InDEL instability in two different tumoral tissues and its forensic significance.

There may be cases where malignant tumor samples can be used for forensic DNA profiling studies. STRs are the first systems preferred in forensic science laboratories for identification purposes. However, genetic instability in tumoral tissues causes STR polymorphism to change, leading to erroneous results. On the other hand, insertion/deletion polymorphism (InDels) are used as genetic markers in forensic science, as they have features that make both STR and SNPs preferable. Although previous studies approved that STR instability is observed in many different tumors, there are only a few studies that have displayed the instability of InDels in tumoral tissues before. In this study, it was aimed to determine whether instability is observed in formalin-fixed paraffin-embedded breast and thyroid tumoral tissues at 36plex InDel Panel. A total of 47 cases, 26 of which were diagnosed as breast cancer and 21 as thyroid cancer, were included in the study. In 21 of 26 (80.76%) breast cancers mutational changes were observed, however only 6 of 21 (28.57%) thyroid carcinoma cases displayed instability.Moreover, in these six cases, mutations were detected at only 1 or 2 loci. The most common change in both tissues was loss of heterozygosity. These findings suggest that paraffin embedded tissues of thyroid tumor can be used in cases of forensic genetic identification, however paraffin embedded breast cancer tissues should be examined with care. In conclusion, low InDel mutation rates compared to STR instability, make InDel analysis from paraffin blocks suitable for forensic genetic identification. However, researchers should keep in mind that there may be differences between the profiles of the tumoral tissues taken as reference and the actual case. In addition, by incorporating additional markers such as SNPs and microhaplotypes with low mutation rates into the study alongside Indels, researchers can significantly enhance the discrimination power in identification processes.

Epigenetic-based age prediction in blood samples: Model development.

Aging is a complex process influenced by genetic, epigenetic, and environmental factors that lead to tissue deterioration and frailty. Epigenetic mechanisms, such as DNA methylation, play a significant role in gene expression regulation and aging. This study presents a new age estimation model developed for the Turkish population using blood samples. Eight CpG sites in loci TOM1L1, ELOVL2, ASPA, FHL2, C1orf132, CCDC102B, cg07082267, and RASSF5 were selected based on their correlation with age. Methylation patterns of these sites were analyzed in blood samples from 100 volunteers, grouped into age categories (20-35, 36-55, and ≥56). Sensitivity analysis indicated a reliable performance with DNA inputs ≥1 ng. Statistical modeling, utilizing Multiple Linear Regression, underscores the reliability of the primary 6-CpG model, excluding cg07082267 and TOM1L1. This model demonstrates strong correlations with chronological age (r = 0.941) and explains 88% of the age variance with low error rates (MAE = 4.07, RMSE = 5.73 years). Validation procedures, including a training-test split and fivefold cross-validation, consistently confirm the model's accuracy and consistency. The study indicates minimal variation in error scores across age cohorts and no significant gender differences. The developed model showed strong predictive accuracy, with the ability to estimate age within certain prediction intervals. This study contributes to the age prediction by using DNA methylation patterns, which can have disparate applications, including forensic and clinical assessments.

The potential of Raman and FT-IR spectroscopic methods for the detection of chlorine in human nail samples.

Although chlorine (Cl2) has been used as a chemical warfare agent since World War I there is no known specific and reliable biomarker to indicate the presence of chlorine. We distinguished chlorinated human nails from unchlorinated ones using Raman spectroscopy and Fourier Transform Infrared (FT-IR) Spectroscopy. This research was carried out between October 2018 and July 2019 on two nail samples taken from 55 male and 104 female volunteers. One sample from each participant was chlorinated, while the second sample was used as a control. Spectral data were collected from chlorinated and unchlorinated (control) human nails using Raman and FT-IR spectroscopy. Raman measurements were made between 100 and 3200 cm-1, while FT-IR measurements were recorded over the range of 650 to 4000 cm-1. Partial least squares regression-discriminant analysis (PLS-DA) was used to develop classification models for each spectral instrument. Results showed that the control and chlorinated nail samples were successfully discriminated with similar results achieved with both instruments. Minor differences were observed in the performance of classification models. The FT-IR spectroscopy model (sensitivity = 95%, specificity = 99%, accuracy = 97%) was found to be more successful with a smaller margin of error (sensitivity = 95%, specificity = 99%, accuracy = 96%) compared to the Raman spectroscopy model. This method can be used successfully for both ante-mortem and post-mortem diagnosis of chlorine exposure.

Femicide in Turkey between 2000 and 2010.

Although intimate partner violence (IPV) is an important problem that threatens women's health, very few studies focus on the victim-perpetrator relationship or examine this relationship across Turkey. The aim of this study is to contribute to a better understanding of femicide cases in Turkey and to describe the socio-demographic, clinical, forensic, and criminological characteristics of femicide victims and offenders. This study analysed 162 femicide cases that occurred in 12 cities in Turkey from 1 January 2000 to 31 December 2010. Eighty women were killed by their partners (classified as intimate partner femicide, IPF), and 81 women were killed by one of their relatives, friends, or strangers (classified as non-intimate partner femicide, non-IPF). According to our results, the typical IPF victim is of child-bearing age, does not have a paid job, is married or divorced, is killed in a domestic setting due to injuries to the thorax or abdomen produced by an edged/pointed weapon or firearm, and is possibly a victim of overkill. The typical IPF perpetrator is close to his victim's age, has a paid job, has no mental disability, owns a gun, and has threatened his partner or ex-partner previously because of jealousy/infidelity/honour or separation. The typical non-IPF victim is very similar to the IPF victim; however, her marital status can be single, married or divorced, and she is commonly killed by a relative. The surveillance and screening of femicide and IPV is an important step when analysing and attempting to prevent femicide. Second, the training and sensitization of health professionals are important. Moreover, health staff should be encouraged to participate in advocacy interventions. Third, gun ownership must be brought under control.

The pathology of lethal exposure to the Riot Control Agents: towards a forensics-based methodology for determining misuse.

The aim of this is to review deaths associated with the use of Riot Control Agents (RCAs) and to assess how the presenting pathologies is such cases may better inform cause of death conclusions upon autopsy. We also sought to present which additional steps should be added to the Minnesota protocol and the European harmonization of medico-legal autopsy rules in suspected cases of deaths associated with the use of RCAs. We included 10 lethal cases in our study. In three cases, RCAs were found to be the sole cause of death, in three cases RCAs were ruled a secondary cause of death due asphyxia or asthma subsequent to exposure to RCAs and in four cases RCAs were contributory factors to death. In three cases the responsible agents were identified as Chloroacetophenone (CN), Chlorobenzylidene malononitrile (CS) and Oleoresin capsicum (OC) and in the remaining 7 cases, the agent was OC alone. As there are no specific findings in suspected cases of death associated with RCA use, establishing cause of death and whether RCAs are the sole cause or only a contributory factor will be based on the elimination of other possible causes of death. For this reason, a specifically structured autopsy is essential. This specifically structured autopsy should contain basic principles of the Minnesota Protocol and the European harmonization of medico-legal autopsy rules with the following additional steps taken: examination of clothing, eyes, and skin; examination of pharyngeal, tracheobronchial, and eusophegeal mucosas; and a thorough recording of the steps taken by the party conducting the arrest, including other possible causes of in-custody death, as well as a detailed medical history of the deceased.

The approaches of physicians working in the field of pathology regarding forensic pathology practice and the training process.

OBJECTIVE: Forensic autopsies are performed by the forensic medicine department and the microscopic examination processes by pathology specialists within the forensic medicine practice in Turkey. This disconnection in the process raises problems in the training of both branches. The aim of this study was to determine the awareness of pathology staff on forensic medicine practices and responsibilities and their opinion on the pathology training model in the forensic medicine specialty and to discuss the matter within the framework of the present situation and global applications. MATERIAL AND METHOD: A 15-item questionnaire form distributed to the participant physicians during registration at the 21st National Pathology Congress held in 2011 was evaluated. RESULTS: 94 participants responded. A negative opinion was expressed by 72% about the interest in the general post-mortem process. The view that pathology specialists should undergo a separate training to perform autopsies was predominant and there was a general lack of interest in all kinds of autopsy processes. The percentage who said they knew the legal responsibility of a pathology specialist regarding forensic autopsies correctly was 37%. The questions "what are the necessary factors to contribute to the pathology training in forensic medicine" and "if anything is required, which of them would take priority" were respectively answered as "for me to be interested (46%)" and "a system guaranteeing that training will always be given by pathology specialists (67%)". Despite the possibility of becoming a forensic medicine specialist in two years, the mean answer score of the participants to the phrase "I do not consider becoming a forensic medicine specialist" was 4.1 (out of 5). CONCLUSION: A reluctance among the pathologists in our country was seen regarding forensic medicine specialists being able to perform post-mortem microscopic examination. However, despite their legal responsibilities, their interest in forensic pathology practice was low. There seems to be rational factor that would increase this interest in the near future. Cooperation is necessary to enable forensic medicine specialists to perform post-mortem pathology procedures. This cooperation should be based on improving the training of pathology research assistants.

Why did the patient die? The relationship between ambulance accidents and death of patients: forensic medical issues.

This article's aim is investigating traumatic consequences of ambulance accident on patients and discussing difficulties to give a decision about the relation between death and accident at these cases. The cases were selected among the forensic medical reports concluded between 1996 and 2005 years. They were documented for age, sex, causes of urgent call, localization and extent of traumatic lesion, properties of events and board decisions. A total of 21 cases were found. 15 cases died on the day of the accident. Skin injuries at head (8 cases) and legs (6 cases) were most common traumatic lesions. Totally 6 deaths were found related with ambulance accident. Death of patient after ambulance accidents may not be associated easily to the accident. Delay due to accident or concomitant contributing medical conditions may also facilitate the death in this type of cases. Reliable medical records were needed for accurate medicolegal evaluation.

Diffuse alveolar damage of the lungs in forensic autopsies: assessment of histopathological stages and causes of death.

INTRODUCTION: Diffuse alveolar damage (DAD) is a morphological prototype of acute interstitial pneumonia. Hospital autopsies or open-lung biopsies are used to monitor common alveolar damage and hyaline membrane (HM) development histopathologically. The aim of this study was to detect histopathological profiles and frequency of DAD and HM in adult forensic autopsies. MATERIALS AND METHODS: In total, 6813 reports with histopathological samples in 12,504 cases on which an autopsy was performed between 2006 and 2008 were investigated. Sixty-six individuals >18 years of age who were diagnosed with DAD were included. Hematoxylin- and eosin-stained lung preparations were reexamined in line with the 2002 American Thoracic Society/European Respiratory Society idiopathic interstitial pneumonia consensus criteria. RESULTS: Histopathological examination revealed that 50 cases (75.7%) were in the exudative phase and 16 (24.2%) were in the proliferative phase. Only the rate of alveolar exudate/oedema in exudative phase cases (P = 0.003); those of alveolar histiocytic desquamation (P = 0.037), alveolar fibrosis (P = 0.017), chronic inflammation (P = 0.02), and alveolar fibrin (P = 0.001) in proliferative cases were significantly higher. The presence of alveolar fibrin was the only independent variable in favour of proliferative cases (P = 0.016). CONCLUSION: The detection of all DAD morphological criteria with the same intensity is not always possible in each case. Forensic autopsies may provide a favourable means for expanding our knowledge about acute lung damage, DAD, and interstitial lung disease.

Upon a failure to equal entry and exit wounds: a possible case of tandem bullets in view of the literature.

Forensic medicine specialists take account of the projectiles remaining in the body when determining whether there are an equal number of entry and exit wounds. The absence of projectiles should suggest blank cartridges, a single exit wound despite several firings and bullet embolization, whereas the presence of more projectiles than expected may indicate tandem projectiles and multiple projectiles entering through the same hole. Radiological examination of the whole body, follow-up of the bullet trajectories, examination of the clothes, and examination of the gun and projectiles play a key role in solving difficult cases. We review such situations based on a case of tandem bullets. Two 7.65-mm bullets created lethal wounds entering through a 32-year-old victim's neck followed the same trajectory to a certain point and diverted. We discussed the possibilities in cases that show inequalities between entry and exit wounds, in light of relevant literature.

Prognostic significance of CD44 and c-erb-B2 protein overexpression in patients with gastric cancer.

BACKGROUND/AIMS: The aim of the study is to evaluate the correlation between c-erb-B2 and CD44 overexpression and survival of patients with gastric cancer. METHODOLOGY: The paraffin blocks of 48 patients with gastric carcinoma were retrospectively analyzed. The pathological specimens were stained with CD44 and c-erb-B2 by immunohistochemical methods. RESULTS: The positivity of c-erb-B2 was detected in 9 patients. In six of them, predominantly strong cytoplasmic staining was observed. The remaining three tumors were predominantly membranous stained. No correlation was found between the c-erb-B2 positivity and overall survival (OS). Seventeen specimens (35.4%) were CD44 positive, all localized in cell membrane. The median OS time of CD44 positive patients was worse than that of patients with CD44 negative (11 vs. 17 months, respectively). This difference was statistically significant (p=0.03). In 5 patients both CD44 and c-erb-B2 were detected as positive. However, there were 23 patients with both CD44 negative and c-erb-B2 negative. The median OS time for patients with both CD44 and cerb- B2 negative was better than those of patients with both CD44 and c-erb-B2 positive (37 vs. 11 months, respectively, p=0.03). The relationship between CD44 and c-erb-B2 positivities and clinicopathological factors (p>0.05). CONCLUSIONS: Our results showed that there was no correlation between c-erb-B2 positivity and OS, except for CD44. In addition, we found significant association of simultaneous positivities of c-erb-B2 and CD44 with OS of patients with gastric cancer. CD44 alone can be taken as a prognostic factor and also simultaneous overexpression of CD44 and c-erb-B2 may be used as a marker of poor prognosis.

Interinstitutional review of slides for forensic pathology: types of inconsistencies.

Because of the specific structure of forensic medicine in Turkey, reexamination of histopathologic specimens is a frequent practice. The aim of the present study is the assessment of microscopic diagnostic consistency in forensic pathology between different laboratories. Reports of the Council of Forensic Medicine between 2001 and 2004 were examined, and 150 cases with second pathologic examination were found. Results of histopathologic reports from peripheral laboratories were compared with those made by the Council pathologists with regard to diagnostic consistency. Consistency was assessed in 3 groups and 1 subgroup. Group 1, consistent and minor inconsistency; includes a major consistency subgroup. Group 2, major inconsistency, is the second diagnosis which is lethal; group 3, major inconsistency, is the first diagnosis which is lethal. The lung was found to be the organ with the highest frequency of diagnostic major inconsistency (group 2 and 3) and major consistency. Bronchopneumonia was the most common diagnosis. The brain had the highest frequency of intercenter diagnostic overall consistency (90.2%, group 1). Myocardial infarction was the diagnosis most frequently rejected on reevaluation (group 3). In conclusion, forensic pathology requires different experience than surgical ones. In cases of discrepancy between the anamnesis of the lethal event and pathologic findings, reevaluation of specimen is mandatory to avoid any diagnostic errors. Quality assurance systems with all include internal and external control mechanisms will improve the diagnostic reliability.

Microsurgical and histomorphometric study of the occipital sinus: quantitative measurements using a novel approach of stereology.

Quantitative descriptions of the occipital sinus are lacking in the extant medical literature. Posterior fossa duras with the superior sagittal sinus, the inferior and superior petrosal sinuses were dissected and taken out from fresh human cadavers by cutting at the superior sagittal sinus, the marginal sinuses and the petrosal sinuses bilaterally. The length of the occipital sinuses was measured using calipers. A 0.5-cm section of the occipital sinus was cut out at its midpoint and prepared for measurements of the perimeter and diameter using a stereology workstation. The sinuses were also examined qualitatively using a surgical microscope. There was no occipital sinus in 6.6% of total 30 cases. Multiple occipital sinuses were seen in 10%. In one specimen, the sinus seemed incomplete, failing to reach the marginal sinuses. Some specimens gave the impression that more than one occipital sinus was present, nevertheless, careful dissection showed connections. The breadth of the sinus steadily narrowed downward in direction of foramen magnum. The inner wall with many fibrous bridges was tight, except the lateral parts that were easily separated into two dural sheets. The length of the sinus varied from 10 to 37 mm. The inner diameter (feret maximum) varied from 0.33 to 7.06 mm at midpoint. The breadth of the multiple sinuses did not exceed the mean of our series except in one case. The occipital sinus, which is generally ellipsoid in shape, functions in the majority of cases as a thin, single midline sinus. It may have less resistant recesses laterally.

Methanol intoxication: pathological changes of central nervous system (17 cases).

The nervous system has increased susceptibility for methanol intoxication. The aim of this study is to investigate various central nervous system lesions of methanol intoxication in 17 cases autopsied in the mortuary department of the Council of Forensic Medicine in Istanbul, Turkey. The reasons of methanol intoxication in the cases was likely the unwitting ingestion of methanol while drinking illegal alcohol. Survival times ranged from several hours to days. In 8 cases (47%), cerebral edema and in 9 cases (53%) at occipital, temporal and parietal cortex, basal ganglia and pons, petechial bleeding was observed. In addition to these findings, hemorrhagic necrosis were observed in thalamus, putamen, and globus pallidus in 5 cases (29.4%) and, in cerebral cortex in another 3 cases (17.6%). In 3 of the cases (17.6%) in which cerebral edema was found, herniation findings accompanied to the situation and in 2 cases (11.7%), pons bleeding was observed. Around the basal ganglia, in 2 of the cases with hemorrhagic necrosis, the situation ended with a ventricular compression. In 7 cases (41%), the associated findings of chronic ischemic changes in cortical neurons, lacunae formation, degeneration of granular cell layer of the cerebellum, and reactive gliosis were considered as the results of chronic alcoholism.

Anterolateral approach to the cervical spine: major anatomical structures and landmarks. Technical note.

OBJECT: The authors undertook a study to explore the topographic anatomical features seen during the anterolateral approach to cervical spine, anatomical variations, and certain landmarks related to the surgical procedure. METHODS: The study was conducted in 30 fresh cadavers. RESULTS: The common carotid artery bifurcation was mostly found at the level of C-4 (78%). The inferior belly of the omohyoid muscle was seen to cross the sternocleidomastoid muscle at the C5-6 disc level along the entire C-6 vertebral body. To reach the lower cervical region, the sacrifice of this muscle makes the procedure easier. The facial vein drained into the internal jugular vein mostly at the level of C3-4 (54%). The superior ganglion of the cervical sympathetic chain was located at the C-4 vertebra, but the location of the intermediate ganglion exhibited some variation. The vertebral artery entered the transverse foramen of C-6 in 27 cadavers (90%), the transverse foramen of C-7 in two cadavers (7%), and the transverse foramen of C-4 in one cadaver (3%). Because the inferior thyroid artery crossed the C6-7 interspace obliquely, the course of the inferior thyroid artery may complicate the procedure. The C-5 uncinate process was shortest and narrowest and had the greatest distance from the medial edge of the process to the anterior tubercle (p < 0.001). CONCLUSIONS: Understanding the qualitative anatomy of this region not only improves the safety of anterior and anterolateral cervical spine surgery but also allows adequate decompression of neural elements and resolution of the other pathological processes of this region. In this fresh cadaveric study, our goal was to improve the approach and decrease the incidence of complications.

[Cardiac ruptures following myocardial infarction in medicolegal cases]. / Infarkt sonrasi gelisen kardiyak rüptürler; adli otopsi serisi.

OBJECTIVE: Characteristics of legal autopsy cases with cardiac rupture following myocardial infarction are investigated in this retrospective observational study and the results are compared with a control group consisting of acute myocardial infarction cases without rupture. METHODS: Legal autopsy reports of 50 cases with heart tamponade resulting from heart muscle rupture following myocardial infarction, autopsied at the Morgue Department of the Council of Forensic Medicine between the years 1998-2005 were retrospectively reviewed. Findings were compared to control group consisting of 30 myocardial infarction cases without rupture. RESULTS: The rupture was located in the left ventricle in 48 of 50 cases. At microscopic examination, infarction date was consistent with first three days, 4-7 days and 1-2 weeks for 30, 12 and 8 cases, respectively. The average volume of fluid leading to tamponade was 467 ml in males and 352.3 ml in females. There were no statistical differences between rupture and control groups for existence of hypertrophy and scar tissue in myocardium and advanced atheromatous lesions in coronaries (p>0.05). Considering the manner of death of the cases died due to heart wall rupture and tamponade formation, 28 of the cases were found dead at home, 6 died suddenly by falling to the ground at home or on the street, and 5 were delivered dead to the hospital. CONCLUSION: The rupture was located in the left ventricle in almost all cases. Ruptures in the left ventricle were found most frequently in the anterior wall. There was no relationship between development of rupture and existence of hypertrophy and scar tissue in myocardium, and advanced atheromatous lesions in coronaries.