In forensic anthropology, skeletal structures play an important role in sex identification. The cranium and pelvis bones provide a higher accuracy rate in identification in terms of sexual dimorphism. The calvaria, which is a part of the cranium, is an important structure in terms of sex identification because it shows sex-related differences in shape, structure, and size. This study aims to estimate sex with deep learning (DL) models based on calvaria photographs. In the study, calvaria photographs of autopsied cases over the age of 18 were analyzed. We analyzed 210 photographs of the inner (endocranial) surface (105 male, 105 female) and 310 photographs of the outer (ectocranial) surface (155 male, 155 female). Calvaria photographs were trained and tested with Support Vector Machine (SVM) and K-Nearest Neighbor (K-NN) algorithms using attributes obtained with the ResNet50 DL model. As a result, the highest success rate for sex estimation from endocranial photographs was 96.43% with Fine K-NN, while the most successful model for estimation from ectocranial photographs was Cubic SVM with 96.77% accuracy. Successful results were obtained in the sex estimation study performed with DL models directly from calvaria photographs without morphometric measurements. Future studies are needed to improve the performance of DL models.
{"title":"Sex estimation from human calvarial bone photographs with deep learning approach","authors":"Sefa Sonmez , Omer Faruk Nasip , Ahmet Depreli , Merve Nur Ozgen , Berna Dogan , Sadik Bugrahan Simsek , Caner Beskoc","doi":"10.1016/j.jflm.2026.103070","DOIUrl":"10.1016/j.jflm.2026.103070","url":null,"abstract":"<div><div>In forensic anthropology, skeletal structures play an important role in sex identification. The cranium and pelvis bones provide a higher accuracy rate in identification in terms of sexual dimorphism. The calvaria, which is a part of the cranium, is an important structure in terms of sex identification because it shows sex-related differences in shape, structure, and size. This study aims to estimate sex with deep learning (DL) models based on calvaria photographs. In the study, calvaria photographs of autopsied cases over the age of 18 were analyzed. We analyzed 210 photographs of the inner (endocranial) surface (105 male, 105 female) and 310 photographs of the outer (ectocranial) surface (155 male, 155 female). Calvaria photographs were trained and tested with Support Vector Machine (SVM) and K-Nearest Neighbor (K-NN) algorithms using attributes obtained with the ResNet50 DL model. As a result, the highest success rate for sex estimation from endocranial photographs was 96.43% with Fine K-NN, while the most successful model for estimation from ectocranial photographs was Cubic SVM with 96.77% accuracy. Successful results were obtained in the sex estimation study performed with DL models directly from calvaria photographs without morphometric measurements. Future studies are needed to improve the performance of DL models.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103070"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-30DOI: 10.1016/j.jflm.2025.103060
Varun Modgil , Yogender S. Bansal , Nirmal Nagar
Introduction
Ventriculoperitoneal (VP) shunt is a surgical procedure done for hydrocephalus, usually during childhood. Unfortunately, in some cases shunt failure occurs either due to obstruction or disconnection. In rare cases, sudden death can happen due to cerebral edema caused by shunt failure.
Case presentation
We report a rare case of 32-year-old Indian male, who died suddenly. An autopsy revealed obstruction of the left VP shunt, and disconnection of the right VP shunt device just near the burr hole. Both shunt procedures were done in his childhood for obstructive hydrocephalus. Death was attributed to acute diffuse cerebral edema with brain herniation.
Discussion
VP shunt failure can arise from tissue overgrowth, fibrosis, or mechanical disconnection, all of which may impair CSF drainage and increase intracranial pressure. Severe unilateral hypoplasia of the transverse and sigmoid venous sinuses is a very rare congenital anomaly that can cause hydrocephalus in early childhood. Careful postmortem examination of the shunt system, including patency, positioning, and connection integrity, is essential in such cases to establish the cause of death.
Conclusion
This case illustrates the fatal potential of VP shunt failure. Regular monitoring and long-term follow-up in patients with VP shunts are critical. A thorough forensic autopsy is essential to confirm shunt failure, establish the precise cause of death, and provide valuable insights to prevent similar fatal outcomes in clinical practice. The findings of this case also serve as a useful reference for forensic pathologists when diagnosing rare deaths associated with VP shunt failure.
{"title":"Sudden death due to ventriculoperitoneal shunt dysfunction: A case report","authors":"Varun Modgil , Yogender S. Bansal , Nirmal Nagar","doi":"10.1016/j.jflm.2025.103060","DOIUrl":"10.1016/j.jflm.2025.103060","url":null,"abstract":"<div><h3>Introduction</h3><div>Ventriculoperitoneal (VP) shunt is a surgical procedure done for hydrocephalus, usually during childhood. Unfortunately, in some cases shunt failure occurs either due to obstruction or disconnection. In rare cases, sudden death can happen due to cerebral edema caused by shunt failure.</div></div><div><h3>Case presentation</h3><div>We report a rare case of 32-year-old Indian male, who died suddenly. An autopsy revealed obstruction of the left VP shunt, and disconnection of the right VP shunt device just near the burr hole. Both shunt procedures were done in his childhood for obstructive hydrocephalus. Death was attributed to acute diffuse cerebral edema with brain herniation.</div></div><div><h3>Discussion</h3><div>VP shunt failure can arise from tissue overgrowth, fibrosis, or mechanical disconnection, all of which may impair CSF drainage and increase intracranial pressure. Severe unilateral hypoplasia of the transverse and sigmoid venous sinuses is a very rare congenital anomaly that can cause hydrocephalus in early childhood. Careful postmortem examination of the shunt system, including patency, positioning, and connection integrity, is essential in such cases to establish the cause of death.</div></div><div><h3>Conclusion</h3><div>This case illustrates the fatal potential of VP shunt failure. Regular monitoring and long-term follow-up in patients with VP shunts are critical. A thorough forensic autopsy is essential to confirm shunt failure, establish the precise cause of death, and provide valuable insights to prevent similar fatal outcomes in clinical practice. The findings of this case also serve as a useful reference for forensic pathologists when diagnosing rare deaths associated with VP shunt failure.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103060"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aims to investigate whether a relationship exists between craniofacial structures and bite marks, thereby enabling the prediction of facial type based on bite mark characteristics.
Materials and methods
Thirty-eight volunteers (aged 19–25) without orthodontic treatment, craniofacial anomalies, or temporomandibular dysfunction participated. Bite marks were created on wax-covered sponge rollers. Intercanine distance, arch depth, and arch length were measured from wax models using a caliper and from intraoral scans using the iTero Scanner. Facial profile photographs were analyzed using GIMP software to calculate FH/GoMe angle and LFH/TFH ratio (Lower face height/Total face height). Statistical analyses included intraclass correlation, Wilcoxon and paired t-tests, and Spearman's correlation (p < 0.05).
Results
Significant differences were found between wax and digital measurements except for arch lenght. FH/GoMe angle correlated with upper and lower wax arch lengths, and LFH/TFH ratio correlated with lower arch length. No correlation was found between the facial type parameters and intercanine and arch depth measurements.
Conclusion
Although distortion may influence wax impressions, the correlations observed suggest that certain bite mark metrics—particularly lower arch length—may provide morphologic indicators of facial phenotype. These findings are preliminary and not intended for individual identification; larger, diverse samples are needed to validate their forensic relevance.
{"title":"From bite marks to vertical facial phenotype: Investigating the relationship between craniofacial and dental arch parameters using conventional wax and digital models","authors":"Elis Dayan , Merve Kurnaz , Özgür Önder Kuşçu , Sibel Biren , Elif Sepet","doi":"10.1016/j.jflm.2026.103078","DOIUrl":"10.1016/j.jflm.2026.103078","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to investigate whether a relationship exists between craniofacial structures and bite marks, thereby enabling the prediction of facial type based on bite mark characteristics.</div></div><div><h3>Materials and methods</h3><div>Thirty-eight volunteers (aged 19–25) without orthodontic treatment, craniofacial anomalies, or temporomandibular dysfunction participated. Bite marks were created on wax-covered sponge rollers. Intercanine distance, arch depth, and arch length were measured from wax models using a caliper and from intraoral scans using the iTero Scanner. Facial profile photographs were analyzed using GIMP software to calculate FH/GoMe angle and LFH/TFH ratio (Lower face height/Total face height). Statistical analyses included intraclass correlation, Wilcoxon and paired t-tests, and Spearman's correlation (p < 0.05).</div></div><div><h3>Results</h3><div>Significant differences were found between wax and digital measurements except for arch lenght. FH/GoMe angle correlated with upper and lower wax arch lengths, and LFH/TFH ratio correlated with lower arch length. No correlation was found between the facial type parameters and intercanine and arch depth measurements.</div></div><div><h3>Conclusion</h3><div>Although distortion may influence wax impressions, the correlations observed suggest that certain bite mark metrics—particularly lower arch length—may provide morphologic indicators of facial phenotype. These findings are preliminary and not intended for individual identification; larger, diverse samples are needed to validate their forensic relevance.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103078"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-03DOI: 10.1016/j.jflm.2026.103069
Richard Cherehani Kashindye , Divya Yadav , Rakesh Yadav
Background
Isotonitazene, a highly potent synthetic opioid, has become a major public health issue due to its potency, and it can lead to fatal overdoses, even at low concentrations. A total of 80 people who died from isotonitazene have been reported. Its rapid rise in popularity has presented unique challenges for forensic toxicology laboratories tasked with identifying and quantifying it in biological and non-biological samples due to its low dose, its analogues, lack of reference standard, and matrix effects. As a result, forensic laboratories are continually working to develop and refine analytical techniques. Therefore, a referenced compilation of previously published analytical techniques on isotonitazene for sample preparation, detection, and quantification would be useful.
Methods
PubMed and Scopus databases were searched using keywords related to isotonitazene and new synthetic opioids. English-language articles published between November 2019 and April 2025 were included, along with reports from international organizations like the United Nations Office on Drugs and Crime (UNODC), European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), and World Health Organization (WHO).
Results
Isotonitazene is characterized and described in terms of synthesis, physical and chemical properties, available forms, pharmacokinetics, pharmacodynamics, medical use, toxic effects, production, distribution, and trafficking. This article also outlines sample preparation and analytical techniques for identifying and quantifying isotonitazene in both biological and non-biological samples. Lastly, the treatment of synthetic opioid overdoses is discussed.
Conclusions
This review offers forensic scientists, public health authorities, law enforcement, and toxicologists up-to-date data on detecting and quantifying isotonitazene in various biological and non-biological matrices.
{"title":"Unraveling isotonitazene: Insights into chemistry, pharmacology, and analytical techniques in forensic toxicology","authors":"Richard Cherehani Kashindye , Divya Yadav , Rakesh Yadav","doi":"10.1016/j.jflm.2026.103069","DOIUrl":"10.1016/j.jflm.2026.103069","url":null,"abstract":"<div><h3>Background</h3><div>Isotonitazene, a highly potent synthetic opioid, has become a major public health issue due to its potency, and it can lead to fatal overdoses, even at low concentrations. A total of 80 people who died from isotonitazene have been reported. Its rapid rise in popularity has presented unique challenges for forensic toxicology laboratories tasked with identifying and quantifying it in biological and non-biological samples due to its low dose, its analogues, lack of reference standard, and matrix effects. As a result, forensic laboratories are continually working to develop and refine analytical techniques. Therefore, a referenced compilation of previously published analytical techniques on isotonitazene for sample preparation, detection, and quantification would be useful.</div></div><div><h3>Methods</h3><div>PubMed and Scopus databases were searched using keywords related to isotonitazene and new synthetic opioids. English-language articles published between November 2019 and April 2025 were included, along with reports from international organizations like the United Nations Office on Drugs and Crime (UNODC), European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), and World Health Organization (WHO).</div></div><div><h3>Results</h3><div>Isotonitazene is characterized and described in terms of synthesis, physical and chemical properties, available forms, pharmacokinetics, pharmacodynamics, medical use, toxic effects, production, distribution, and trafficking. This article also outlines sample preparation and analytical techniques for identifying and quantifying isotonitazene in both biological and non-biological samples. Lastly, the treatment of synthetic opioid overdoses is discussed.</div></div><div><h3>Conclusions</h3><div>This review offers forensic scientists, public health authorities, law enforcement, and toxicologists up-to-date data on detecting and quantifying isotonitazene in various biological and non-biological matrices.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103069"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-02-03DOI: 10.1016/j.jflm.2026.103087
Titus Oloruntoba Ebo , Kemi Ipinmoye , Oluwatosin Timothy Taiwo , Dolapo Mary Ebo , Eghosasere Egbon , David B. Olawade
End-of-life (EOL) care for patients with serious mental illness (SMI) in forensic mental health settings remains a critical yet underexplored area of healthcare. Individuals with SMI experience significant health disparities, including reduced life expectancy due to preventable chronic illnesses. These challenges are compounded in forensic settings by legal constraints, systemic neglect, and limited access to palliative care services. This narrative review examines the unique barriers to EOL care in forensic psychiatric institutions. Key issues explored include diagnostic overshadowing, restricted patient autonomy, and the absence of integrated palliative care models. Additionally, ethical and legal dilemmas, such as involuntary treatment and advance care planning (ACP), are analysed in the context of forensic mental health. Best practices for improving EOL care in forensic psychiatric settings include the integration of multidisciplinary palliative care teams, trauma-informed approaches, and the development of hospice and alternative care models. Policy and systemic recommendations highlight the need for early palliative care consultations, legal reforms that balance patient rights with public safety, and enhanced staff training in EOL care competencies. Despite these proposed interventions, significant gaps remain in research, particularly in evaluating the effectiveness of palliative interventions in forensic settings. Addressing these gaps is crucial to ensuring forensic psychiatric patients receive compassionate, dignified, and ethically sound EOL care.
{"title":"End-of-life care for forensic psychiatric patients: Ethical, legal, and systemic challenges in integrating palliative approaches","authors":"Titus Oloruntoba Ebo , Kemi Ipinmoye , Oluwatosin Timothy Taiwo , Dolapo Mary Ebo , Eghosasere Egbon , David B. Olawade","doi":"10.1016/j.jflm.2026.103087","DOIUrl":"10.1016/j.jflm.2026.103087","url":null,"abstract":"<div><div>End-of-life (EOL) care for patients with serious mental illness (SMI) in forensic mental health settings remains a critical yet underexplored area of healthcare. Individuals with SMI experience significant health disparities, including reduced life expectancy due to preventable chronic illnesses. These challenges are compounded in forensic settings by legal constraints, systemic neglect, and limited access to palliative care services. This narrative review examines the unique barriers to EOL care in forensic psychiatric institutions. Key issues explored include diagnostic overshadowing, restricted patient autonomy, and the absence of integrated palliative care models. Additionally, ethical and legal dilemmas, such as involuntary treatment and advance care planning (ACP), are analysed in the context of forensic mental health. Best practices for improving EOL care in forensic psychiatric settings include the integration of multidisciplinary palliative care teams, trauma-informed approaches, and the development of hospice and alternative care models. Policy and systemic recommendations highlight the need for early palliative care consultations, legal reforms that balance patient rights with public safety, and enhanced staff training in EOL care competencies. Despite these proposed interventions, significant gaps remain in research, particularly in evaluating the effectiveness of palliative interventions in forensic settings. Addressing these gaps is crucial to ensuring forensic psychiatric patients receive compassionate, dignified, and ethically sound EOL care.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103087"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-08DOI: 10.1016/j.jflm.2026.103075
Myrsini Voulgari , Ioanna Anastopoulou , Elena Kranioti , Christina Papageorgopoulou , Konstantinos Moraitis
The methods for reassociating and sequencing the thoracic vertebrae are based mainly on the morphological characteristics of the bones and the expertise of the forensic anthropologist. However, the thoracic vertebrae T2-T9 show no morphological differences, and therefore, it is challenging to reassociate and sequence them, especially in cases of commingling or extensive trauma. The aim of this study was to develop a new method based on the integration of 3D geometric morphometric analysis from 3D models to provide accurate results regarding the sequencing of the thoracic vertebrae. The sample consisted of 98 individuals from three different skeletal assemblages from various contexts of Greece and was scanned with a handheld 3D scanner. A total of 28 landmarks were placed on the 3D models of the vertebrae. The shape of each vertebra was compared to a reference sample. The identification rates showed that T2 had the highest identification rates and T6 the lowest. Each vertebra was matched to its anatomical counterpart within the first three possible selections of the reference skeleton, in a percentage greater than 67% and in most cases, more than 81%. On the contrary, T6 had a rate lower than 50%. It is proposed that the presented method be examined in other samples to see its application as a tool for sequencing the typical thoracic vertebrae.
{"title":"A novel landmark-based morphometric approach for sequencing typical thoracic vertebrae","authors":"Myrsini Voulgari , Ioanna Anastopoulou , Elena Kranioti , Christina Papageorgopoulou , Konstantinos Moraitis","doi":"10.1016/j.jflm.2026.103075","DOIUrl":"10.1016/j.jflm.2026.103075","url":null,"abstract":"<div><div>The methods for reassociating and sequencing the thoracic vertebrae are based mainly on the morphological characteristics of the bones and the expertise of the forensic anthropologist. However, the thoracic vertebrae T2-T9 show no morphological differences, and therefore, it is challenging to reassociate and sequence them, especially in cases of commingling or extensive trauma. The aim of this study was to develop a new method based on the integration of 3D geometric morphometric analysis from 3D models to provide accurate results regarding the sequencing of the thoracic vertebrae. The sample consisted of 98 individuals from three different skeletal assemblages from various contexts of Greece and was scanned with a handheld 3D scanner. A total of 28 landmarks were placed on the 3D models of the vertebrae. The shape of each vertebra was compared to a reference sample. The identification rates showed that T2 had the highest identification rates and T6 the lowest. Each vertebra was matched to its anatomical counterpart within the first three possible selections of the reference skeleton, in a percentage greater than 67% and in most cases, more than 81%. On the contrary, T6 had a rate lower than 50%. It is proposed that the presented method be examined in other samples to see its application as a tool for sequencing the typical thoracic vertebrae.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103075"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-08DOI: 10.1016/j.jflm.2026.103079
Florent Ferrer , Damien Richard , Nicolas Authier , Nicolas Kerckhove , Bruno Pereira , Vincent Lopez , Frédéric Abriat , Baptiste Boyer , Célian Bertin
{"title":"Psychoactive substances in a general forensic autopsy population: prevalence and associations with cause and manner of death","authors":"Florent Ferrer , Damien Richard , Nicolas Authier , Nicolas Kerckhove , Bruno Pereira , Vincent Lopez , Frédéric Abriat , Baptiste Boyer , Célian Bertin","doi":"10.1016/j.jflm.2026.103079","DOIUrl":"10.1016/j.jflm.2026.103079","url":null,"abstract":"","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103079"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The objective of this study was to investigate whether linear, angular, and area measurements derived from lateral cephalometric radiographs can serve as an additional method for determining sex in a sample of Greek population.
Materials and methods
The study sample comprised digital lateral cephalometric radiographs from 150 Greek individuals aged 18–65 years, who sought orthodontic treatment at the School of Dentistry, National and Kapodistrian University of Athens, Greece. Patient records were screened based on eligibility criteria for inclusion in the study. The sample was categorized by sex and age, with age intervals of 5 years. An equal number of lateral cephalometric radiographs for males and females were distributed within each age group. Twelve cephalometric points visible on lateral cephalometric radiographs were digitally traced using ViewBox software, including glabella, nasion, orbitale, sella, basion, porion, anterior nasal spine, posterior nasal spine, anterior, superior, posterior and inferior points of sinus. The present cross-sectional study used a binary logistic regression (BLR) model.
Results
Sex was predicted with an overall accuracy of 74.7 %. A value lower than 0.41 identified a male participant, and a value higher than 0.41 a female participant. The estimated sensitivity and specificity are 85.3 % and 64.0 %, respectively, indicating that the model has satisfactory adjustment. The area under the Receiver Operating Characteristic (ROC) curve (area under the curve - AUC) was 0.80, indicating good discriminative ability.
Conclusions
Cephalometric analysis using radiographs for sex estimation could be useful as a complementary method to conventional sex estimation approaches and may serve as a reliable sex predictor in the Greek population, particularly when alternative techniques cannot be used to estimate sex.
本研究的目的是研究从侧位头颅x线片获得的线性、角度和面积测量是否可以作为确定希腊人口样本性别的额外方法。材料和方法研究样本包括150名年龄在18-65岁的希腊人的数字侧位头颅x线片，他们在希腊雅典国立和卡波迪特里安大学牙科学院寻求正畸治疗。根据纳入研究的资格标准筛选患者记录。样本按性别和年龄分类，年龄间隔为5年。在每个年龄组中，男性和女性的侧位头颅x线片的数量相等。采用ViewBox软件对侧位头颅x线片上可见的12个点进行数字追踪，包括眉间、鼻鼻、眶、鞍、基底、部分、鼻前棘、鼻后棘、鼻窦前、上、后、下点。本横断面研究采用二元逻辑回归（BLR）模型。结果预测性别的总体准确率为74.7%。低于0.41的值为男性，高于0.41的值为女性。估计灵敏度和特异度分别为85.3%和64.0%，表明该模型具有满意的调整效果。受试者工作特征（ROC）曲线下面积（area under curve - AUC）为0.80，判别能力较好。结论：使用x线片进行脑测量分析的性别估计可以作为传统性别估计方法的补充方法，并且可以作为希腊人群中可靠的性别预测器，特别是当替代技术无法用于估计性别时。
{"title":"Is lateral cephalometric analysis useful to sex estimation in forensic science? A cross-sectional study","authors":"Anastasia Mitsea , Ioanna Pouliezou , Nikolaos Christoloukas , Iosif Sifakakis","doi":"10.1016/j.jflm.2026.103077","DOIUrl":"10.1016/j.jflm.2026.103077","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study was to investigate whether linear, angular, and area measurements derived from lateral cephalometric radiographs can serve as an additional method for determining sex in a sample of Greek population.</div></div><div><h3>Materials and methods</h3><div>The study sample comprised digital lateral cephalometric radiographs from 150 Greek individuals aged 18–65 years, who sought orthodontic treatment at the School of Dentistry, National and Kapodistrian University of Athens, Greece. Patient records were screened based on eligibility criteria for inclusion in the study. The sample was categorized by sex and age, with age intervals of 5 years. An equal number of lateral cephalometric radiographs for males and females were distributed within each age group. Twelve cephalometric points visible on lateral cephalometric radiographs were digitally traced using ViewBox software, including glabella, nasion, orbitale, sella, basion, porion, anterior nasal spine, posterior nasal spine, anterior, superior, posterior and inferior points of sinus. The present cross-sectional study used a binary logistic regression (BLR) model.</div></div><div><h3>Results</h3><div>Sex was predicted with an overall accuracy of 74.7 %. A value lower than 0.41 identified a male participant, and a value higher than 0.41 a female participant. The estimated sensitivity and specificity are 85.3 % and 64.0 %, respectively, indicating that the model has satisfactory adjustment. The area under the Receiver Operating Characteristic (ROC) curve (area under the curve - AUC) was 0.80, indicating good discriminative ability.</div></div><div><h3>Conclusions</h3><div>Cephalometric analysis using radiographs for sex estimation could be useful as a complementary method to conventional sex estimation approaches and may serve as a reliable sex predictor in the Greek population, particularly when alternative techniques cannot be used to estimate sex.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103077"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-14DOI: 10.1016/j.jflm.2026.103081
Aaro Mäkelä
Purpose
This study investigates the prevalence of sexually transmitted infections (STIs) among individuals suspected of rape in the Helsinki metropolitan area, focusing on the immediate aftermath of the alleged incidents.
Methods
A retrospective observational analysis was conducted using data from 472 forensic examinations performed at the Finnish Institute for Health and Welfare (THL) between 2020 and 2024. Biological samples were tested for chlamydia, gonorrhea, syphilis, hepatitis B, hepatitis C, and HIV. The mean interval between the alleged incident and sample collection was calculated to assess the temporal relationship.
Results
Of the 456 individuals tested, 108 (23.68 %) exhibited STI-related findings, with 54 (11.84 %) deemed probably contagious. Prevalence rates were 6.92 % for chlamydia, 1.11 % for gonorrhea, 2.64 % for contagious hepatitis B, and 2.57 % for active hepatitis C. HIV was detected in 1.10 % of individuals, with none deemed contagious. Fewer than 5 syphilis cases were deemed to be contagious. The mean interval between the alleged incident and sample collection was 1.04 days.
Conclusion
This study provides an examination of STI prevalence among suspects of rape, offering insights into transmission risks immediately following alleged incidents. The findings underscore the importance of routine STI screening in forensic examinations and highlight the potential for such data to inform public health interventions and forensic practices.
{"title":"Sexually transmitted infections of sexual crime suspects","authors":"Aaro Mäkelä","doi":"10.1016/j.jflm.2026.103081","DOIUrl":"10.1016/j.jflm.2026.103081","url":null,"abstract":"<div><h3>Purpose</h3><div>This study investigates the prevalence of sexually transmitted infections (STIs) among individuals suspected of rape in the Helsinki metropolitan area, focusing on the immediate aftermath of the alleged incidents.</div></div><div><h3>Methods</h3><div>A retrospective observational analysis was conducted using data from 472 forensic examinations performed at the Finnish Institute for Health and Welfare (THL) between 2020 and 2024. Biological samples were tested for chlamydia, gonorrhea, syphilis, hepatitis B, hepatitis C, and HIV. The mean interval between the alleged incident and sample collection was calculated to assess the temporal relationship.</div></div><div><h3>Results</h3><div>Of the 456 individuals tested, 108 (23.68 %) exhibited STI-related findings, with 54 (11.84 %) deemed probably contagious. Prevalence rates were 6.92 % for chlamydia, 1.11 % for gonorrhea, 2.64 % for contagious hepatitis B, and 2.57 % for active hepatitis C. HIV was detected in 1.10 % of individuals, with none deemed contagious. Fewer than 5 syphilis cases were deemed to be contagious. The mean interval between the alleged incident and sample collection was 1.04 days.</div></div><div><h3>Conclusion</h3><div>This study provides an examination of STI prevalence among suspects of rape, offering insights into transmission risks immediately following alleged incidents. The findings underscore the importance of routine STI screening in forensic examinations and highlight the potential for such data to inform public health interventions and forensic practices.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103081"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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