International Journal of Legal Medicine最新文献

Acrolein, a polyamine produced from spermine during brain infarction, has recently been used in clinical settings for brain infarction risk assessment. However, few studies have investigated the diagnostic usefulness of acrolein measurement in postmortem specimens. In this study, we measured the acrolein concentration in postmortem specimens to assess its potential as a marker for stroke diagnosis. Acrolein concentrations in the serum and urine were measured using an enzyme-linked immunosorbent assay in 25, 19, 21, and 93 brain infarction, subarachnoid hemorrhage, cerebral hemorrhage, and control cases, respectively. No correlations or significant differences were observed between the acrolein concentrations in blood or urine, age, time since death, or sex. However, the serum acrolein concentrations increased significantly in cases of brain infarction, subarachnoid hemorrhage, and cerebral hemorrhage compared with non-stroke cases, with diagnostic cutoff values of 117.1, 119.9, and 130.3 nmol/mL, respectively. Conversely, the urinary acrolein concentrations decreased in specimens from subarachnoid hemorrhage and cerebral hemorrhage cases, suggesting dilution due to higher urine volumes. In conclusion, our findings suggest that serum acrolein concentration remains unaffected by the time elapsed after death. Moreover, the measurement of serum acrolein in postmortem specimens is effective in diagnosing stroke.

Globally, thousands of truck occupants die annually from motor vehicle incidents. During medico-legal investigations of such incidents, forensic practitioners are required to undertake thorough examinations of the injuries present. Despite this, very few studies assessing skeletal fractures in particular, in deceased truck occupants are currently available in the literature for practitioners. Consequently, this research aimed to investigate the whole-body skeletal fracture patterns resulting from fatal truck incidents. The study group comprised 62 adult truck occupants who died in motor vehicle incidents between 2006 and 2020 and were examined at the Victorian Institute of Forensic Medicine, Australia, and the East Midlands Forensic Pathology Unit, United Kingdom. Available intrinsic and extrinsic variable information was extracted from medico-legal reports and fracture patterns were documented using associated post-mortem computed tomography scans. Descriptive and basic inferential statistics were performed to analyse the pattern and extent of fracturing, and where possible, the role of variables. The study found 97% of occupants exhibited skeletal blunt force trauma, with 94% fracturing multiple anatomical regions. The thorax (85%), followed by the skull (63%) and cervical vertebrae (56%) comprised the most fractured and fragmented skeletal regions, whilst the upper limb (23%) and pelvic girdle (31%) were fractured least often. The variables body mass index, impact velocity and truck type were associated with fracture patterning. This research provides medico-legal investigators with a greater evidence base of the fracture patterns that result from fatal truck incidents, including the patterning, complexity and quantity of fracturing, and the potential mechanisms behind them.

Introduction: This study aimed to assess students' knowledge, awareness, and attitudes regarding forensic-medicine concepts taught during a Medicine and Surgery degree program at eight Italian universities. Additionally, the study aimed to evaluate the impact of the course on students' knowledge and attitudes toward choosing medical residency.

Materials and methods: A cross-sectional study was conducted through an anonymous web-based survey of medical students at eight italian universities. Descriptive, univariate, and logistic regression analyses were performed for the selected questions.

Results: The survey was completed by 1022 students. Forensic medicine appears to be important for providing training in the fundamental concepts of forensic medicine, especially professional liability, defensive medicine, and forensic pathology. The descriptive and univariate analyses demonstrate that the course can assist students in choosing their specialisation school. The multivariate analysis highlighted the impact of the forensic medicine course on orienting students' choice of medical residency, increasing it by nine times after attending the course. In the logistic regression analysis of the influence of medical liability on the choice of medical residency, students recognised a doubled effect after attending the course. Finally, the perceived usefulness of the course was significantly higher after attendance.

Conclusions: Forensic medicine courses have the task of defining the duties and responsibilities of forensic physicians, providing indispensable tools for future medical practitioners regardless of their future specialisation, and limiting the increasing use of defensive medicine. In conclusion, it is imperative for governments to implement measures directed at diminishing the risk of burnout arising from the ongoing pressure associated with the fear of medicolegal litigation, encompassing both criminal and civil contexts.

This article evaluates the criteria for diatom testing in forensic investigations, focusing on drowning cases. Diatoms, unicellular algae found in aquatic environments, are critical to the determination of drowning because water containing diatoms is inhaled during submersion. The primary objectives include defining the exact amount and type of tissue to be analyzed, expressed in terms of diatom concentration relative to tissue weight, and detailing the conditions under which water samples are collected to study the diatom flora at the site. In addition, the importance of accurately identifying diatom taxa and comparing them by unit weight is emphasized. To improve the reliability of diatom testing, the study discusses advanced methods such as microwave digestion, vacuum filtration, and automated scanning electron microscopy (MD-VF-Auto SEM), which offer higher sensitivity and specificity. The integration of DNA sequencing and deep learning techniques is explored, offering promising improvements in diatom detection and classification. These advances aim to reduce false positives and improve the accuracy of determining drowning as the cause of death. The article highlights the need for standardized protocols for diatom testing to ensure consistency and reliability. By incorporating new technologies and refining existing methods, the forensic application of diatom testing can be significantly improved, allowing for more accurate and reliable conclusions in drowning investigations.

Estimation of the age of epidural hematoma (EDH) is a challenge in clinical forensic medicine, and this issue has yet to be conclusively resolved. The advantages of objectivity and non-invasiveness make computing tomography (CT) imaging an potential diagnostic method for EDH in living individuals. Recently, radiomics, the extraction hidden information from medical images, has emerged as a promising method for constructing predictive models. The aim of this study is to explore the feasibility and applicability of CT-based radiomics in predicting the timing of EDH injuries in surviving victims. A cohort of 95 EDH cases with definite injured time (within 12 h since injury) was selected. Clinical characteristics (age, gender, injury time, bleeding location, bleeding volume, and fracture) were recorded. The datasets were divided randomly into training and test cohorts. LIFEx software was used to segment the hematoma area in the CT and extract radiomic features. Machine learning algorithms were applied for features selection and model building. Twenty-three features were selected to calculate the Radscore, a key metric in our analysis. Utilizing this Radscore in conjunction with the time since injury, we constructed an Ordinary Least Squared (OLS) model. Our validation study has shown that mean absolute error (MAE) of the test cohort was 2.42 h, indicating a high degree of accuracy. In order to enhance the accuracy of prediction, the dataset was divided into unstable phase, occurring within the first 5 h post injury, and the stable phases. The Random Forest algorithm presented a significant divergence in predictive performance between the two phases, achieving an area under the curve (AUC) of 0.79, with an accuracy of 75.86%. The MAE of the regression model was 1.05 h for the unstable phase, and 1.23 h for the stable phase. Our findings underscore the potential of CT-based radiomics to offer a novel, convenient, and efficient approach to dating EDH, promising to illuminate new avenues in the field of medical diagnostics.

Identification of human remains is a challenge in forensic genetics without relatives or personal items available. In Slovenia, a Konfin II mass grave from the Second World War (WWII) was found, containing skeletal remains of 65 victims. The archival documents detailing victims' information describe 45 persons of which 33 could be considered Germanic and 12 Slavic. This study aims to check for concordance between the victim list and actual victims found by using uniparental markers to differentiate between Slavic and non-Slavic origin by attempting to infer ancestry by analyzing the control region (CR) of mitochondrial DNA (mtDNA) and Y-chromosomal STRs. Diaphyses of femurs were used as a DNA source. Next Generation Sequencing (NGS) technology was used for mtDNA- namely HID Ion Chef™ Instrument, Precision ID mtDNA Control Region Panel, and Ion GeneStudio™ S5 System. For the Y-chromosome, PowerPlex^® Y23 System (Promega) kit and SeqStudio™ for human identification (HID) were used. European DNA Profiling mtDNA Population Database (EMPOP) and Y-Chromosome STR Haplotype Reference Database (YHRD) were searched for haplotype matches. Closest haplogroups were predicted using EMPOP, Y-DNA Haplogroup Predictor- NevGen, and Whit Athey's Haplogroup Predictor. Despite mitotypes being more diverse than Y-haplotypes, the Y-haplotypes had more database matches and more unequivocal differentiation between populations. 16 victims could be considered Slavic, 15 non-Slavic, and the remaining 34 had a rather scarce informativeness- either unclear or not providing any match. To address ancestry inference more comprehensively, analysis of autosomal ancestry informative markers as well as expansion on haploid markers will be conducted in future research.

Applying existing sexing methodologies to different populations, and reporting these findings is important to enhance their applicability and accuracy in real cases across the world. DSP was published in 2005 (Murail et al., 2005) and updated as a DSP2 in 2017 (Brůžek et al., 2017) based on a database of 10 pelvic measurements from 2040 individuals worldwide. These tools have been applied subsequently to various populations, however, its applicability to a dry Spanish population is lacking. 303 hipbones belonging to 157 individuals from the School of Legal Medicine from the University Complutense of Madrid (Spain), of which 140 individuals were documented, were analyzed to investigate the reliability, applicability and accuracy of the DSP2 sex estimation methodology, examining side and sex-based potential differences for the first time. In most of the DSP variables, intra-rater reliability showed excellent results and % applicability was higher than 85.0%. Overall % accuracy was higher than 94.0% regardless of the number or discriminant power of the utilized DSP variables. However, % sexing decreased when less variables or less discriminant ones were used for estimations, reaching 45.51% (left) and 43.31% (right). Regarding sexual dimorphism, females' results of % applicability, % sexing and % accuracy were higher compared to males. In addition, left os coxae achieved better outcomes (aforementioned percentages) in most of the cases in the sex-pooled sample. Decreasing the mandatory posterior probability by 10% yielded an increase in the % sexing but reduced % accuracy, and thus, does not seem to enhance the approach's performance. The present study validates the applicability and reliability of DSP for sexing a Spanish population. Future investigations will attempt to assess its applicability within virtual anthropology.

Autoerotic deaths, defined as accidental fatalities occurring during solitary sexual activities, show complex forensic challenges due to their different mechanisms and variable death scene presentations. This study combines a systematic review of global literature spanning 44 years (from 1980 to 2024) with a detailed case series analysis from the Legal Medicine Institutes of Bologna and Milan, Italy, to provide comprehensive insights into this phenomenon.The systematic review identified 67 relevant reports from databases namely Scopus, Web of Science, and PubMed. In parallel, a case series of 7 autoerotic fatalities was analyzed, highlighting victims' demographics, causes of death, and associated factors.Findings from 101 cases of autoerotic deaths included in the systematic review indicate a predominant prevalence of asphyxial deaths, with hanging being the most common method, followed by intoxication. The study underscores significant gender disparities, with men comprising most cases (n = 91), spanning a broader age range (12-87 y.o.) compared to women (17-48 y.o.). The findings are fully consistent with the Italian case series presented here, in which all the subjects were men aged 18 to 72 years, and the cause of death was asphyxia in 6 cases.Toxicological analyses played a crucial role in elucidating the cause and manner of death in most cases, yet their utilization varies widely, impacting data reliability and evaluation of the cause of death. Notably, the evidence of volatile substances, especially inhalants, creates an emerging area of interest with potential epidemiological and preventive implications. The systematic analysis revealed substantial variability in death scene characteristics and forensic procedures, emphasizing the need for standardized investigative protocols.This study highlights the multifaceted nature of autoerotic deaths and the importance of a holistic forensic approach encompassing death scene investigation, autopsy, and toxicological analysis. By enhancing the understanding and awareness about this phenomenon, this research aims to inform evidence-based practices in forensics, mitigate diagnostic uncertainties, and facilitate preventive interventions.

Massively parallel sequencing (MPS) overcomes many PCR-CE limitations to analyze STRs and allow simultaneous inclusion of SNPs in forensic cases. By MPS, the ForenSeq™ DNA Signature Prep kit analyzes 27 aSTRs, 7 X-STRs, 24Y-STRs, and 94 identity-informative SNPs (iiSNPs) with the DNA Primer Set-A (DPS-A). Optionally, the DNA Primer Set-B (DPS-B) adds to the analysis 56 ancestry-informative SNPs (aiSNPs) and 24 phenotype-informative SNPs (piSNPs), but diminishes from 96 to 32 the number of samples per sequencing run. We assessed the forensic informativity provided by the loci analyzed by these two DPS in admixed individuals from Mexico City (Center, Mexico). For STRs, we report length-based (LB) and sequence-based (SB) allele frequencies and forensic parameters of the 152 identity informative markers (DPS-A). For aSTRs, the combined PD of SB genotypes (PD ~ 100%) was ~ 2949 times larger than that from LB. Conversely, the observed phenotype distribution offered low PD levels (PD = 6.6% and 10.4%), whereas piSNPs predicted accurately only the modal brown eye and dark hair colors, respectively. Similarly, aiSNPs detected a large prevalence of admixed individuals (97.3%; PD = 5.4%). Although few individuals were inferred as Europeans and Native Americans (1.37% each), they were self-declared as admixed, which result confusing for HID purposes. In brief, SB genotypes increased significantly the informativity of STRs to solve complex cases (DPS-A), whereas aiSNPs and piSNPs added mostly irrelevant information (DPS-B). We provide useful cost-benefit criteria in one Latin American population to choose DPS-A (96 samples) instead of DPS-B (32 samples) of the Forenseq kit.