Camponotus sericeus Fabricius, 1798 and Camponotus perrisii Forel, 1886. The activity of insect on treatments was well matched but the decomposition rate differs. Spectrophotometric analysis of insect larvae collected from decomposing pigs revealed they had presence of lead. Insect larvae and microbes identified are good entomotoxicological tools in crimes associates with lead poisoning.
       
  • Mephedrone and chemsex: a case report
    • Abstract: Publication date: Available online 11 November 2019Source: Legal MedicineAuthor(s): Luca Anzillotti, Luca Calò, Antonio Banchini, MariaLaura Schirripa, Francesca Marezza, Rossana CecchiAbstractThe chemsex or slamsex phenomenon has attracted attention worldwide, with concerns also expressed by health professionals for the spread of sexually transmitted diseases.Mephedrone or 4-methylmethcathinone, a substituted cathinone homolog of ephedrine, is one of the most popular substances used as a cheaper alternative to other traditional drugs.Fatal cases of chemsex are still rare. We present here the first case-report to the best of our knowledge of a mephedrone-related acute toxicity case in Parma (Italy) detected and quantitated in biological specimens (2.0 mg/L in urine sample, 1.1 mg/L in bile and 1.0 mg/L in central blood while 0.8 mg/L in peripheral blood). None of the other most common drugs of abuse could be detected. Autopsy findings such as facies edematosa, oedema and polyvisceral congestion, interstitial petechiae are compatible elements with a death from acute cardio-respiratory failure, with peri-mortem agony of few minutes in which the cardiac hypertrophy, the moderate aortocoronary sclerosis and mephedrone injection have played a substantial role in the evaluation of the final cause due to an accidental acute intoxication with mephedrone.
       
  • Evaluation of a co-extraction kit for mRNA, miRNA and DNA
           methylation-based body fluid identification
    • Abstract: Publication date: Available online 11 November 2019Source: Legal MedicineAuthor(s): Ken Watanabe, Tomoko AkutsuAbstractRecently, messenger RNA (mRNA), micro RNA (miRNA), and DNA methylation (DNAm) have been reported as novel markers for body fluid identification (BFID). Comprehensive analysis of these markers should be a flexible and reliable BFID method for various types of forensic samples. However, independent extraction of all targets can be difficult depending on the usable amounts of samples. In this study, the applicability of a co-extraction kit for these molecules, the AllPrep DNA/RNA/miRNA Universal Kit (APU), was evaluated by comparing RNA and DNA extracted from blood and saliva stains by the APU with those extracted by standard kits for each molecule and by previously reported methods for mRNA/DNA or miRNA/DNA co-extraction. Electrophoresis using the Bioanalyzer platform and real-time PCR analysis revealed that the APU performed almost equivalently to each standard kit in the quality of RNA or DNA extracted and extraction efficiency of mRNAs, miRNAs, and DNA. Moreover, the APU outperformed the co-extraction methods, especially in RNA integrity and miRNA extraction efficiency. In addition, pyrosequencing revealed that the methylation ratios of DNA extracted by the APU were not different from those extracted by standard DNA extraction kits. Overall, the APU is applicable to comprehensive analysis of mRNA/miRNA/DNAm markers for BFID analysis. Because the DNA eluate can also be used for DNA typing, the APU may be among the best choices for forensic examination of body fluid samples in terms of its flexibility and reliability in BFID and efficiency in sample consumption.
       
  • Analysis of nondegraded and degraded DNA mixtures of close relatives using
           massively parallel sequencing
    • Abstract: Publication date: Available online 25 October 2019Source: Legal MedicineAuthor(s): Hsiao-Lin Hwa, Ming-Yih Wu, James Chun-I Lee, Hsiang-I Yin, Pi-Mei Hsu, Shwu-Fang Li, Wuh-Liang Hwu, Chih-Wen SuAbstractIdentification of the minor contributor in DNA mixture of close relatives remains a dilemma in forensic genetics. Massively parallel sequencing (MPS) can analyze multiple short tandem repeats (STRs) and single nucleotide polymorphism (SNPs) concurrently and detect non-overlapping alleles of the minor contributors in DNA mixtures. A commercial kit for MPS of 59 identity informative STRs (iiSTRs) and 94 autosomal identity-informative SNPs (iiSNPs) was used to analyzed 34 nondegraded and 33 highly degraded two-person artificial DNA mixtures of close relatives with various minor to major ratios (1:9, 1:19, 1:29, 1:39, 1:79, 1:99). EuroForMix software was used to determine the minor contributors in the mixtures based on the likelihood ratios calculated from the MPS data, and relMix software was used to perform kinship analysis of the contributors. The STRs and SNPs of the 34 nondegraded and 33 degraded DNA mixtures were genotyped using MPS. Using EuroForMix based on the genotypes of autosomal iiSTRs and autosomal iiSNPs, 82.4% (28/34) and 54.5% (18/33) of minor donors could be accurately assigned for the nondegraded and degraded DNA mixtures, respectively. The relMix software correctly inferred the relationship between contributors in 97.1% (33/34) of nondegraded mixtures and in 97.0% (32/33) of degraded mixtures. In conclusion, combined EuroForMix and MPS data of STRs and SNPs can assist in the assignment of minor donors in nondegraded DNA mixtures of close relatives, and relMix can be used to infer relationship among contributors.
       
  • An autopsy case of thyroid storm associated with chronic lymphocytic
           thyroiditis
    • 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 UenoAbstractA 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.
       
 
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