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Legal Medicine
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  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1344-6223
Published by Elsevier Homepage  [3162 journals]
  • Diagnostic Value of Multiphase Postmortem Computed Tomography Angiography
           in Selected Cases of Blunt Traumatic Deaths
    • Abstract: Publication date: Available online 11 July 2018Source: Legal MedicineAuthor(s): Dina Ali Shokry, Maged Nabil Hussein, Fatma Mohamed Hassan, Axel Heinemann, Herman Vogel, Klaus Pueschel ObjectivesRecently, multiphase postmortem computed tomography angiography (MPMCTA) has been proven as a reliable tool in the diagnosis of vascular pathology, while its potential efficiency in the detection of soft tissue lesions is ignored. In this study, we have evaluated the overall diagnostic value of MPMCTA in the diagnosis of blunt traumatic deaths in selected cases to determine its additional advantages and limitations in order to identify its potential applications.MethodsThis prospective study examined 14 decedents presented to the Department of Legal Medicine of Hamburg University that alleged death due to blunt trauma. For each case, MPMCTA and conventional autopsy findings were compared. Both radiological and autopsy findings are divided according to the body regions in addition to the detection of the cause of death.ResultsBoth MPMCTA and the conventional autopsy showed the major findings but not all findings. MPMCTA was better in the demonstration of vascular and skeletal lesions, while the diagnosis of parenchymal injury remains autopsy-dependent. The efficiency of MPMCTA for detection of haemorrhage was relatively affected by the blood amount and the location of the bleeding source. The presented MPMCTA-related artefacts interfered with the accurate diagnosis of certain injuries.ConclusionThe combination of MPMCTA with conventional autopsy appears to be the gold standard for investigation of blunt traumatic deaths. Depending on the death circumstances and the expected findings, MPMCTA can be performed alone in selected cases.
  • Pericardial fluid is suitable as an alternative specimen for the
           measurement of β-hydroxybutyrate within 96 h after death
    • Abstract: Publication date: July 2018Source: Legal Medicine, Volume 33Author(s): Tatsushi Mizutani, Takashi Yoshimoto, Akira Ishii We examined postmortem β-hydroxybutyrate (BHB) levels in the body fluids obtained from 253 forensic autopsy cases whose causes of death were determined. Postmortem changes of BHB levels according to postmortem intervals (PMI) in various body fluids (plasma, urine, vitreous humor, and pericardial fluids) were investigated to determine appropriate alternative specimens as plasma samples. Our study has indicated the following points: 1) the BHB levels in plasma specimens from three sampling sites showed no significant differences, 2) postmortem changes of BHB levels in plasma and pericardial fluids could be negligible within 96 h PMI, while urine and vitreous humor BHB levels showed postmortem changes, and 3) pericardial fluid would thus be most suitable as an alternative to plasma in postmortem BHB level. We have also proposed that BHB levels could be applicable for the diagnosis of metabolic disorders in forensic autopsy.
  • Circulating miRNAs expression profiling in drug-resistant epilepsy:
           Up-regulation of miR-301a-3p in a case of sudden unexpected death
    • Abstract: Publication date: July 2018Source: Legal Medicine, Volume 33Author(s): Maria De Matteis, Giovanni Cecchetto, Giada Munari, Laura Balsamo, Marina Paola Gardiman, Renzo Giordano, Guido Viel, Matteo Fassan
  • Sudden death in a female child doe to undiagnosed pleuropulmonary blastoma
           – An autopsy case and review of literature
    • Abstract: Publication date: July 2018Source: Legal Medicine, Volume 33Author(s): Rie Nishikata, Naho Kato, Miwako Suto, Mami Rinno, Naohito Kuroda, Yuko Hashimoto
  • Low-template methods yield limited extra information for PowerPlex®
           Fusion 6C profiling
    • Abstract: Publication date: July 2018Source: Legal Medicine, Volume 33Author(s): Francisca Duijs, Linda van de Merwe, Titia Sijen, Corina C.G. Benschop Advances in autosomal DNA profiling systems enable analyzing increased numbers of short tandem repeat (STR) loci in one reaction. Increasing the number of STR loci increases the amount of information that may be obtained from a (crime scene) sample. In this study, we examined whether even more allelic information can be obtained by applying low-template methods. To this aim, the performance of the PowerPlex® Fusion 6C STR typing system was assessed when increasing the number of PCR cycles or enhancing the capillary electrophoresis (CE) injection settings. Results show that applying these low-template methods yields limited extra information and comes at cost of more background noise. In addition, the gain in detection of alleles was much smaller when compared to the gain when applying low-template methods to the 15-loci AmpFLSTR® NGM™ system. Consequently, the PowerPlex® Fusion 6C STR typing system was implemented using standard settings only; low-template methods were not implemented for our routine forensic casework.
  • Applying 3D prints to reconstructing postmortem craniofacial features
           damaged by devastating head injuries
    • Abstract: Publication date: July 2018Source: Legal Medicine, Volume 33Author(s): Petra Urbanová, Tomáš Vojtíšek, Jan Frišhons, Ondřej Šandor, Mikoláš Jurda, Jan Krajsa Postmortem facial identification is one of the most common techniques for establishing a deceased person’s identity. In victims suffering from devastating cranial injuries, the feasibility of facial identification tasks can be compromised by damage to or disfigurement of the identifying cranial features. Although there are several reconstructive approaches, which help experts to restore the essence of person’s physical appearance, thus enhancing the chances of recognition, only a few of them involve restoring the fractured cranial bones as the foundation for the reconstructed soft tissues. Here, we propose a technique based on replacement of heavily damaged hard tissues with generic prosthetics manufactured by 3D printing. Our approach does not require medical imaging technologies or other costly lab equipment. It is simple, affordable and relatively labor-efficient. The deceased’s reconstructed craniofacial features can be subsequently assessed, photographed, drawn or otherwise reproduced in order to help determine his or her identity. In addition, the imagery can be displayed, published or broadcasted in media without concerns of being overly graphic.
  • DRD2/ANKK1 gene polymorphisms in forensic autopsies of methamphetamine
           intoxication fatalities
    • Abstract: Publication date: July 2018Source: Legal Medicine, Volume 33Author(s): Aya Matsusue, Takaki Ishikawa, Tomoya Ikeda, Naoto Tani, Hisatomi Arima, Brian Waters, Kenji Hara, Masayuki Kashiwagi, Mio Takayama, Natsuki Ikematsu, Shin-ichi Kubo Dopamine D2 receptor/ankyrin repeat and kinase domain containing 1 (DRD2/ANKK1) gene polymorphisms have been associated with responses to psychotropic drugs and addiction. We analyzed two DRD2/ANKK1 polymorphisms, Taq1A and –141C Ins/Del, in 37 fatal methamphetamine (MA) intoxication cases and 235 control cases in which MA and psychotropic drugs were not detected. The association among polymorphism, cause of death, and cerebrospinal fluid (CSF) dopamine concentration was evaluated. The Taq1A polymorphism distribution in the fatal MA intoxication cases differed from in the controls (P = 0.030) with a significantly high A1/A1 + A1/A2 genotype frequency. No significant associations were observed between –141C Ins/Del polymorphisms and MA intoxication cases or between DRD2/ANKK1 polymorphisms and CSF dopamine concentrations. Our findings suggest that the DRD2/ANKK1 Taq1A polymorphism is associated with susceptibility to fatal MA intoxication.
  • The study of protection of operators and surrounding workers at the time
           of using portable intraoral X-ray unit
    • Abstract: Publication date: July 2018Source: Legal Medicine, Volume 33Author(s): Atsushi Iwawaki, Yusei Otaka, Ruri Asami, Tomonori Ozawa, Maki Izawa, Hideki Saka
  • The third molars for indicating legal adult age in Montenegro
    • Abstract: Publication date: July 2018Source: Legal Medicine, Volume 33Author(s): Marija Antunovic, Ivan Galic, Ksenija Zelic, Nenad Nedeljkovic, Emira Lazic, Marija Djuric, Roberto Cameriere AimFrom a medico-legal and penalty point of view, it is essential to conclude if an individual is a minor or an adult (18 years of age). Methods based on the third molar development have been used for this purpose. The present article aims to verify the Nolla’s stages of mineralization of the third molars and a third molar maturity index (I3M) which is based on the measures of the projections of open apices normalized by their height in the sample of Montenegrins.Method and sampleThe sample consisted of 683 panoramic radiographs (324 males and 359 females) between 13 and 24 years of age. The specific mineralization stages of Nolla and the cut-off value of I3M 
  • Evaluation of skin- or sweat-characteristic mRNAs for inferring the human
           origin of touched contact traces
    • Abstract: Publication date: July 2018Source: Legal Medicine, Volume 33Author(s): Tomoko Akutsu, Ken Watanabe, Ayari Takamura, Koichi Sakurada The source of small amounts of touch DNA, which is transferred from the skin to an object when it is handled or touched, could be an issue in the forensic analysis of criminal cases. Here, we performed an extended evaluation of skin- or sweat-characteristic mRNAs to investigate their usability to infer whether an object has been handled or touched by someone. First, we compared the expression levels of candidate genes between skin swabs and other body fluids by quantitative RT-PCR analysis. Among the analyzed genes, corneodesmosin (CDSN), late cornified envelope 1C (LCE1C), filaggrin (FLG), desmocollin 1, and dermcidin were selected for further analysis on the basis of their specificities and sensitivities. Then, we tried to detect these genes from mock casework samples. As a result, CDSN, LCE1C, and FLG could be good markers because of their detectability. Finally, we determined the correlation between the expression of these genes and DNA yield of skin swabs to assess their adaptability as a screening test for touch DNA samples. However, the detectability of these genes was not correlated with the DNA yield of skin swab samples. In conclusion, gene expression analysis of the skin- or sweat-characteristic mRNAs CDSN, LCE1C, and FLG could be useful for inferring the skin origin of touched contact traces, but the use of the expression levels of these mRNAs for the prediction of DNA yield is problematic. To develop a screening test for touch DNA samples, other markers that have a well-correlated sensitivity with DNA analysis should be investigated.
  • Study of chemiluminescence measured by luminometry and its application in
           the estimation of postmortem interval of bone remains
    • Abstract: Publication date: July 2018Source: Legal Medicine, Volume 33Author(s): Jesús Sarabia, Cristina Pérez-Martínez, Juan Pedro Hernández del Rincón, Aurelio Luna A substantial challenge faced by forensic medicine is determining the postmortem interval (PMI) of skeletonized remains. Currently, the luminol method is of limited forensic usefulness, since it uses qualitative and subjective methods to estimate PMI by the naked eye assessing the degree of chemiluminescence (CL) emitted by bone remains, a technique which is not sensitive enough to distinguish between historical or forensically significant time intervals. The aim of the present study was to use a direct and accurate measurement of the CL by luminol technique in relative light units (RLU) using a luminometer to establish this method as a possible complementary and low cost tool for the determination of the PMI for distinguishing between remains of medical-legal (
  • Dental age estimation using four Demirjian’s, Chaillet’s and
           Willems’ methods in Kosovar children
    • Abstract: Publication date: July 2018Source: Legal Medicine, Volume 33Author(s): Jeta Kelmendi, Marin Vodanović, Ferit Koçani, Venera Bimbashi, Blerim Mehmeti, Ivan Galić BackgroundTooth formation was recognized as useful body system to assess maturity and predict age. Tooth mineralization is much less affected by the endocrine and different nutritional status than bone mineralization, and teeth formation provides a more reliable indication of chronological age. Demirjian et al. in 1973 presented a scoring system and method for dental age estimation on a sample of French-Canadian children. Chaillet et al. and Willems et al. modified original Demirjian method. This study aimed to evaluate the accuracy of four Demirjian’s, Chaillet and Willems methods for age estimation in the children of Kosovo.Materials and methodsThe cross-sectional study was based on the evaluation of the sample of 1022 orthopantomograms (OPTs) of healthy Kosovar children, aged between 5 and 14 years. OPTs were taken from the Radiology unit of University Dentistry Clinical Center of Kosova, as part of random clinical treatment. We tested the accuracy of four methods based on seven mandibular teeth, Demirjian from 1973 (Dem73) and 1976 (Dem76), Chaillet from 2005 (Chaillet) and Willems from 2001 (Willems) and two Demirjian’s methods based on different sets of four teeth (Dem76PM1 and Dem76IN2).ResultsFor most tested methods, we found statistically significant differences between the chronological age (CA) and dental age (DA) (p 
  • Japaneseplex: A forensic SNP assay for identification of Japanese people
           using Japanese-specific alleles
    • Abstract: Publication date: July 2018Source: Legal Medicine, Volume 33Author(s): Isao Yuasa, Atsushi Akane, Toshimichi Yamamoto, Aya Matsusue, Minoru Endoh, Mayumi Nakagawa, Kazuo Umetsu, Takaki Ishikawa, Morio Iino It is sometimes necessary to determine whether a forensic biological sample came from a Japanese person. In this study, we developed a 60-locus SNP assay designed for the differentiation of Japanese people from other East Asians using entirely and nearly Japanese-specific alleles. This multiplex assay consisted of 6 independent PCR reactions followed by single nucleotide extension. The average number and standard deviation of Japanese-specific alleles possessed by an individual were 0.81 ± 0.93 in 108 Koreans from Seoul, 8.87 ± 2.89 in 103 Japanese from Tottori, 17.20 ± 3.80 in 88 Japanese from Okinawa, and 0 in 220 Han Chinese from Wuxi and Changsha. The Koreans had 0–4 Japanese-specific alleles per individual, whereas the Japanese had 4–26 Japanese-specific alleles. Almost all Japanese were distinguished from the Koreans and other people by the factorial correspondence and principal component analyses. The Snipper program was also useful to estimate the degree of Japaneseness. The method described here was successfully applied to the differentiation of Japanese from non-Japanese people in forensic cases. This Japanese-specific SNP assay was named Japaneseplex.Graphical abstractGraphical abstract for this article
  • How do skeletons with HIV present' A study on the identified CAL
           Milano Cemetery Skeletal Collection
    • Abstract: Publication date: July 2018Source: Legal Medicine, Volume 33Author(s): Lucie Biehler-Gomez, Antonio Cabrini, Danilo De Angelis, Cristina Cattaneo With the Human Immunodeficiency Virus (HIV) infection and Acquired Immune Deficiency Syndrome (AIDS) pandemic, the study of HIV/AIDS on bones has become of pivotal interest for research in bone pathologies, forensic applications (especially in the matter of identification when confronted to antemortem data) and medical purposes. In this paper, we document and discuss the macroscopic lesions found on the skeletons of nine individuals with known HIV, including four with known AIDS, coming from the identified CAL Milano Cemetery Skeletal Collection. As a result, several types of lesions were observed on bones: periosteal new bone formation, dental lesions, thickening of the frontal diploë, destructive localized porosity and evidence of trauma. None of the lesions reported can be directly linked to HIV because the virus does not directly affect bones in a macroscopic way. However, HIV/AIDS-induced infections and inflammations and HIV-related risk factors may leave bone markers. The differential diagnosis of each of the lesions noted in this research and its potential link to HIV or AIDS was discussed. Although it is not possible to diagnose HIV on bare bones, this was not the focus of this study. To our knowledge, no anthropological study has ever been performed on known HIV individuals. With this paper, we present for the first time skeletons with known HIV.
  • Editorial Board (Issue 1)
    • Abstract: Publication date: July 2018Source: Legal Medicine, Volume 33Author(s):
  • microRNAs in Sudden Unexpected Death in Epilepsy (SUDEP): Location matters
    • Abstract: Publication date: July 2018Source: Legal Medicine, Volume 33Author(s): Fulvio A. Scorza, Ana C. Fiorini, Carla A. Scorza, Josef Finsterer
  • Effects of PCR inhibitors on mRNA expression for human blood
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Shusaku Matsumura, Aya Matsusue, Brian Waters, Masayuki Kashiwagi, Kenji Hara, Shin-ichi Kubo Detection of body fluid-specific mRNAs, such as those specific for blood, using real-time polymerase chain reaction (PCR) has become a useful tool in forensic science. Blood stains often contain PCR inhibitors that may be co-extracted with RNA and adversely affect PCR. The effects of inhibitors on the detection of mRNA markers for blood identification, namely, hemoglobin beta (HBB) and actin beta, were examined herein. Inhibitors were added to a real-time PCR mix, reverse transcription mix, and blood samples before RNA extraction, and the following parameters: Ct, delta Ct (dCt), and melting temperature (Tm) values, were monitored. Hematin, humic acid, indigo carmine, and tannic acid were used as PCR inhibitors. The results showed that Ct values for HBB in samples containing inhibitors in their real-time PCR mix increased in a concentration-dependent manner, and were undetectable at higher concentrations. Moreover, Ct values for HBB in tannic acid-spiked samples reached a maximum once, and inhibition decreased at higher concentrations. dCt values increased in hematin-spiked samples, but decreased in tannic acid-spiked samples. Tm values decreased following the addition of each inhibitor. The reverse transcription reaction was scarcely inhibited at concentrations that markedly affected real-time PCR. The complete removal of inhibitors added to blood was difficult. However, the observed inhibitory effects were weaker than those when inhibitors were added to the PCR cocktail. PCR inhibition was effectively reduced by repurification of complimentary DNA with DNA extraction kits. These results will assist examiners in deducing contaminating inhibitors and selecting an appropriate method to remove them.Graphical abstractGraphical abstract for this article
  • Non-invasive prenatal paternity testing using cell-free fetal DNA from
           maternal plasma: DNA isolation and genetic marker studies
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Shanshan Zhang, Shuyi Han, Maoxiu Zhang, Yunshan Wang Invasive prenatal paternity tests can result in miscarriage and congenital malformations; therefore, a non-invasive method of testing is preferable. However, little progress could be made in this field until the introduction of cell-free fetal DNA (cffDNA) in 2009. In this review, two aspects regarding the history and development of non-invasive prenatal paternity testing (NIPAT) are summarized: (1) extraction and enrichment of cffDNA and (2) genetic marker-based studies. Although column-based kits are used widely for NIPAT, some researchers have suggested that an automated method, such as magnetic extraction, generally has a higher cffDNA yield than that of manual column-based extraction; therefore, its popularity might increase in the near future. In addition, size- and methylation-based enrichment methods are expected to perform better than formaldehyde-based methods. On the other hand, single nucleotide polymorphism-based techniques have contributed to NIPAT, whereas the application of short tandem repeat testing has so far been restricted to pregnant women bearing male fetuses only. Additional methods and techniques are expected to be innovated to facilitate the forensic practice of NIPAT.
  • Strangulation of the heart presenting as sudden cardiac death: A deadly
           but forgotten complication of epicardial pacing device
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Martin Janík, Petr Hejna, Ľubomír Straka, Jozef Krajčovič, František Novomeský Strangulation of the heart appears to be an exceedingly rare mechanical phenomenon that can develop with epicardial pacing wires in individuals undergoing somatic growth. Over the passage of time, owing to size mismatch between a fixed wire length and dynamically growing heart, the epicardial wire may embed around the heart resulting in the progressive over-pressurizing of involved cardiac structures. Depending on the location of the peak constriction pressures, cardiac strangulation may damagingly affect coronary circulation, heart valves function, or physiologic filling of the heart chambers, with risk of myocardial ischemia, decreased cardiac output, acute cardiac failure, ventricular arrhythmias and death. We report a case of a 29-year-old male with sudden cardiac death owing to cardiac strangulation with epicardial pacing wire that had been retained in place almost 30 years. At autopsy, an enlarged and abnormally contoured heart was found to be strangulated by an epicardial pacing wire; histopathologic examination confirmed hypertrophy of the myocardial fibers, myofiber disarrangement, and replacement-type fibrolipomatosis. In addition, this article consolidates the available literature on cardiac strangulation by an epicardial wire and highlight relevant clinical and medico-legal features for the forensic professionals.
  • Body packing and intra-vaginal body pushing of cocaine: A not-so-rare
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Simone Cappelletti, Daria Piacentino
  • Fatal varicella in immigrants from tropical countries: Case reports and
           forensic perspectives
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Gianni Guadagnini, Simone Lo Baido, Francesca Poli, Annamaria Govi, Sveva Borin, Paolo Fais, Susi Pelotti The primary Varicella Zoster Virus (VZV) infection results in varicella, a generally benign, self-limiting disease in immunocompetent children. Despite the usual course a possible fatal evolution of the primary infection is observed predominantly in immunocompromised subjects and in adults, especially emigrating from tropical regions. Two cases of fatal varicella have been investigated and discussed. Death occurred in two patients over 40 years of age, coming from South Asia and receiving chronic immunosuppressive therapy. The forensic expert must be cautious and consider all clinical records in managing fatal varicella cases, bearing in mind risk factors and pre-existing conditions such as age, geographical provenance and pathological comorbidity, which may lead to a bad prognosis irrespective of therapies. Based on the severe and fatal course observed in the reported cases, an extension of the immunization program appears advisable for immigrants from tropical countries, especially before scheduled immunotherapy.
  • Tangential cranial ballistic impact: An illustration of the limitations of
           post-mortem CT scan'
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Clémence Delteil, Pierre Gach, Noura Ben Nejma, Françoise Capasso, Pierre Perich, Pierre Massiani, Guillaume Gorincour, Marie-Dominique Piercecchi-Marti, Lucille Tuchtan Post-mortem imaging has become more frequently used in forensic procedures, notably in a ballistic context. Despite many advances in this field, the interpretation of computed tomography (CT) can be a very complex matter. Our case illustrates the difficulties of interpretation after quasi-tangential cranial ballistic impact and keyhole wounds. These wounds are difficult to visualize on CT and are among the factors complicating the precise determination of ballistics. These sources of error remind us that CT findings must be interpreted in close comparison with autopsy findings.
  • A case of transnasal intracranial penetrating injury with skull base
           fracture caused by a broken golf club shaft
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Hideaki Kato, Sanae Kanno, Jun Ohtaki, Yoshimi Nakamura, Tetsuya Horita, Mamiko Fukuta, Kazuhito Eguchi, Mohamed Hassan Gaballa, Yasuhiro AokiGraphical abstractGraphical abstract for this article
  • Suicidal shot in the mouth with rubber bullets
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Malou Guérant, Marie-Aude Vaz, Michel Peoc'h, Yvan Gaillard, Baptiste Boyer Rubber bullets weapons can have tragic consequences when used at short range and on vulnerable body areas. A man in his forties was found deceased at his house, covered in blood. A “non-lethal” firearm was found near the bed: the «SAPL GC27». This is a single shot handgun with mini Gomm Cogne ammunition: 12 rubber spherical pellets, 7.4 mm in diameter. The findings were consistent with an intra buccal shot, and an ingestion-inhalation of blood and projectiles. Cause of the death was linked to both the hemorrhage due to mouth and aero digestive crossroad trauma, responsible of a mechanical asphyxia, and blood absorption in lungs. This case insists on the deadly potential of this weapon if misused. Fortunately, the term “non-lethal” has been progressively replaced, but sometimes still can be seen, especially in gunsmith and webstores. It should be deleted to avoid confusion among inexperienced people, and at best, this weapon should be restricted to certain professions.
  • Liquid chromatography-tandem mass spectrometry detection of benzalkonium
           chloride (BZK) in a forensic autopsy case with survival for 18 days post
           BZK ingestion
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Satoko Mishima-Kimura, Kosei Yonemitsu, Yuki Ohtsu, Ako Sasao, Hiroshi Tsutsumi, Shota Furukawa, Yoko Nishitani We report a forensic autopsy case of an elderly man who ingested unknown amount of germicidal disinfectant containing 50% benzalkonium chloride (BZK). He survived for 18 days after BZK ingestion and then died because of pneumonia. A liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was used to detect three BZK compounds (C12-BZK, C14-BZK and C16-BZK) in the blood. Extraction of BZK was carried out according to a modified QuEChERS method. Chromatographic separation was achieved on an ODS column and detection was performed in selected reaction monitoring mode. The accuracy and the precision were acceptable for quantitative analysis in the concentration range of 10–200 ng/mL for the three BZK compounds. BZK was detected in heart and femoral vein blood samples even 18 days after BZK ingestion. Taking into consideration clinical information during 18 days hospitalization and the autopsy findings, the cause of death was attributed to BZK poisoning. Several toxico-kinetic factors regarding absorption and excretion of BZK in the body were also discussed to elucidate the detection of BZK such a long time after ingestion.
  • Subarachnoid hemorrhage in a Japanese cocaine abuser: Cocaine-related
           sudden death
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Mio Takayama, Brian Waters, Hiroshi Fujii, Kenji Hara, Masayuki Kashiwagi, Aya Matsusue, Natsuki Ikematsu, Shin-ichi Kubo Based on a prospective case-control study of forensic autopsies, the causes of cocaine (COC)-related sudden death (SD) are cardiovascular events in 62.0% of cases, cerebrovascular events in 14.0%, and others. A forensic autopsy of a male in his early forties revealed subarachnoid hemorrhage (SAH) at the base of the brain. A cerebral arterial aneurysm was not detected even though hemorrhage was clearly observed in the anterior cerebral artery (ACA) bifurcation area. The brain weighed 1488 g and was edematous. We histopathologically examined the left-ACA, right-ACA, and anterior communicating artery (Acom). Thickening of the internal vessel wall was observed as a pathological change. The internal elastic lamina of the right-ACA, near the peripheral part of Acom, was meandered with a jagged appearance. A toxicology examination detected COC and its metabolites, particularly benzoylecgonin, in blood and urine samples. Therefore, the present case was regarded as a non-fatal intoxication case, but also a COC-related death. Ethanol was also detected, indicating that COC was taken in combination with alcohol. The cause of COC-related death in the present case was SAH. COC use is known to induce aneurysmal SAH; however, whether an aneurysm had formed in the present case was unclear. Meander, extension, and degeneration of the internal elastic lamina of the right-ACA were observed near the bifurcation from the Acom. This area corresponded macroscopically with that considered to be the bleeding point from the blood vessel. Therefore, the present case was diagnosed as COC-related SD.Graphical abstractMeander, extension, and degeneration of the internal elastic lamina of the right anterior cerebral artery (rt-ACA) were observed near the bifurcation from the anterior communicating artery (Acom). This area corresponded macroscopically with that considered to be the bleeding point from the blood vessel.This case was diagnosed as cocaine (COC)-related sudden death.Graphical abstract for this article
  • Infant fatality case with excessive chylous ascites
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Nozomi Idota, Mami Nakamura, Misa Tojo, Hiroaki Ichioka, Kaori Shintani-Ishida, Hiroshi Ikegaya An 11-month-old boy with marked abdominal distension was found dead in the prone position at home. Since there were many bruises in the non-protruding regions of the head, face, and abdomen, a medicolegal autopsy was performed the following day. The boy was smaller than average (height: 68.5 cm; weight: 7.8 kg); his extremities were thin; and his abdomen was remarkably bulging. Chylous ascites (1600 mL) was observed in the peritoneal cavity and chylous pleural effusion (left: 5 mL; right: 10 mL) in the thoracic cavity. A fibrous induration, approximately 2.0 × 1.5 cm in size, was observed in the root of the small bowel mesentery. Congenital chylothorax and chylous ascites were suspected. However, the remarkably withered thymus and an old injury in the superior labial frenulum suggested that the chylous ascites may have been further deteriorated by injuries sustained during physical abuse. Examination suggested that the death was sudden. Thus, we inferred that the cause of death was circulatory and respiratory failure due to excessive chylous ascites. Among the reported cases of chylous ascites in pediatric patients, some patients experiencing abuse were identified on the basis of their chief complaints of vomiting or abdominal distension. Medical and child welfare staff should be made aware of this information.
  • An autopsy case of nearly complete ossification of the stylohyoid chain:
           Eagle syndrome in forensic aspect
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Hideaki Kato, Sanae Kanno, Jun Ohtaki, Yoshimi Nakamura, Katsumasa Kobayashi, Yasuhiro Aoki
  • The “Social-mobile autopsy”: The evolution of psychological autopsy
           with new technologies in forensic investigations on suicide
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): I. Aquila, M.A. Sacco, S. Gratteri, M. Sirianni, P. De Fazio, P. Ricci Suicide is a huge deal in general public health, representing the second cause of mortality in young people worldwide. The suicidal setting analysis is usually performed through psychological autopsy, a method of investigation commonly used to study what leads to suicide. Psychological autopsy, though, requires the involvement of family and friends, or the finding of a diary or a suicide note. Nowadays, this is not always possible, especially during adolescence, the more if we consider new categories of people that are more used to live in a web dimension, than in a real one. So, with the advent of a new kind of social system including the web, psychological autopsy, as we know it, is not enough to determine the setting of an event. We here report the case of a 17-year old girl who committed suicide by hanging down from her house, leaving no suicide note. We propose a new investigation method developed through the analysis of phone messages and Facebook profile in order to better reconstruct the event. Although the standing difficulties in reconsidering the intimate motivations leading to such a decision, psychological autopsy nowadays needs to consider also social networks in order to prevent similar situations and even reconstruct the psychological dimension of the fact. We propose a model of Social-mobile autopsy.Graphical abstractGraphical abstract for this article
  • Forensic parameters for 15 autosomal STRs in Mestizo population from the
           state of Guerrero (South, Mexico)
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): G.J. Locia-Aguilar, B. López-Saucedo, S. Deheza-Bautista, O.V. Salado-Beltrán, V.M. Martínez-Sevilla, H. Rangel-Villalobos Allele distribution and forensic parameters were estimated for 15 STR loci (AmpFlSTR Identifiler kit) in 251 Mexican-Mestizos from the state of Guerrero (South, Mexico). Genotype distribution was in agreement with Hardy–Weinberg expectations for all 15 STRs. Similarly, linkage disequilibrium test demonstrated no association between pair of loci. The power of exclusion and power of discrimination values were 99.999634444% and>99.99999999%, respectively. Genetic relationship analysis regarding Mestizo populations from the main geographic regions of Mexico suggests that the Center and the present South regions conform one population cluster, separated from the Southeast and Northwest regions.
  • sjTREC quantification using SYBR quantitative PCR for age estimation of
           bloodstains in a Japanese population
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Eisuke Yamanoi, Saori Uchiyama, Makoto Sakurada, Yasuhiro Ueno Individual age is a phenotypic trait that provides useful information in forensic investigations. Levels of signal joint T-cell receptor rearrangement excision circle (sjTREC) in human peripheral blood are known to decline with increasing age. The advantages of sjTREC quantification are the simple procedures and highly accurate age estimation results. Whereas TaqMan quantification PCR (qPCR) is widely used for sjTREC quantification, SYBR qPCR assay is not routinely used for evaluating ethnic data. Therefore, we focused on the advantages of the SYBR qPCR assay, which is cheaper and simpler to set up than the TaqMan probe assay. In this study, we developed a SYBR qPCR assay for sjTREC quantification from bloodstains from a Japanese population and evaluated the strength of correlation between sjTREC levels and actual age. The results were obtained from 194 individuals ranging from 18 to 81 years old, and showed a negative correlation between sjTREC level and individual age (r =  −0.786). The equation for age estimation was Age =  −6.27 dCt (CtTBP − CtsjTREC) − 25.841 with standard error ±8.0 years. Furthermore, this formula for the SYBR assay can be applied to not only fresh bloodstains, but also whole blood and bloodstains up to 1 month old. These results indicate that SYBR qPCR is an effective method for age estimation from bloodstains, and its practicality and affordability make it an attractive sjTREC quantification technique.
  • Concordance of mitochondrial DNA sequencing methods on bloodstains using
           Ion PGM™
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Lan Yao, Zhen Xu, Hemiao Zhao, Zheng Tu, Zhifang Liu, Wanshui Li, Lan Hu, Lihua Wan In this study, the complete mitochondrial genome (mtGenome) of six samples from three forensic cases was sequenced using the Ion Torrent Personal Genome Machine (PGM). The analyzed samples from forensic cases included bloodstains from several materials, such as gauze, Flinder’s Technology Associates (FTA) cards and swabs. The age of the samples ranged from two months to twelve years. The complete mtGenomes were amplified using the tiling sequencing strategy which divided the whole mtGenome into 162 amplicons. All amplicons were successfully recovered. A phylogenetic analysis was performed to determine the accuracy of the PGM data, and which were compared to partial Sanger-based sequencing data. The average coverage of the PGM data were above 4000× in all case samples, and 99.86% concordance was observed using both sequencing methods. In conclusion, we demonstrate the ability to recover the complete mtGenome from bloodstains with relatively poor DNA quality by PGM. Moreover, the results are concordant with Sanger sequencing data. This new method has potential use in forensic practice.
  • Mutation analysis of 19 commonly used short tandem repeat loci in a
           Guangdong Han population
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Cheng Xiao, Zhiyong Peng, Feilong Chen, Hui Yan, Bofeng Zhu, Yunchun Tai, Pingming Qiu, Chao Liu, Xuheng Song, Zihao Wu, Ling Chen Short tandem repeats (STRs) are the most widely used genetic markers in current forensic practice. However, STR mutations have troubled paternity test all the time. To ensure the accuracy in parentage testing, it is important to obtain population mutation data and identify factors that affect STR mutation rates. In the present study, we performed a comprehensive analysis on 322 mutation events in 19 autosomal STR loci from 12,752 meiotic events in 9,626 parentage test cases. The average mutation rate for the 19 STR loci was estimated at 1.329‰ per meiosis. Most mutations were single-step and occurred in the male germline. Further, the mutation rates increased with the paternal age at child birth, but not the maternal age. Multidimensional scaling analysis showed differences in the profiles of the mutation rates of the 13 CODIS STR loci among several different worldwide populations. Our findings also showed that locus-specific mutation rates were correlated with heterozygosity, and longer alleles have higher mutation rates than shorter alleles do. The data from our study may provide useful information for parentage testing, kinship analysis, and population genetics.
  • Chained nuclei and python pattern in skeletal muscle cells as histological
           markers for electrical injury
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Hiroki Tanaka, Katsuhiro Okuda, Seiji Ohtani, Masaru Asari, Kie Horioka, Shotaro Isozaki, Akira Hayakawa, Katsuhiro Ogawa, Shiono Hiroshi, Keiko Shimizu Electrical injury is damage caused by an electrical current passing through the body. We have previously reported that irregular stripes crossing skeletal muscle fibers (python pattern) and multiple small nuclei arranged in the longitudinal direction of the muscle fibers (chained nuclear change) are uniquely observed by histopathological analysis in the skeletal muscle tissues of patients with electrical injury. However, it remains unclear whether these phenomena are caused by the electrical current itself or by the joule heat generated by the electric current passing through the body. To clarify the causes underlying these changes, we applied electric and heat injury to the exteriorized rat soleus muscle in situ. Although both the python pattern and chained nuclear change were induced by electric injury, only the python pattern was induced by heat injury. Furthermore, a chained nuclear change was induced in the soleus muscle cells by electric current flow in physiological saline at 40 °C ex vivo, but a python pattern was not observed. When the skeletal muscle was exposed to electrical injury in cardiac-arrested rats, a python pattern was induced within 5 h after cardiac arrest, but no chained nuclear change was observed. Therefore, a chained nuclear change is induced by an electrical current alone in tissues in vital condition, whereas a python pattern is caused by joule heat, which may occur shortly after death. The degree and distribution of these skeletal muscle changes may be useful histological markers for analyzing cases of electrical injury in forensic medicine.
  • Postmortem interval estimation using the animal model of postmortem gas
           volume changes
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Chika Iwamoto, Kenoki Ohuchida, Miki Okumura, Yosuke Usumoto, Junji Kishimoto, Masaharu Murata, Noriaki Ikeda, Makoto Hashizume It is important to estimate the postmortem interval in forensic autopsy. Many methods to estimate the postmortem interval have been reported, and are typically associated with internal examination. However, there are issues such as rejection of autopsy by the family and a lack of forensic doctor in internal examination. Therefore, it is necessary to develop new methods, such as autopsy imaging, that can substitute for internal examination. Here, we first evaluated whether gas volume in the body increased with postmortem interval. Time-dependent X-ray CT imaging of euthanized Crl:CD (SD) rats (n = 3) was performed immediately after euthanasia and at seven subsequent time points up to 168 h (7 days) at 24-hour intervals. The data revealed that gas volume in the body increased in a time-dependent manner. Next, we reconstructed 3D images of isolated gas and calculated the gas volume using Amira software. In all cases, the volume of both portal venous gas and intestinal gas increased in a time-dependent manner. The volume of portal venous gas increased exponentially, while the volume of intestinal gas increased in a linearly with time. These data might be suggested that the postmortem gas volume change is one of indicators for estimating the postmortem interval. In addition, it would be possible to estimate more accurate postmortem interval by combining not only gas volume changes at the above two sites but also gas volume changes of the other sites such as heart cavities, kidney parenchyma, or abdominal aorta.
  • Comparative sensitivity and inhibitor tolerance of GlobalFiler® PCR
           Amplification and Investigator® 24plex QS kits for challenging samples
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Kyleen Elwick, Carrie Mayes, Sheree Hughes-Stamm In cases such as mass disasters or missing persons, human remains are challenging to identify as they may be fragmented, burnt, been buried, decomposed, and/or contain inhibitory substances. This study compares the performance of a relatively new STR kit in the US market (Investigator® 24plex QS kit; Qiagen) with the GlobalFiler® PCR Amplification kit (Thermo Fisher Scientific) when genotyping highly inhibited and low level DNA samples.In this study, DNA samples ranging from 1 ng to 7.8 pg were amplified to define the sensitivity of two systems. In addition, DNA (1 ng and 0.1 ng input amounts) was spiked with various concentrations of five inhibitors common to human remains (humic acid, melanin, hematin, collagen, calcium). Furthermore, bone (N = 5) and tissue samples from decomposed human remains (N = 6) were used as mock casework samples for comparative analysis with both STR kits.The data suggest that the GlobalFiler® kit may be slightly more sensitive than the Investigator® kit. On average STR profiles appeared to be more balanced and average peak heights were higher when using the GlobalFiler® kit. However, the data also show that the Investigator® kit may be more tolerant to common PCR inhibitors. While both STR kits showed a decrease in alleles as the inhibitor concentration increased, more complete profiles were obtained when the Investigator® kit was used.Of the 11 bone and decomposed tissue samples tested, 8 resulted in more complete and balanced STR profiles when amplified with the GlobalFiler® kit.
  • A simple method for calculating the likelihood ratio in a kinship test
           using X-chromosomal markers incorporating linkage, linkage disequilibrium,
           and mutation
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Mamiko Fukuta, Mohammed Hassan Gaballah, Hideaki Kato, Yasuhiro Aoki X-chromosomal short tandem repeats (X-STRs) are useful for personal identification and kinship tests. However, it has not yet been fully established how to incorporate linkage and linkage disequilibrium (LD) into the calculation of the likelihood ratio (LR). In this paper, we describe a simple calculation method of LR for X-STRs that incorporated linkage, LD, and mutations. Initially, Japanese population data of 27 X-STRs (DXS6807, DXS9902, DXS6795, DXS6810, DXS10076, DXS10077, DXS10078, DXS10162, DXS10163, DXS10164, DXS7132, DXS981, DXS6800, DXS6803, DXS6809, DXS6789, DXS6799, DXS7424, DXS101, DXS7133, GATA172D05, DXS10103, HPRTB, GATA31E08, DXS8377, DXS10147, and DXS7423) were collected from 748 unrelated individuals to estimate the influence of LD. Significant LD was observed on six pairs of loci. Subsequently, using the population data, a simulation study was performed to evaluate the validity of the present calculation method for LR in cases of father-daughter, full-sisters, paternal half-sisters, maternal half-sisters, and unrelated pairs of females (FD, FS, PHS, MHS, and UR, respectively). As a result, the distribution of LR among FD was completely separated from that among UR. In the sibship test, 98.6% of FS and 98.0% of PHS surpassed the maximum value of UR in combined LR. Even in the FS versus MHS setting, 60.5% of FS had a higher LR than any MHS. We conclude that the present model is powerful in discriminating the relationship and is able to obtain a reasonable LR with fewer computations.
  • Determining the number of contributors to DNA mixtures in the low-template
           regime: Exploring the impacts of sampling and detection effects
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Sarah Norsworthy, Desmond S. Lun, Catherine M. Grgicak The interpretation of DNA evidence may rely upon the assumption that the forensic short tandem repeat (STR) profile is composed of multiple genotypes, or partial genotypes, originating from n contributors. In cases where the number of contributors (NOC) is in dispute, it may be justifiable to compute likelihood ratios that utilize different NOC parameters in the numerator and denominator, or present different likelihoods separately. Therefore, in this work, we evaluate the impact of allele dropout on estimating the NOC for simulated mixtures with up to six contributors in the presence or absence of a major contributor. These simulations demonstrate that in the presence of dropout, or with the application of an analytical threshold (AT), estimating the NOC using counting methods was unreliable for mixtures containing one or more minor contributors present at low levels. The number of misidentifications was only slightly reduced when we expand the number of STR loci from 16 to 21. In many of the simulations tested herein, the minimum and actual NOC differed by more than two, suggesting that low-template, high-order mixtures with allele counts fewer than six may be originating from as many as four-, five-, or six-persons. Thus, there is justification for the use of differing or multiple assumptions on the NOC when computing the weight of DNA evidence for low-template mixtures, particularly when the peak heights are in the vicinity of the signal threshold or allele counting methods are the mechanism by which the NOC is assessed.
  • Use of postmortem computed tomography to retrieve small metal fragments
           derived from a weapon in the bodies of victims in two homicide cases
    • Abstract: Publication date: May 2018Source: Legal Medicine, Volume 32Author(s): Rie Sano, Yoichiro Takahashi, Akira Hayakawa, Masayuki Murayama, Rieko Kubo, Satoshi Hirasawa, Hiroyuki Tokue, Takehiro Shimada, Sachiko Awata, Hiroyuki Takei, Masahiro Yuasa, Shinji Uetake, Hisashi Akuzawa, Yoshihiko Kominato Postmortem computed tomography (PMCT) is becoming a commonly used modality in routine forensic investigation. Mechanical injuries including lacerations, incisions, stab wounds and gunshot wounds frequently contain foreign bodies that may have significant value as clues in criminal investigations. CT is a sensitive modality for detection of metal foreign bodies that may be associated with injuries to the victim in cases of homicide or traffic accidents. Here we report two cases in which PMCT was able to act as a guide to forensic pathologists for retrieval of metal fragments in the corpses of the victims, the retrieved fragments then being used to validate the confessions of the assailants through comparison with the knife and the crowbar, respectively, that had been used in the crimes. In these cases, the small metal fragments retrieved from the corpses of the victims with the aid of PMCT were decisive pieces of evidence confirming the circumstances of the crimes. These cases illustrate how PMCT can be used to complement the findings of classical autopsy for integrative investigation of corpses with injury.
School of Mathematical and Computer Sciences
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