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Legal Medicine
Journal Prestige (SJR): 0.678
Citation Impact (citeScore): 1
Number of Followers: 364  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1344-6223
Published by Elsevier Homepage  [3182 journals]
  • 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 Szustowski IntroductionCathinones 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-Russo In 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 Delbreil An 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 Abdullahi This 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 Cecchi The 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 Akutsu Recently, 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.
       
  • Wild-type ATTR amyloidosis may be associated with unexpected death among
           the elderly
    • Abstract: Publication date: Available online 31 October 2019Source: Legal MedicineAuthor(s): Tetsuya Shiozaki, Noriko Sato, Tokotaro Hayashi, Kanya Kobayashi, Hideki Asamura Wild-type ATTR amyloidosis (ATTR-wt) is characterized by the accumulation of amyloid in the heart, leading to fatal heart failure and arrhythmia. In this study, we investigated the amyloid deposits in the heart from 556 forensic autopsy cases over 60 years of age. The prevalence of ATTR-wt was 5.8% (32 of the 556), with the prevalence increasing as a function of age. We identified an ATTR-wt-specific morbidity rate of 12.3% for patients over 80 years of age, while the prevalence among individuals over 90 years of age was 34.9%. In none of these 32 cases had a clinical diagnosis of ATTR-wt been made. In 29 of the 32 cases found to be ATTR-wt positive, an obvious extraneous cause of death was identified and included burning, drowning, hypothermia, suicide, and traffic accident. On the other hand, heart failure due to ATTR-wt was confirmed as the cause of death in 3 of the 32 cases. It is suggested that ATTR-wt may be associated with unexpected death among the elderly.
       
  • 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 Su Identification 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 unbalanced tri-allelic pattern at the D10S1248 locus: Characteristics,
           genetic basis and transmission
    • Abstract: Publication date: Available online 25 October 2019Source: Legal MedicineAuthor(s): Chao Xiao, Tian Wei, Daixin Huang To address issues related to unbalanced tri-allelic patterns, an example at the D10S1248 locus characterized by the sum of heights of alleles 13 and 15 approximately equal to allele 14 was intensively investigated. The coexistence of these three alleles was confirmed by profiling the rs2246512-D10S1248 marker using fluorescently labelled primers and allelic sequencing. Multi-tissue genotyping revealed that this pattern had chimeric characteristics, and pedigree analysis found that allele 13 or allele 14 were inherited to offspring independently of the other two alleles. These evidences suggest that the pattern should stem from a somatic mutation in early embryonic development and that peak height ratio is not an accurate indicator of mutation time point and direction. The rs2246538-D10S1248-rs2246512 marker was subsequently used to determine the mutation from allele 15 to allele 13. Notably, allele 13 with the lowest peak height was misidentified as a stutter peak when genotyped using next generation sequencing.
       
  • Cyanide concentrations in blood and tissues of fire victims
    • Abstract: Publication date: Available online 25 October 2019Source: Legal MedicineAuthor(s): Thu Thu Htike, Fumio Moriya, Satoru Miyaishi Cyanide poisoning has been regarded to contribute the fatal outcome in fire victims. The toxicity of inhaled hydrogen cyanide (HCN) at the cellular level was evaluated considering the impact of methemoglobin (MetHb) produced by fire gases. Cyanide (CN) concentrations and total hemoglobin contents were measured in right heart blood (RHB) and seven organs/tissues (basal ganglia, brain stem, heart, lung, liver, kidney and psoas muscle) collected from 20 fire fatalities. MetHb and carboxyhemoglobin saturations were also measured in RHB. The amount of CN probably bound to the cytochrome c oxidase (CCO-CN) of the tissue cells was extrapolated from CN and hemoglobin contents in RHB and organs/tissues, MetHb saturation in RHB and binding capacity of MetHb for CN. CN concentrations in RHB showed a wide range with the highest concentration of 8.927 μg/mL. The lung contained the largest CN content among organs/tissues with the mean concentration of 2.219 μg/g, then the heart (0.259 μg/g) and it was lower than 0.100 μg/g in others. Exceedingly large amount of CN in the lung could be explained by high hemoglobin content, being the port of entry of HCN and postmortem diffusion of fire gases. CCO-CN was theoretically present in about 20% of organ/tissue samples, most commonly in the basal ganglia (10 samples, with the mean of 0.059 μg/g) followed by heart (eight samples, with the mean of 0.109 μg/g). No CCO-CN was found in liver and kidney. HCN might have the effect on brain and heart.
       
  • A case report positive for synthetic cannabinoids: Are cardiovascular
           effects related to their protracted use'
    • Abstract: Publication date: Available online 25 October 2019Source: Legal MedicineAuthor(s): Luca Anzillotti, Francesca Marezza, Luca Calò, Antonio Banchini, Rossana Cecchi The use of synthetic cannabinoids is being increasingly recognised worldwide, but the chemical compositions and physiological effects of these drugs are poorly characterised and are continually changing. New substances are constantly being added to the content of synthetic cannabinoids and they are rarely identified on toxicological screening tests. Due to their structures synthetic cannabinoids and their effects have been compared to the psychoactive compound, Δ-9-tetrahydrocannabinol (THC), found in marijuana. On the molecular level, they are potent cannabinoid receptor agonists that also may have affinity for other types of receptors such as those on platelets. Reported symptoms of toxicity include anxiety, agitation, paranoia, hallucinations, tachycardia, hypertension, excessive sweating, nausea, and vomiting. They can also be linked to serious adverse cardiovascular events and can affect the cardiovascular system causing hypotension and bradycardia, myocardial infarction, atrial fibrillation, prolonged QTc, and Mobitz type II atrioventricular block, as well as interfere with the aggregation of platelets.We present a case report of a cardiac tamponade with toxicological findings positive for synthetic cannabinoids. This case highlights the importance of testing routinely for novel psychoactive compounds, and recognising their potential to cause life-threatening conditions.
       
  • Applicability of the third molar maturity index for assessment of age of
           majority in Eastern China
    • Abstract: Publication date: Available online 25 October 2019Source: Legal MedicineAuthor(s): Miaochen Wang, Linfeng Fan, Shihui Shen, Xuebing Bai, Jian Wang, Fang Ji, Jiang Tao From a legal and penalty point of view, it is essential to conclude if an individual has reached the legal age (also known as age of majority). Although Cameriere’s third molar maturity index (I3M) has been used to discriminate between adults and minors, no study has tested the applicability of I3M in the Eastern Chinese population. The aim of this study was to assess the validity of the region-specific cut-off value of I3M for discriminating minors from adults in an Eastern Chinese population. Five hundred fifty-six subjects (276 males and 280 females) aged 14–24 years participated in this study. A logistic regression analysis was conducted by considering the adult and minor ages as dichotomous dependent variables and I3M and sex as predictor variables. The results showed that sex was not statistically significant in distinguishing adults and minors. The receiver operating curve analysis showed the best performance of the cut-off value of I3M 
       
  • Genetic distributions and diversity analysis of 23 Y-STR loci in
           Xi’an Han population
    • Abstract: Publication date: Available online 25 October 2019Source: Legal MedicineAuthor(s): Jie Zhao, Xiaoye Jin, Zhen Song, Sanping Song, Wei Cui, Chong Chen, Chunmei Shen Xi’an is the most populous city in Northwest China, in which most residents are Han Chinese. In this study, we analyzed genetic distributions of 23 Y-STR loci in Xi’an Han population and evaluated genetic affinities between Xi’an Han population and other reference populations based on the PowerPlex® Y23 System.
       
  • Estimation of stature and sex from skull measurements by multidetector
           computed tomography in Chinese
    • Abstract: Publication date: Available online 30 September 2019Source: Legal MedicineAuthor(s): Meng-jun Zhan, Jing-hui Cui, Kui Zhang, Yi-jiu Chen, Zhen-hua Deng The present study is an attempt to estimation of stature and sex from skull measurements by multidetector computed tomography (MDCT) in contemporary Chinese. In the present study, fifteen measurements for every skull were taken from CT image of 382 Chinese. The sample was composed of 200 males and 182 females with an average age of 47 and 46 years, respectively. Discriminant function was used in sex determination and regression analysis was used in stature estimation from skull measurements. The stepwise analysis of all measurements yielded a sex classification accuracy rate of 89.3%. The classification accuracy rates of the univariate discriminant function analyses were from 50.5% to 84.8%. For stature estimation, the standard error of estimate (SEE) ranged from 5.072 to 6.355 cm for male, from 5.090 to 5.829 cm for female, respectively. This study is the first to provide a metric and statistical characterization of the skull in contemporary Chinese, and indicates that it is feasible to sex estimation by skull measurement. Furthermore, the equations presented for stature estimation in this study may be used as alternatives in forensic cases, particularly in cases where better predictors such as the long bones are not available.
       
  • 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 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
           Malpractice
    • 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.
       
 
 
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