Detrimental effects of scene manipulations on temperature-based time since death estimation.

In forensic casework, time since death (TSD) estimations may play a crucial role to establish chains of events as well as for alibi assessment in homicide cases. Classical TSD estimation relies on reasonably stable ambient temperatures and a correct documentation of ambient and rectal temperatures. This constancy is in some cases disturbed by post-discovery alterations of the crime scene, e.g. opening a window. In order to develop a better understanding of this alteration-based detrimental impact on TSD estimation as well as to identify feasible recommendations for casework, the present pilot study examined ambient temperature effects of different window opening scenarios regarding various time intervals (5 to 360 min) in a furnished 10 m2 apartment during winter. In this context, in addition to the ambient temperature and thus the cooling rate of the room, re-approximation to initial room temperature, potential influences on a nomogram-based time since death estimation using a fictitious case, and the impact of the measurement height above the ground were investigated. Our data indicate a significant reduction of the mean temperature decrease rate after 15 min regardless of the remaining opening time and a correlation with the size of the respective opening surfaces. Re-approximation to initial room temperatures was observed with up to three times longer than the initial opening time. There was no evidence of a substantial advantage of temperature measurements above the level of the corpse (> 0.1 m). The limitations of the study and its applicability for forensic casework are critically reviewed.

Forensic, legal, and clinical aspects of deaths associated with implanted cardiac devices.

As the population ages, the prevalence of heart failure and individuals wearing an implanted cardiac device is increasing. The combination of different underlying pathophysiologies and (the combination of) implanted cardiac devices can become a challenge with regard to the determination of cause and manner of death in such individuals. Additionally, heart disease is frequently associated with mental disease, ranging from anxiety and depression to suicidality and suicide (attempts). At the same time, the correct diagnosis of cause and manner of death is the basis for quality assurance, further therapeutic advances, legal safety, and suicide prevention. By that, an interdisciplinary field between legal medicine, clinicians, and law enforcement opens up. In this field, the different participants can simultaneously benefit from and need each other. For example, legal medicine experts need investigatory results and clinical expertise for the interpretation of readout data of implanted cardiac devices in order to correctly determine the cause of death. A correctly determined cause of death can assist law enforcement and help clinicians to further improve various therapeutic approaches based on correct mortality data collection. In addition, it is the basis for identification of suicides of device carriers, allowing psychological and psychiatric experts to better understand the burden of mental disease in this particular cohort. Against this interdisciplinary background, this manuscript summarizes information about psychiatric comorbidities and suicidality while being on a device. Thereby, basic information on complications and malfunctions of implanted cardiac devices, device-associated deaths with particular emphasis on device manipulation is displayed as basic information needed for correct determination of the cause of death. Also, legal and ethical issues in this field are outlined. The final result is a proposal of an interdisciplinary assessment workflow for a conjoint approach to improve the diagnosis of deaths associated with implanted cardiac devices. It will allow for a differentiation between an individual who died with or due to the device.

"Scalping" in the context of criminal dismemberment and mutilation-a case report and review of the literature.

We report on a case of criminal dismemberment and attempted scalping of a homicide victim with a "Mohawk" haircut. Case findings are presented. A review of the literature was performed for scalping in its historical and cultural context and particularly in criminal dismemberment and mutilation: Historically, scalping was prevalent in many ancient cultures around the world, where scalps were taken as trophies or "proof of kill", much like shrunken heads, trophy skulls, and other artefacts. Scalping was particularly widespread in Northern America in the context of tribal warfare, both before and after colonization. The iconic "Mohawk" haircut is closely linked with scalping, as it was meant to taunt the enemy. In the modern forensic context, scalping constitutes a form of criminal mutilation. However, cases of criminal dismemberment and mutilation are rare in forensic casework. Our literature review revealed a low number of scalping in criminal dismemberment and mutilation cases. The documentation was overall poor. Positioning scalping within the classification of criminal mutilation and dismemberment was difficult. In literature, even though case numbers were small, the majority of "textbook scalping" cases were German. The presented case, to our best knowledge, is the first modern-day photo-documented case of (attempted) scalping, even more so of a person wearing a "Mohawk".

Gunshots through laminated glass: expelled compounded fragments as a function of bullet type.

In the frame of an experimental setting, the formation of round-shaped compounded glass fragments on the exit site after gunshots through a windshield was examined. For that purpose, a 9 × 19 mm pistol (HK P30) and two different cartridges containing (a) a full metal jacketed round-nosed projectile and (b) a deformation projectile were used. On the basis of 52 gunshots, the morphology, impact angles and terminal ballistics of occurring compounded glass fragments were examined. The results showed that the compounded glass fragments' morphology allowed for the differentiation of two used projectiles. Fragments were able to cause round-shaped defects in a single cotton layer (T-shirt) with subsequent penetration of up to 2.4 cm into ballistic gelatin (10%, 4 °C). As a function of the projectile type, the compounded glass fragments showed different reproducible impact angles that differed notably from the known conical pattern of expelled glass fragments after bullet penetration. These findings might help to explain the atypical morphology of gunshot wounds with laminated glass as an intermediate target and prevent possible misinterpretations when reconstructing the sequence of events.

Diagnostics of messenger ribonucleic acid (mRNA) severe acute respiratory syndrome-corona virus­2 (SARS-CoV­2) vaccination-associated myocarditis-A systematic review.

Background: During the recent pandemic with the severe acute respiratory syndrome-corona virus­2 the first messenger ribonucleic acid (mRNA) vaccines were approved. To facilitate mass vaccination, confidence of the general population in these new vaccines is mandatory, which is in turn strongly dependent on the availability of reliable data on complications. Objective: Summary of the current knowledge on mRNA vaccination-associated myocarditis as a potentially fatal side effect. Methods: Systematic literature review. Results: Diagnostic algorithm for the postmortem diagnosis of mRNA vaccination-associated myocarditis. Conclusion: Autopsy series of fatalities following mRNA SARS-CoV­2 vaccination up to 6 weeks with subsequent sophisticated and interdisciplinary work-up are necessary to complement clinical data on vaccination-associated myocarditis, especially regarding the incidence of fatal courses. Supplementary Information: The online version of this article (10.1007/s00194-022-00587-9) includes a PDF file with supplemental clinical features.

Atypical wound trajectory after a tangential pistol shot.

Three intermediate-range shots from a Browning, model 1955, 7.65 mm caliber, pistol were fired from the driver's seat of a car at a woman in the passenger seat. She sustained three wounds: An, ultimately fatal, penetrating head wound, a graze wound across her forehead, and a tangential, perforating, wound, with bullet entry over the medial sternum and exit through the right flank. Neither postmortem CT nor forensic autopsy discovered bony thoracic injuries or perforations of the thoracoabdominal cavities. There was pulmonary contusion in the medial lobe of the right lung and hemorrhage in the adipose tissue around the right kidney. The tangential bullet had left an almost 40-cm-long wound channel through a pronounced layer of subcutaneous fat. Based on 3D reconstructed CT-data determinations, a straight bullet trajectory between entry and exit wounds would have traversed the abdominothoracic cavities, right lung, and liver. The actual trajectory, however, described a prominent curve, without signs of deflection by bone. Postulated explanations for this unusual bullet track are that the woman was twisting her body in a dynamic scene when the bullet struck; further, due to its shallow angle of incidence on the skin, the bullet was deflected to an intracutaneous path. Additionally, soft tissue resistance may have caused the bullet to yaw. Caution should, thus, be exercised when reconstructing bullet trajectories solely from entry and exist wounds, also for bullet wounds through basically homogenous soft tissues.

Bioarchaeological investigations of the princely grave at Helmsdorf attesting to the violent death of an Early Bronze Age leader.

The Helmsdorf "princely" tomb, excavated at the beginning of the twentieth century, is one of the most important archaeological discoveries dating from the Early Bronze Age in central Germany. In addition to the burial inventory, which points to an elevated social position of the deceased, a number of highly fragmented skeletal remains were preserved. Forensic anthropological investigation identified three distinctive bone defects, the surfaces of which were macromorphologically and microscopically examined in greater detail. Micro-CT analyses were also carried out. The results of all examinations suggested that the defects represented three perimortem injuries. The wound morphology was indicative of the use of a bladed weapon. The combination of injuries and their locations supported the assumption of a targeted use of force to kill. A comparison of Early Bronze Age weapons and tools with the bone lesions led to the identification of a type of weapon possibly used in the attack.

Body-kun/body-chan style model figures for artists in forensic visualization applications.

Posture and body position are often in the focus of forensic medicine. Visualization for the purposes of documentation, teaching, scientific presentation or expert opinion in court is often desired. Plenty of possible tools to support visualization are available. However, there is a significant gap between quick drawings and more complex techniques. Body-chan (female) and body-kun (male) artist's model figurines (genericized trademark) may provide a useful means to fill this gap. These models, about 12-15 cm in height, are multi-articulated humanoids of realistic proportions, intended to serve as models for manga (japanese comic) drawing. Plenty of different models are available in different quality which usually are equipped with interchangeable hand and feet attachments, a frame for 'levitating' positions as well as assorted objects to scale. These inexpensive models may be positioned quickly and intuitively. Photodocumentation from various angles can be performed using a mobile phone camera. Images may be further improved applying digital image manipulation software. Taken together, the process is quick and intuitive and the level of achievable complexity is sufficient for many forensic applications.

Assessment of renal glomerulosclerosis and thickness of the carotid intima-media complex as a means of age estimation in Western European bodies.

INTRODUCTION: The estimation of age-at-death of unidentified cadavers is a central aspect of the identification process. With increasing age, the incidence of glomerulosclerosis and the thickness of the carotid wall have been observed to also increase. This correlation has been demonstrated in various international histological studies. The aim of our study was to assess whether these correlations also apply to a Western European population. METHODOLOGY: In this retrospective observational study, kidney and common carotid artery samples from 216 cases autopsied at the Institute of Legal Medicine at the Justus-Liebig University in Giessen, Germany, were examined. Only cases with available tissue samples from both body sides were included. Exclusion criteria were poor sample quality and an age younger than 21 years. After histological processing, the tissue samples were assessed and digitally evaluated. Regression and classification analyses were used to investigate the correlation between age-at-death and intima-media thickness and age-at-death and the incidence of renal glomerular sclerosis. RESULTS: Of the 216 autopsy cases, 183 were included for evaluation. Analysis of the carotid artery segments showed a strong correlation (Pearson correlation coefficient r = 0.887) between the intima-media-complex thickness and chronological age. Classification of the glomerulosclerotic incidence showed a correlation of 37.7-43.1% with the predicted age group. DISCUSSION: Both the intima-media thickness and the proportion of sclerotic glomeruli can be used to estimate age in Western European cadavers. On the basis of these results, both methods are suited to supplement other already established methods for age-at-death estimation in the identification of an unknown cadaver.

Retrograde dye perfusion of the proximal aorta - A postmortem technical study.

Introduction: Multiple cardiovascular conditions can lead to unexpected fatality, which is defined as sudden cardiac death. One of these potentially underlying conditions is aortic regurgitation, which can be caused by discrete changes of the geometry of the proximal aorta. To analyze aortic valve competency and furthermore to elucidate underlying pathological alterations of the coronary arteries and the vasa vasorum a perfusion method to simulate a diastolic state was designed. Material and methods: A postmortem approach with retrograde perfusion of the ascending aorta with methylene blue was applied to three bodies. The procedure comprised cannulation of the brachiocephalic trunk, clamping of the aortic arch between brachiocephalic trunk and left carotid artery, infusion of 250 ml of methylene blue, and optical clearing of the superficial tissue layers after perfusion. Organs were examined directly following perfusion and after optical clearing. Results: Assessment and visualization of aortic valve competency and the vasa vasorum were possible in all three instances. Visualization of the coronary perfusion was impaired by postmortem thrombus formation. Optical clearing did not provide additional information. Discussion: The method presented here is a time- and cost-efficient way of visualizing aortic valve competency and the vasa vasorum. The visualization of the vasa vasorum highlights the potential of this method in basic research on diseases of the great arteries and coronaries. However, for a time-efficient functional analysis of the coronaries, other methods must be applied.

Application of the "bubbling" procedure to dead body portraits in forensic identification.

PURPOSE: A procedure is needed for bodies with disfiguring injuries to the face and the use of their portrait for visual identification. METHOD: We present the application of a simple image processing procedure, otherwise known as "bubbling," which is based on the concept of "perceptual filling-in," to images for visual identification in the forensic context. The method is straight forward and can be performed using readily available software and hardware.. RESULTS: The method is demonstrated and examples are shown. The visual recognition of known persons using "bubbled" images was successfully tested. CONCLUSION: The "bubbling" procedure for visual identification enhancement is quick and straightforward and may be attempted before escalating to more involved identification methods and procedures.

Aortic Regurgitation Is Associated With Ascending Aortic Remodeling in the Nondilated Aorta.

OBJECTIVE: The probability of aortic complications in patients with bicuspid aortic valve is higher in association with aortic regurgitation (AR) compared with aortic stenosis (AS) or normally functioning valves. The objective of this study was to determine whether this is related to the specific characteristics of aneurysmatic dilatation that includes AR or whether AR itself has a negative impact on the aortic wall, independent of aneurysmatic dilatation. Approach and Results: Nondilated aortic specimens were harvested intraoperatively from individuals with tricuspid aortic valves and either AS (n=10) or AR (n=16). For controls, nondilated aortas were harvested during autopsies from individuals with tricuspid aortic valves and no evidence of aortic valve disease (n=10). Histological and immunohistochemical analyses revealed that compared with control aortas, overall medial degeneration was more severe in AR-aortas (P=0.005) but not AS-aortas (P=0.23). This pathological remodeling included mucoid extracellular matrix accumulation (P=0.005), elastin loss (P=0.003), elastin fragmentation (P=0.008), and decreased expression of fibrillin (P=0.003) and collagen (P=0.008). Furthermore, eNOS (endothelial nitric oxide synthase) expression was decreased in the intima (P=0.0008) and in vasa vasorum (P=0.004) of AR-aortas but not AS-aortas (all P>0.05). Likewise, subendothelial apoptosis was increased in AR-aortas (P=0.03) but not AS-aortas (P=0.50). CONCLUSIONS: AR has a negative effect on the nondilated ascending aortic wall. Accordingly, our results support the need for more detailed studies of the aortic wall in relation to aortic valve disease and may ultimately lead to more aggressive clinical monitoring and/or surgical criteria for patients with relevant AR. Graphic Abstract: A graphic abstract is available for this article.

Relative blood loss in forensic medicine-do we need a change in doctrine?

In forensic medicine, blood loss is encountered frequently, either as a cause of death or as a contributing factor. Here, risk to life and lethality assessment is based on the concept of relative blood loss (absolute loss out of total volume). In emergency medicine, the Advanced Trauma Life Support (ATLSⓇ) classification also refers to relative blood loss. We tested the validity of relative blood loss benchmarks with reference to lethality. Depending on the quality of the total blood volume (TBV) estimation formula, relative blood loss rates should be reflected in the case cohort as significantly higher absolute blood loss in heavier individuals since all TBV estimation formulas positively correlate body weight with TBV. METHOD: 80 autopsy cases with sudden, quantifiable, exclusively internal blood loss were retrospectively analyzed and a total of 8 different formulas for TBV estimation were applied. RESULTS: No statistical correlation between body weight and absolute blood loss was found for any of the tested TBV estimation algorithms. All cases showed a wide spread of both absolute and relative blood loss. DISCUSSION: The principle of relative blood loss is of very limited use in casework. It opens the forensic expert opinion to unnecessary criticism and possible negative legal implications. CONCLUSION: We challenge the use of relative blood loss benchmarks in textbooks and practical casework and advocate for its elimination from the ATLSⓇ 's grading system. If necessary, we recommend the use of BMI-adjusted algorithms for TBV estimation.

Mongolian spots as a finding in forensic examinations of possible child abuse-implications for case work.

Mongolian spots (MS) are congenital dermal conditions resulting from neural crest-derived melanocytes migration to the skin during embryogenesis. MS incidences are highly variable in different populations. Morphologically, MS present as hyperpigmented maculae of varying size and form, ranging from round spots of 1 cm in diameter to extensive discolorations covering predominantly the lower back and buttocks. Due to their coloring, which is also dependent on the skin type, MS may mimic hematoma thus posing a challenge on the physician conducting examinations of children in cases of suspected child abuse. In the present study, MS incidences and distribution, as well as skin types, were documented in a collective of 253 children examined on the basis of suspected child abuse. From these data, a classification scheme was derived to document MS and to help identify cases with a need for recurrent examination for unambiguous interpretation of initial findings alongside the main decisive factors for re-examination such as general circumstances of the initial examination (e. g., experience of the examiner, lighting conditions) and given dermatological conditions of the patient (e. g., diaper rash).

A massacre of early Neolithic farmers in the high Pyrenees at Els Trocs, Spain.

Violence seems deeply rooted in human nature and an endemic potential for such is today frequently associated with differing ethnic, religious or socio-economic backgrounds. Ethnic nepotism is believed to be one of the main causes of inter-group violence in multi-ethnic societies. At the site of Els Trocs in the Spanish Pyrenees, rivalling groups of either migrating early farmers or farmers and indigenous hunter-gatherers collided violently around 5300 BCE. This clash apparently resulted in a massacre of the Els Trocs farmers. The overkill reaction was possibly triggered by xenophobia or massive disputes over resources or privileges. In the present, violence and xenophobia are controlled and sanctioned through social codes of conduct and institutions. So that, rather than representing an insurmountable evolutionary inheritance, violence and ethnic nepotism can be overcome and a sustainable future achieved through mutual respect, tolerance and openness to multi-ethnic societies.

Definitions of frontal bone inclination: Applicability and quantification.

In sex determination from crania, a "vertical" forehead is considered a female feature, while a "sloping" forehead is considered a male feature. Precise description of frontal inclination with a quantitative measure like an angle is considerably more difficult as it requires accurate identification of clearly defined craniometric points. In the literature, the morphognostic terms "frontal bone inclination," or "frontal profile," are defined in numerous ways. The aim of this study was to determine which of these frontal inclination definitions is best suited for sex estimation. In a study in the context of the digital forensic osteology project, 10 of the frontal angle definitions described in the literature were assessed for their usefulness in sex determination on 211 virtual crania, reconstructed from postmortem CT-data. Custom-developed software was used for the automated measurement of frontal bone inclination angles from lateral-profile, volume-rendered 3D cranial images in which 10 anthropometric landmarks had been manually marked. Discriminant function analysis was performed to determine if satisfactory accuracy rates for the classification of sex could be achieved with defined variables. Four of the ten examined definitions were found to be highly significant for sex determination; three of these, also provided satisfactory intra- and inter-observer reliability. The frontal angle according to Schwalbe provided the best accuracy rate of 75.4% and a critical discriminatory value (separation value) of 88.6°: angles greater than this, suggest female sex; angles smaller than this, suggest male sex. Further, the open-source, custom-developed software introduced here proved compatible with commonly used image-processing and statistical programs and allowed quick, automated, valid measurement of numerous cranial angles. Other craniometric angles can, thus, also be quickly and easily determined with this software.

Detectability, visualization, and DNA analysis of bloodstains after repainting the walls.

A recurrent observation in forensic casework is that culprits and/or their abettors attempt to remove or mask bloodstain patterns, e.g., by painting the walls. The present study was designed to elucidate whether luminol treatment of bloodstains on (a) plastered and (b) wallpapered walls may help with the visualization of respective patterns after being repainted beyond macroscopic recognition. Furthermore, wallpaper punches of luminol-positive spots were analyzed for DNA. The experiments showed that the prospects for visualization after a four- to sixfold paint application declined considerably as the drying time of the paint increased. A compelling explanation for this observation is that paint becomes increasingly resistant to water during the drying process after paint application. In these cases, moistening the surface in question with distilled water for 15 min has been proven to be a promising pretreatment before luminol application. DNA analysis revealed full STR profiles in 74% of luminol-positive wallpaper punches, whereas rubs of the aforementioned positively tested regions (luminol and human blood pretests) demonstrated negative results.

Morphometric investigations to assess the compatibility of mandible and skull.

When a morphologically separated skull and mandible are found in the same case context, the possibility of a match arises. Two criteria with which to determine a match are the rough articulation between the mandibular condyles and cranial base itself and, most importantly, the fit of the teeth. However, when there has been intravital or postmortem tooth loss, this important criterion is not available. To date, only Reichs (1989) has investigated further compatibility criteria to solve the question of putative commingling in a case where a mandible seemed to originate from a female, while all other bones originated from a male individual. In a different reported case (Preißler et al. 2017), a mandible seemed too big for a skull; DNA analysis, however, confirmed that both originated from the same female individual. To investigate the metric relationship between mandible and skull we measured the postmortem CT data records of 223 corpses (virtual skulls) in OsiriX© MD for the following linear parameters: bicondylar breadth (KDB), biradicular breadth (AUB), and bizygomatic breadth (ZYB). The indices KDB/ZYB and KDB/AUB were developed and used to define ranges for matches and mismatches. Furthermore, the intra-observer reliability for the method was assessed. An intraclass correlation coefficient of >0.99 for every parameter showed that the used measurements are highly reliable. The 2.5-97.5 percentile for the KDB/AUB index lay between 0.91 and 1.05, while the range for the KDB/ZYB index was between 0.87 and 1.00. Within these ranges, it is possible to roughly assess whether or not a mandible and skull might be compatible, even if this can only be verified by forensic DNA analysis. If an index value lies outside these ranges, it can be assumed that skull and mandible do not match. Future studies should include more samples from a broader population spectrum so that these metric relationships can be used for different populations.

The feasibility of physiologically based pharmacokinetic modeling in forensic medicine illustrated by the example of morphine.

In forensic medicine, expert opinion is often required concerning dose and time of intake of a substance, especially in the context of fatal intoxications. In the present case, a 98-year-old man died 4 days after admission to a hospital due to a femur neck fracture following a domestic fall in his retirement home. As he had obtained high morphine doses in the context of palliative therapy and a confusion of his supplemental magnesium tablets with a diuretic by the care retirement home was suspected by the relatives, a comprehensive postmortem examination was performed. Forensic toxicological GC- and LC-MS analyses revealed, besides propofol, ketamine, and a metamizole metabolite in blood and urine, toxic blood morphine concentrations of approximately 3 mg/l in femoral and 5 mg/l in heart blood as well as 2, 7, and 10 mg/kg morphine in brain, liver, and lung, respectively. A physiologically based pharmacokinetic (PBPK) model was developed and applied to examine whether the morphine concentrations were (i) in agreement with the morphine doses documented in the clinical records or (ii) due to an excessive morphine administration. PBPK model simulations argue against an overdosing of morphine. The immediate cause of death was respiratory and cardiovascular failure due to pneumonia following a fall, femur neck fracture, and immobilization accompanied by a high and probably toxic concentration of morphine, attributable to the administration under palliative care conditions. The presented case indicates that PBPK modeling can be a useful tool in forensic medicine, especially in question of a possible drug overdosing.

Comparison of imaging planes during CT-based evaluation of clavicular ossification: a multi-center study.

Determining the ossification stage of the medial clavicular epiphysis by computed tomography represents the currently recommended methodology for the question of whether a living individual has completed the 18th or 21st year of life. In the present study, thin-slice CT scans of 1078 sternoclavicular joints were reconstructed in axial and coronal image series and evaluated according to the two classification systems established for age diagnostics using the clavicle. Both image series (axial and coronal) were analyzed separately. When comparing the results of axial and coronal view, a different ossification stage was found in 35.6% of the clavicles. The results suggest an influence of the imaging plane on the process of stage determination. In order to further approximate the three-dimensional and asymmetrical structure of the epiphyseal ossification center, the usage of at least two different reformation types may be recommended. In practice, only those reference studies should be applied which exactly employed the same number and orientations of the reformation types that are going to be used in the respective routine case.