Accurate detection and quantification of human nuclear DNA (nDNA), named the human accelerated region 1 (HAR1) assay, was developed to simultaneously prove the human origin of forensic biological samples and optimize nDNA input for PCR in human DNA profiling. The HAR1 assay, a TaqMan probe-based real-time PCR assay targeting HAR1 in nDNA, was exclusively specific to human DNA samples with no cross-reactivity across 23 vertebrate species (mammals including non-human primates, birds, reptiles, amphibians, and fishes). This assay is capable of proving the human origin of the samples from as little as the DNA content of a single somatic cell. Moreover, accurate quantification of human nDNA was achieved down to the minimum input concentration (33 pg/μL) recommended by commercial DNA profiling kits. Furthermore, it was confirmed that the presence of non-human DNA mixed with human DNA did not interfere with the accuracy of human nDNA quantification. Therefore, the HAR1 assay represents a valuable and practical tool for improving both the accuracy and efficiency of human DNA profiling, particularly in forensic casework where sample quantity and quality may be limited and the presence of non-human DNA can complicate analysis.
{"title":"Accurate Detection and Quantification of Human Nuclear DNA","authors":"Toshifumi Nakagawa , Masanori Doi , Kosuke Nishi , Takuya Sugahara","doi":"10.1016/j.legalmed.2025.102715","DOIUrl":"10.1016/j.legalmed.2025.102715","url":null,"abstract":"<div><div>Accurate detection and quantification of human nuclear DNA (nDNA), named the human accelerated region 1 (HAR1) assay, was developed to simultaneously prove the human origin of forensic biological samples and optimize nDNA input for PCR in human DNA profiling. The HAR1 assay, a TaqMan probe-based real-time PCR assay targeting HAR1 in nDNA, was exclusively specific to human DNA samples with no cross-reactivity across 23 vertebrate species (mammals including non-human primates, birds, reptiles, amphibians, and fishes). This assay is capable of proving the human origin of the samples from as little as the DNA content of a single somatic cell. Moreover, accurate quantification of human nDNA was achieved down to the minimum input concentration (33 pg/μL) recommended by commercial DNA profiling kits. Furthermore, it was confirmed that the presence of non-human DNA mixed with human DNA did not interfere with the accuracy of human nDNA quantification. Therefore, the HAR1 assay represents a valuable and practical tool for improving both the accuracy and efficiency of human DNA profiling, particularly in forensic casework where sample quantity and quality may be limited and the presence of non-human DNA can complicate analysis.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"79 ","pages":"Article 102715"},"PeriodicalIF":1.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145364467","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 : 2025-09-19DOI: 10.1016/j.legalmed.2025.102716
Enrico Pilia , Andrea Mastrostefano , Tommaso Germanò , Giuseppe Amato , Gozzelino Camilla , Corrado Ciccu , Ernesto d’Aloja , Emanuela Locci , Alberto Chighine
Objective
The post-mortem diagnosis of fatal anaphylaxis presents significant challenges due to the absence of pathognomonic findings. Serum tryptase has been proposed as a potential biomarker to support forensic diagnosis, but optimal post-mortem thresholds remain undefined. This systematic review investigates the sensitivity and specificity of post-mortem blood tryptase in diagnosing fatal anaphylaxis.
Methods
We conducted a systematic literature review adhering to the PRISMA guidelines, with searches across major databases. Studies published between 1990 and 2024 were screened to identify those addressing fatal anaphylactic shock, applying strict inclusion criteria to ensure relevance. A total of 20 studies met our criteria, representing 1033 individuals, including 221 anaphylactic deaths. Sensitivity and specificity of tryptase were analyzed using various thresholds, with data synthesis conducted using the Mann–Whitney–Wilcoxon test and ROC analysis to identify optimal diagnostic cut-offs.
Results
Our findings demonstrated that the cut-off of 30.4 ng/mL proposed by the most recent meta-analysis offers a balanced sensitivity (88.20 %) and specificity (87.00 %). Sensitivity remains stable across tryptase values ranging from 30 to 60 ng/mL, while specificity tends to increase. Youden’s J index was applied to identify the cut-off with the optimal combination of sensitivity and specificity, namely 74.2 ng/mL. Additionally, Negative Likelihood Ratio allowed to identify 12.00 ng/mL as the cut-off at which the possibility of an anaphylactic death can be ruled out.
Conclusion
This review highlights the optimal balance of sensitivity and specificity of post-mortem blood tryptase enhancing forensic diagnostic accuracy for fatal anaphylaxis cases.
{"title":"A systematic review of the diagnostic value of post-mortem blood tryptase in fatal anaphylaxis: assessment of sensitivity and specificity","authors":"Enrico Pilia , Andrea Mastrostefano , Tommaso Germanò , Giuseppe Amato , Gozzelino Camilla , Corrado Ciccu , Ernesto d’Aloja , Emanuela Locci , Alberto Chighine","doi":"10.1016/j.legalmed.2025.102716","DOIUrl":"10.1016/j.legalmed.2025.102716","url":null,"abstract":"<div><h3>Objective</h3><div>The post-mortem diagnosis of fatal anaphylaxis presents significant challenges due to the absence of pathognomonic findings. Serum tryptase has been proposed as a potential biomarker to support forensic diagnosis, but optimal post-mortem thresholds remain undefined. This systematic review investigates the sensitivity and specificity of post-mortem blood tryptase in diagnosing fatal anaphylaxis.</div></div><div><h3>Methods</h3><div>We conducted a systematic literature review adhering to the PRISMA guidelines, with searches across major databases. Studies published between 1990 and 2024 were screened to identify those addressing fatal anaphylactic shock, applying strict inclusion criteria to ensure relevance. A total of 20 studies met our criteria, representing 1033 individuals, including 221 anaphylactic deaths. Sensitivity and specificity of tryptase were analyzed using various thresholds, with data synthesis conducted using the Mann–Whitney–Wilcoxon test and ROC analysis to identify optimal diagnostic cut-offs.</div></div><div><h3>Results</h3><div>Our findings demonstrated that the cut-off of 30.4 ng/mL proposed by the most recent <em>meta</em>-analysis offers a balanced sensitivity (88.20 %) and specificity (87.00 %). Sensitivity remains stable across tryptase values ranging from 30 to 60 ng/mL, while specificity tends to increase. Youden’s J index was applied to identify the cut-off with the optimal combination of sensitivity and specificity, namely 74.2 ng/mL. Additionally, Negative Likelihood Ratio allowed to identify 12.00 ng/mL as the cut-off at which the possibility of an anaphylactic death can be ruled out.</div></div><div><h3>Conclusion</h3><div>This review highlights the optimal balance of sensitivity and specificity of post-mortem blood tryptase enhancing forensic diagnostic accuracy for fatal anaphylaxis cases.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102716"},"PeriodicalIF":1.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109633","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 : 2025-09-15DOI: 10.1016/j.legalmed.2025.102708
Rossana Cecchi , Jessika Camatti , Anna Laura Santunione , Marco Vinceti , Tommaso Filippini , Riccardo Mazzoli , Alice Buzzelli , Alessandra De Martina , Graziamaria Corbi , Carlo Pietro Campobasso , Alessandra Sannella , Paolo Fais , Susi Pelotti , Arianna Giorgetti , Elena Lacchè , Andrea Verzeletti , Bianca Beltrame , Riccardo Zoia , Lorenzo Franceschetti , Giulia Vignali , Raffaella Marino
Femicides are grievous, but little is known about risk factors and preventive measures. We present the results of a study conducted across 27 Italian Forensic Institutes. We analyzed 1,238 cases of female homicide and, adopting the definition of femicide as the murder due to the failure to recognize women’s right to self-determination, we identified 410 cases as femicides and 395 as non-femicides Current partners were identified as aggressors in a much larger proportion of femicide cases (241 femicides vs. 145 non-femicides; odds ratio (OR) of femicide 2.46, 95 % CI 1.85–3.27), such association being more pronounced for ex-partners (102 vs. 11; OR 11.56, 95 % CI 6.10–21.92). Sharp weapons showed a higher frequency in femicides (168 vs. 140; OR 1.26, 95 % CI 0.95–1.68). Femicides were more often associated with bodies found in vehicles (31 vs. 9; OR 3.50, 95 % CI 1.64–7.45) and outdoor (68 vs. 43; OR 1.62, 95 % CI 1.08–2.45).
There was an indication of femicides being more frequently associated with overkilling (87/323 vs. 71/324; OR 1.24, 95 % CI 0.88–1.76) and even more with lesions located in erogenous zones (94/316 vs. 70/325; OR 1.38, 95 % CI: 0.97–1.95). However, the strongest (though statistically imprecise) association emerged for overkilling in erogenous zones (12/398 vs. 6/389; OR 1.95, 95 % CI: 0.72–5.25). The number of lesions showed a nonlinear association with femicide likelihood.
These findings offer forensic indicators that could contribute in predicting and potentially prevent femicide occurrence in a Western population such as the Italian one.
杀害妇女是令人痛心的，但人们对危险因素和预防措施知之甚少。我们提出了在27个意大利法医研究所进行的一项研究的结果。我们分析了1238起女性杀人案，并将杀害女性定义为未承认妇女自决权的谋杀，我们将410起案件确定为杀害女性，395起案件确定为非杀害女性。在杀害女性的案件中，目前的伴侣被确定为侵犯者的比例要大得多（杀害女性的241人对非杀害女性的145人；杀害女性的比值比（OR）为2.46,95% CI为1.85-3.27），这种关联在前伴侣中更为明显(102对11；（11.56, 95% ci 6.10-21.92）。锐利武器在杀害女性中的使用频率更高（168比140；OR 1.26, 95% CI 0.95-1.68）。杀女性者通常与在车辆（31对9；OR 3.50, 95%可信区间1.64-7.45）和户外（68对43；OR 1.62, 95%可信区间1.08-2.45）中发现的尸体有关。有迹象表明，杀女性剂更频繁地与过度杀戮相关（87/323 vs. 71/324; OR 1.24, 95% CI 0.88-1.76），甚至与位于性敏感区的病变相关（94/316 vs. 70/325; OR 1.38, 95% CI: 0.97-1.95）。然而，最强烈的关联（尽管统计上不精确）出现在性敏感区的过度杀戮（12/398比6/389；OR 1.95, 95% CI: 0.72-5.25）。病变的数量与杀害女性的可能性呈非线性关系。这些发现提供了法医指标，可以有助于预测和潜在地防止杀害妇女事件在西方人口中发生，如意大利人。
{"title":"A nationwide forensic case-series of femicides in Italy – Part 2: Clues to its epidemiology, prediction and prevention","authors":"Rossana Cecchi , Jessika Camatti , Anna Laura Santunione , Marco Vinceti , Tommaso Filippini , Riccardo Mazzoli , Alice Buzzelli , Alessandra De Martina , Graziamaria Corbi , Carlo Pietro Campobasso , Alessandra Sannella , Paolo Fais , Susi Pelotti , Arianna Giorgetti , Elena Lacchè , Andrea Verzeletti , Bianca Beltrame , Riccardo Zoia , Lorenzo Franceschetti , Giulia Vignali , Raffaella Marino","doi":"10.1016/j.legalmed.2025.102708","DOIUrl":"10.1016/j.legalmed.2025.102708","url":null,"abstract":"<div><div>Femicides are grievous, but little is known about risk factors and preventive measures. We present the results of a study conducted across 27 Italian Forensic Institutes. We analyzed 1,238 cases of female homicide and, adopting the definition of femicide as the murder due to the failure to recognize women’s right to self-determination, we identified 410 cases as femicides and 395 as non-femicides Current partners were identified as aggressors in a much larger proportion of femicide cases (241 femicides vs. 145 non-femicides; odds ratio (OR) of femicide 2.46, 95 % CI 1.85–3.27), such association being more pronounced for ex-partners (102 vs. 11; OR 11.56, 95 % CI 6.10–21.92). Sharp weapons showed a higher frequency in femicides (168 vs. 140; OR 1.26, 95 % CI 0.95–1.68). Femicides were more often associated with bodies found in vehicles (31 vs. 9; OR 3.50, 95 % CI 1.64–7.45) and outdoor (68 vs. 43; OR 1.62, 95 % CI 1.08–2.45).</div><div>There was an indication of femicides being more frequently associated with overkilling (87/323 vs. 71/324; OR 1.24, 95 % CI 0.88–1.76) and even more with lesions located in erogenous zones (94/316 vs. 70/325; OR 1.38, 95 % CI: 0.97–1.95). However, the strongest (though statistically imprecise) association emerged for overkilling in erogenous zones (12/398 vs. 6/389; OR 1.95, 95 % CI: 0.72–5.25). The number of lesions showed a nonlinear association with femicide likelihood.</div><div>These findings offer forensic indicators that could contribute in predicting and potentially prevent femicide occurrence in a Western population such as the Italian one.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102708"},"PeriodicalIF":1.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087950","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 : 2025-09-15DOI: 10.1016/j.legalmed.2025.102709
Jun Yoshida, Kazuya Mori, Akane Nishi, Fumiya Morioka, Kei Okino, Munehiro Katagi, Takako Sato
In the field of forensic toxicology, deaths related to carbon monoxide (CO) inhalation is one of the most relevant concerns. A common method for measuring CO-hemoglobin (Hb) saturation in blood is to measure the absorbance with a spectrophotometer. We recently encountered a fire case in which there appeared a large discrepancy between the autopsy findings and CO-Hb saturation, where the coagulated blood clots filling the heart and large blood vessels showed CO-Hb saturation of about 80% (CO poisoning level), but no soot was found in the bronchial tubes of the remaining body. We suspected this discrepancy to be caused by the application of spectrophotometry, which normally is applied to liquid blood sample, but in this case was applied to thermally coagulated blood. In this study, firstly we heated blood at various temperatures and times to investigate whether thermally coagulated blood clots were formed or not. Furthermore, CO-Hb saturation was measured in the coagulated blood clots using spectrophotometry to verify the discrepancy between the autopsy findings and CO-Hb saturation in the present case. The results show that CO-Hb saturation in coagulated blood clots that had undergone thermal denaturation and coagulation did not reflect the original values, in particular, blood samples with low CO-Hb saturation can show high CO-Hb saturation that may indicate CO poisoning. When determining cause of death, therefore, CO-Hb saturation value determined by spectrophotometer should be used with caution.
{"title":"Analytical pit-holes in the determination of carboxyhemoglobin saturation in thermally denatured coagulated blood samples","authors":"Jun Yoshida, Kazuya Mori, Akane Nishi, Fumiya Morioka, Kei Okino, Munehiro Katagi, Takako Sato","doi":"10.1016/j.legalmed.2025.102709","DOIUrl":"10.1016/j.legalmed.2025.102709","url":null,"abstract":"<div><div>In the field of forensic toxicology, deaths related to carbon monoxide (CO) inhalation is one of the most relevant concerns. A common method for measuring CO-hemoglobin (Hb) saturation in blood is to measure the absorbance with a spectrophotometer. We recently encountered a fire case in which there appeared a large discrepancy between the autopsy findings and CO-Hb saturation, where the coagulated blood clots filling the heart and large blood vessels showed CO-Hb saturation of about 80% (CO poisoning level), but no soot was found in the bronchial tubes of the remaining body. We suspected this discrepancy to be caused by the application of spectrophotometry, which normally is applied to liquid blood sample, but in this case was applied to thermally coagulated blood. In this study, firstly we heated blood at various temperatures and times to investigate whether thermally coagulated blood clots were formed or not. Furthermore, CO-Hb saturation was measured in the coagulated blood clots using spectrophotometry to verify the discrepancy between the autopsy findings and CO-Hb saturation in the present case. The results show that CO-Hb saturation in coagulated blood clots that had undergone thermal denaturation and coagulation did not reflect the original values, in particular, blood samples with low CO-Hb saturation can show high CO-Hb saturation that may indicate CO poisoning. When determining cause of death, therefore, CO-Hb saturation value determined by spectrophotometer should be used with caution.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102709"},"PeriodicalIF":1.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102674","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 : 2025-09-15DOI: 10.1016/j.legalmed.2025.102713
Andrea Scatena , Julia Lazzari , Pietro Bertini , Valentina Bugelli , Marco Di Paolo
Extracorporeal Membrane Oxygenation (ECMO) is a crucial life-support technology used in intensive care medicine for patients with severe cardiorespiratory failure who do not respond to conventional treatments. While ECMO can be lifesaving, it is a complex procedure that demands a multidisciplinary approach and a thorough understanding of its indications, contraindications, complications, and limitations. The application of ECMO also presents significant challenges for forensic medicine, as patients who undergo ECMO and later die may exhibit physiological changes that can lead to discrepancies between pre-mortem and post-mortem diagnoses. These changes can complicate the interpretation of autopsy findings and impact forensic conclusions. “A systematic review along with eight cases studies dealing with patients died after treatment with ECMO have been reported”. Each case underwent forensic autopsy to illustrate the potential post-mortem changes associated with ECMO and highlight the importance of understanding these effects when evaluating forensic cases. The authors propose a procedure for conducting an external examination before initiating ECMO treatment or during the initial hours of treatment to document and preserve the clinical condition in cases of forensic interest. This approach aims to provide a clearer and more accurate basis for forensic analysis, ensuring that any alterations due to ECMO are properly accounted for during autopsy.
{"title":"Enhancing the detection of ECMO-related morphological changes: a post-mortem observational study and systematic review","authors":"Andrea Scatena , Julia Lazzari , Pietro Bertini , Valentina Bugelli , Marco Di Paolo","doi":"10.1016/j.legalmed.2025.102713","DOIUrl":"10.1016/j.legalmed.2025.102713","url":null,"abstract":"<div><div>Extracorporeal Membrane Oxygenation (ECMO) is a crucial life-support technology used in intensive care medicine for patients with severe cardiorespiratory failure who do not respond to conventional treatments. While ECMO can be lifesaving, it is a complex procedure that demands a multidisciplinary approach and a thorough understanding of its indications, contraindications, complications, and limitations. The application of ECMO also presents significant challenges for forensic medicine, as patients who undergo ECMO and later die may exhibit physiological changes that can lead to discrepancies between pre-mortem and post-mortem diagnoses. These changes can complicate the interpretation of autopsy findings and impact forensic conclusions. “A systematic review along with eight cases studies dealing with patients died after treatment with ECMO have been reported”. Each case underwent forensic autopsy to illustrate the potential post-mortem changes associated with ECMO and highlight the importance of understanding these effects when evaluating forensic cases. The authors propose a procedure for conducting an external examination before initiating ECMO treatment or during the initial hours of treatment to document and preserve the clinical condition in cases of forensic interest. This approach aims to provide a clearer and more accurate basis for forensic analysis, ensuring that any alterations due to ECMO are properly accounted for during autopsy.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102713"},"PeriodicalIF":1.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092936","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}
Commotio cordis (CC) is a rare cause of sudden cardiac death resulting from a blunt, non-penetrating impact to the precordium, in the absence of underlying cardiac pathology or structural damage. Although most frequently described in adolescents engaged in sports activities, CC may also occur in non-sport contexts. We report the case of a 43-year-old male construction worker who died after being struck in the chest by a slow-moving truck. Postmortem computed tomography (PMCT) revealed multiple left rib fractures, costal cartilage fractures, manubriosternal dislocation and pulmonary contusions. Conventional autopsy confirmed the absence of cardiac rupture, coronary disease or pericardial injuries. Histological analysis supported a diagnosis of electromechanical dissociation by fatal arrhythmia.
In our review of six previously published articles involving similar cases, autopsy was the principal diagnostic tool in all instances. PMCT was employed in only one case, prompted by circumstantial suspicion of child abuse.
This case underscores the importance of a multidisciplinary forensic approach, combining PMCT and traditional autopsy to reconstruct the traumatic event and rule out other mechanisms of death. CC remains a diagnosis of exclusion, requiring demonstration of precordial impact, absence of lethal structural injuries, and lack of alternative causes of death on autopsy and toxicological examination.
PMCT should be strongly recommended in cases of sudden death following blunt thoracic trauma, even when external signs are minimal or absent.
{"title":"Commotio cordis: Insights from a case of blunt chest trauma and a road map for the correct diagnosis","authors":"Francesco Calabrò , Alessandra Puggioni , Davide Machado , Valentina Bugelli","doi":"10.1016/j.legalmed.2025.102714","DOIUrl":"10.1016/j.legalmed.2025.102714","url":null,"abstract":"<div><div>Commotio cordis (CC) is a rare cause of sudden cardiac death resulting from a blunt, non-penetrating impact to the precordium, in the absence of underlying cardiac pathology or structural damage. Although most frequently described in adolescents engaged in sports activities, CC may also occur in non-sport contexts. We report the case of a 43-year-old male construction worker who died after being struck in the chest by a slow-moving truck. Postmortem computed tomography (PMCT) revealed multiple left rib fractures, costal cartilage fractures, manubriosternal dislocation and pulmonary contusions. Conventional autopsy confirmed the absence of cardiac rupture, coronary disease or pericardial injuries. Histological analysis supported a diagnosis of electromechanical dissociation by fatal arrhythmia.</div><div>In our review of six previously published articles involving similar cases, autopsy was the principal diagnostic tool in all instances. PMCT was employed in only one case, prompted by circumstantial suspicion of child abuse.</div><div>This case underscores the importance of a multidisciplinary forensic approach, combining PMCT and traditional autopsy to reconstruct the traumatic event and rule out other mechanisms of death. CC remains a diagnosis of exclusion, requiring demonstration of precordial impact, absence of lethal structural injuries, and lack of alternative causes of death on autopsy and toxicological examination.</div><div>PMCT should be strongly recommended in cases of sudden death following blunt thoracic trauma, even when external signs are minimal or absent.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102714"},"PeriodicalIF":1.4,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087915","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}
Accurately estimating the postmortem interval (PMI) is essential for forensic investigations. Brain decomposition observed on postmortem computed tomography (PMCT) may provide useful markers to estimate PMI; however, this approach has not been extensively studied. The aim of this study was to classify and quantify brain decomposition using PMCT findings and to investigate its association with PMI, determinability of cause of death, and environmental factors.
Methods
We retrospectively analyzed 176 adult autopsy cases involving preautopsy PMCT. Brain decomposition was classified into five stages using the visual PMCT findings and quantified using brain area-to-length ratios on axial computed tomography slices. Associations between the PMI and determinability of the cause of death were assessed using correlation and regression analyses.
Results
Brain decomposition stage and quantitative indices showed strong correlations with PMI (ρ = 0.61 to − 0.69), with high predictive performance for estimating PMI ≥ 7–60 days (area under the curves [AUCs]: 0.904–0.984). Brain area ratio showed the highest accuracy for estimating PMI ≥ 60 days (AUC = 0.984, cutoff ≤ 60.7 %). The rate of undetermined causes of death increased from 7.1 % in stage 0 to 92.9 % in Stage IV. Brain deformation ratio was positively correlated with seasonal effects (p = 0.0017).
Conclusion
PMCT-based assessment of brain decomposition may provide objective markers for estimating late PMIs and assist in evaluating the likelihood of cause-of-death in decomposed bodies.
{"title":"Postmortem computed tomography-based evaluation of brain decomposition: Correlation with postmortem interval and cause-of-death determinability","authors":"Haruki Fukuda , Hiroyuki Tokue , Miyuki Shiraishi , Takuya Ishikawa , Akari Kimimura , Kensuke Takatsu , Kouji Oka , Rieko Kubo , Tadashi Hosoya","doi":"10.1016/j.legalmed.2025.102710","DOIUrl":"10.1016/j.legalmed.2025.102710","url":null,"abstract":"<div><h3>Background</h3><div>Accurately estimating the postmortem interval (PMI) is essential for forensic investigations. Brain decomposition observed on postmortem computed tomography (PMCT) may provide useful markers to estimate PMI; however, this approach has not been extensively studied. The aim of this study was to classify and quantify brain decomposition using PMCT findings and to investigate its association with PMI, determinability of cause of death, and environmental factors.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 176 adult autopsy cases involving preautopsy PMCT. Brain decomposition was classified into five stages using the visual PMCT findings and quantified using brain area-to-length ratios on axial computed tomography slices. Associations between the PMI and determinability of the cause of death were assessed using correlation and regression analyses.</div></div><div><h3>Results</h3><div>Brain decomposition stage and quantitative indices showed strong correlations with PMI (<em>ρ</em> = 0.61 to − 0.69), with high predictive performance for estimating PMI ≥ 7–60 days (area under the curves [AUCs]: 0.904–0.984). Brain area ratio showed the highest accuracy for estimating PMI ≥ 60 days (AUC = 0.984, cutoff ≤ 60.7 %). The rate of undetermined causes of death increased from 7.1 % in stage 0 to 92.9 % in Stage IV. Brain deformation ratio was positively correlated with seasonal effects (<em>p</em> = 0.0017).</div></div><div><h3>Conclusion</h3><div>PMCT-based assessment of brain decomposition may provide objective markers for estimating late PMIs and assist in evaluating the likelihood of cause-of-death in decomposed bodies.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102710"},"PeriodicalIF":1.4,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076444","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 : 2025-09-13DOI: 10.1016/j.legalmed.2025.102711
Ugo Da Broi , Francesco Simonit , Alessio Cappelli , Sirio Cividino , Mauro Zaninelli , Rexson Tse , Jack Garland , Benjamin Ondruschka , Lorenzo Desinan
Despite advances in engineering solutions, such as rollover protective structures and improved operator training, tractor rollovers in agricultural settings continue to be the main cause of death necessitating medicolegal investigations to reconstruct event dynamics and determine causal attributions. This study examines the distinction between evidence (observational data consistent with a hypothesis) and proof (conclusive data confirming a hypothesis) in the context of fatal tractor accidents. We propose a three-phase logic model which provides a conclusive reconstruction of the events by integrating engineering data, dynamic modelling, death scene analysis and autopsy findings. Careful analysis of the death scene and circumstantial evidence is essential during investigations of rollover dynamics, encompassing operational safety procedures, the technical characteristics of the vehicle, corpse position, autopsy findings, toxicology data, the victim’s medical history and psychophysical condition at the time of the accident occurred. Systematizing such variables within a unified forensic framework enhances the scientific reliability of forensic investigations and the technical reconstruction of the fatality, thus contributing to the development of prevention strategies, liability assessment and the formulation of safety policy.
{"title":"The role of legal medicine in the reconstruction of fatalities due to tractor rollovers: from evidence to proof","authors":"Ugo Da Broi , Francesco Simonit , Alessio Cappelli , Sirio Cividino , Mauro Zaninelli , Rexson Tse , Jack Garland , Benjamin Ondruschka , Lorenzo Desinan","doi":"10.1016/j.legalmed.2025.102711","DOIUrl":"10.1016/j.legalmed.2025.102711","url":null,"abstract":"<div><div>Despite advances in engineering solutions, such as rollover protective structures and improved operator training, tractor rollovers in agricultural settings continue to be the main cause of death necessitating medicolegal investigations to reconstruct event dynamics and determine causal attributions. This study examines the distinction between evidence (observational data consistent with a hypothesis) and proof (conclusive data confirming a hypothesis) in the context of fatal tractor accidents. We propose a three-phase logic model which provides a conclusive reconstruction of the events by integrating engineering data, dynamic modelling, death scene analysis and autopsy findings. Careful analysis of the death scene and circumstantial evidence is essential during investigations of rollover dynamics, encompassing operational safety procedures, the technical characteristics of the vehicle, corpse position, autopsy findings, toxicology data, the victim’s medical history and psychophysical condition at the time of the accident occurred. Systematizing such variables within a unified forensic framework enhances the scientific reliability of forensic investigations and the technical reconstruction of the fatality, thus contributing to the development of prevention strategies, liability assessment and the formulation of safety policy.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102711"},"PeriodicalIF":1.4,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145105200","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 : 2025-09-12DOI: 10.1016/j.legalmed.2025.102707
Aya Matsusue , Mio Takayama , Naoto Tani , Brian Waters , Masayuki Kashiwagi , Takaki Ishikawa
Monoamine oxidase A (MAOA) catalyzes the oxidative deamination of amine neurotransmitters and xenobiotics. The MAOA gene is located on the X chromosome and has a functional variable number tandem repeat (VNTR) polymorphism of 30 bp repeats in the promoter region (MAOA-uVNTR). The MAOA-uVNTR polymorphism has been associated with transcriptional activity. We herein examined the frequencies of MAOA-uVNTR alleles in 21 cases in which amphetamines or psychotropic drugs were not detected in blood or urine samples (ND cases). We also investigated MAOA protein expression levels in the brains of these cases. In ND cases, brain MAOA expression levels were significantly higher in males with 4-repeat alleles and females who were homozygous for 4-repeat alleles (4 + 4/4 genotype group) than in males with 3-repeat alleles and females who were homozygous for 3-repeat alleles (3 + 3/3 genotype group) (p = 0.0395). Collectively, these results indicate that the MAOA-uVNTR polymorphism affects the brain expression level of MAOA in ND cases.
{"title":"A pilot study on the relationship between a variable number tandem repeat polymorphism and monoamine oxidase A protein expression in the human brain","authors":"Aya Matsusue , Mio Takayama , Naoto Tani , Brian Waters , Masayuki Kashiwagi , Takaki Ishikawa","doi":"10.1016/j.legalmed.2025.102707","DOIUrl":"10.1016/j.legalmed.2025.102707","url":null,"abstract":"<div><div>Monoamine oxidase A (MAOA) catalyzes the oxidative deamination of amine neurotransmitters and xenobiotics. The <em>MAOA</em> gene is located on the X chromosome and has a functional variable number tandem repeat (VNTR) polymorphism of 30 bp repeats in the promoter region (<em>MAOA</em>-uVNTR). The <em>MAOA</em>-uVNTR polymorphism has been associated with transcriptional activity. We herein examined the frequencies of <em>MAOA</em>-uVNTR alleles in 21 cases in which amphetamines or psychotropic drugs were not detected in blood or urine samples (ND cases). We also investigated MAOA protein expression levels in the brains of these cases. In ND cases, brain MAOA expression levels were significantly higher in males with 4-repeat alleles and females who were homozygous for 4-repeat alleles (4 + 4/4 genotype group) than in males with 3-repeat alleles and females who were homozygous for 3-repeat alleles (3 + 3/3 genotype group) (<em>p</em> = 0.0395). Collectively, these results indicate that the <em>MAOA</em>-uVNTR polymorphism affects the brain expression level of MAOA in ND cases.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102707"},"PeriodicalIF":1.4,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092981","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 : 2025-09-08DOI: 10.1016/j.legalmed.2025.102706
Hye-Seon Cho , Ji-woo Lee , Ha-Eun Cha , Jooree Seo , Si-Keun Lim
Various microorganisms have a symbiotic relationship with human skin cells, influenced by intrinsic and extrinsic factors. The composition of the human microbiome varies based on the skin site. To investigate the microbial characteristics of different skin sites in Koreans, microbiome samples were collected from the scalp, forehead, cheek, retroauricular crease, cervical vertebrae, axilla, palm, lateral finger, femur, and plantar skin. The concentrations of human and bacterial DNA were quantified, and QIIME2 and MicrobiomeAnalyst platforms were used for microbial analysis. Forehead and cheek microbiome compositions were similar, with higher proportions of Streptococcus than that at other sites. Palm and lateral finger microbiome compositions were also similar, with higher proportions of Haemophilus than that at other sites. Lawsonella was specifically observed on the scalp, while Mycoplasma was found on cervical vertebrae. Staphylococcus, observed on all sites, was particularly predominant on axilla. The microbial composition of plantar was distinct, with no prevalent genus compared to that at other sites. Further research analyzing skin microbiomes from forensic evidence could help identify the origin of skin samples, aiding in crime scene reconstruction. Comparing our findings from Korean participants with international studies, it suggests that expanding research to include diverse populations could reveal regional and national differences in skin microbiomes, providing valuable insights for forensic science.
{"title":"Comparative analysis of skin microbiome across 10 sites in Koreans for forensic applications: a pilot study","authors":"Hye-Seon Cho , Ji-woo Lee , Ha-Eun Cha , Jooree Seo , Si-Keun Lim","doi":"10.1016/j.legalmed.2025.102706","DOIUrl":"10.1016/j.legalmed.2025.102706","url":null,"abstract":"<div><div>Various microorganisms have a symbiotic relationship with human skin cells, influenced by intrinsic and extrinsic factors. The composition of the human microbiome varies based on the skin site. To investigate the microbial characteristics of different skin sites in Koreans, microbiome samples were collected from the scalp, forehead, cheek, retroauricular crease, cervical vertebrae, axilla, palm, lateral finger, femur, and plantar skin. The concentrations of human and bacterial DNA were quantified, and QIIME2 and MicrobiomeAnalyst platforms were used for microbial analysis. Forehead and cheek microbiome compositions were similar, with higher proportions of <em>Streptococcus</em> than that at other sites. Palm and lateral finger microbiome compositions were also similar, with higher proportions of <em>Haemophilus</em> than that at other sites. <em>Lawsonella</em> was specifically observed on the scalp, while <em>Mycoplasma</em> was found on cervical vertebrae. <em>Staphylococcus</em>, observed on all sites, was particularly predominant on axilla. The microbial composition of plantar was distinct, with no prevalent genus compared to that at other sites. Further research analyzing skin microbiomes from forensic evidence could help identify the origin of skin samples, aiding in crime scene reconstruction. Comparing our findings from Korean participants with international studies, it suggests that expanding research to include diverse populations could reveal regional and national differences in skin microbiomes, providing valuable insights for forensic science.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102706"},"PeriodicalIF":1.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151748","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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