Sharp bone trauma diagnosis: a validation study using epifluorescence microscopy.

Identifying tool mark and involved weapon in sharp force trauma is essential to understanding the circumstances of death. But accuracy and reliability of such expert testimony remains unknown, and validation studies are rare in forensic literature. That is why, we conducted an experiment in order to determine error rates and predictive values on identifying the right implement through different types of knife-inflicted trauma. Human bone cut marks were analysed through epifluorescence microscopy. The samples were examined through a randomised, blinded, controlled study by three researchers with varying degrees of experience with direct and indirect observation of cut marks (photography). Our results showed that identifying the weapon involved is possible thanks to numerous criteria analysis. Correct classification rates were high and misclassifications rare. Asymmetric blades obtained better results than symmetric blades. Predictive values were also calculated, and the negative one reached very high levels, near 100% with regard to all the implements. Positive predictive values were more variable. But even if individual diagnoses remain in doubt, triage can be done and tools not implicated in injury can be eliminated with certainty. Moreover, our work clearly highlighted the importance of experience in such activities. A high level of experience is fundamental to obtain the best values, especially in such a context where evidence reliability is extremely important for forensic admissibility testimony in the court.

An automated landmark method to describe geometric changes in the human mandible during growth.

OBJECTIVE: The principal aim of this study was to assess an automatic landmarking approach to human mandibles based on the atlas method. The secondary aim was to identify the areas of greatest variation in the mandibles of middle-aged to older adults. DESIGN: Our sample consisted of 160 mandibles from computed tomography scans of 80 men and 80 women aged between 40 and 79 years. Eleven anatomical landmarks were placed manually on mandibles. The automated landmarking through point cloud alignment and correspondence (ALPACA) method implemented in 3D Slicer was used to automatically place landmarks to all meshes. Euclidean distances, normalized centroid size, and Procrustes ANOVA were calculated for both methods. A pseudo-landmarks approach was followed using ALPACA to identify areas of changes among our sample. RESULTS: The ALPACA method showed significant differences in Euclidean distances for all landmarks compared to the manual method. A mean Euclidean distance of 1.7 mm was found for the ALPACA method and 0.99 mm for the manual method. Both methods found that sex, age, and size had a significant effect on mandibular shape. The greatest variations were observed in the condyle, ramus, and symphysis regions. CONCLUSION: The results obtained using the ALPACA method are acceptable and promising. This approach can automatically place landmarks with an average accuracy of less than 2 mm, which may be sufficient in most anthropometric analyses. In the light of our results, however, odontological application such as occlusal analysis is not recommended.

Root and canal morphology of the permanent teeth in medieval and current French population.

OBJECTIVE: This work describes and compares the root and root canal morphology of a medieval population dating from the 8th to 10th century from the southwest of France, and a current French population. DESIGN: The root morphology of 579 teeth from 70 medieval individuals was analyzed using cone beam computed tomography, and compared with 690 teeth from a current French population of 329 individuals. The Vertucci classification was used to describe the root canal configuration. RESULTS: In the medieval population, the maxillary first premolar usually had one root. In contrast, in the current population this tooth predominantly had two roots, and the three-root form had appeared. Mandibular canine with two roots was observed in 5.7% of cases, and in the current population this form was found in 1.6% but the difference was not significative. The greatest variability between the two populations in terms of root canal configuration was in one-rooted maxillary first and second premolars, the mandibular canines, and the distal roots of the mandibular first molars. Differences in root numbers and canal configurations of the maxillary molars investigated among the two populations were not significant. CONCLUSIONS: This study indicated that the upper first premolar of the current population tended to have more than one root, while this tooth type of the medieval group mostly appeared with only one. For the root canal configuration, studies in the upper premolars, lower canines and first molars of the current population apparently revealed a significant simplification compared with the ancient group.

[Damage repair in breast cancer has to evolve]. / Évaluation du dommage corporel en sénologie : une nécessaire évolution.

Breast damage is likely to result in compensation according to the principle of full compensation. However, breast damage, little covered in the scales usually used, requires a specific methodology. The quantification of functional prejudice must be done with regard to the age of the victim and must take into account the possible repercussions on mobility (shoulder and/or spine) as well as the psychological repercussions. Whether or not the nipple and areola are preserved should be described. Temporary aesthetic damage (before breast reconstruction) must be assessed on the basis of objective elements, its duration and quantification on a scale of 0 to 7. Permanent aesthetic damage takes into account scars, deformities, amputations and quality of the prosthesis. A new scale for evaluating permanent aesthetic damage is proposed. Sexual prejudice must take into account an impairment of the pleasure related to sexuality and its erotic function, in line with the concept of sexual health. However, even after reconstruction, the areas of quality of sexual life and sexual satisfaction often remain affected. An exploration using standardized questions from validated questionnaires such as BREAST-Q can be useful. The sequelae linked to the damage on a breast can also lead the woman to limit certain pleasure activities, in particular because of psychological discomfort or even be the cause of a loss of opportunity to carry out a family's life plan.

Three-dimensional analysis of bitemarks: A validation study using an intraoral scanner.

Conservation of the three-dimensional aspect of bitemarks optimizes their analysis. Although bitemarks could be recorded with a surface scanner, in clinical dentistry, intraoral scanners are used as an alternative to conventional dental impressions. Here we assess the reproducibility and the reliability of a three-dimensional bitemark analysis protocol using an intraoral scanner. Twenty-seven volunteers bit on different materials: dental wax, hard cheese, chocolate and apple. Then, bitemarks and dentitions were scanned with the PlanMeca® Emerald intraoral scanner and the scans obtained were exported into the mesh comparison software, CloudCompare®, which can generate overlays automatically. For this purpose, dentitions were aligned and compared with the indentations. The meshing and non-meshing areas were visualized using a colorimetric scale. First, the same blinded observer compared the bitten materials by analyzing 256 meshing areas for each. Secondly, comparisons of bitemarks from wax were analyzed in a randomized blinded study involving four observers (dentist, dental student, forensic scientist and police officer) and predictive values were calculated. The wax support obtained the best result and apple the worst. The rate of correct classifications was high and misclassification was rare. For the all observers, negative predictive values were near 100%. Positive predictive values were more variable. Moreover, the work clearly highlighted the importance of experience in odontology.

Old hearts for modern investigations: CT and MR for archaeological human hearts remains.

INTRODUCTION: Among 800 burials dated between the 15th and 18th centuries and found in the center of Rennes (Brittany, France), a collection of five heart-shaped lead urns was discovered. This material was studied using classical methods (external study, autopsy and histology), and also modern imaging like computed tomography (CT), magnetic resonance (MR) before and after coronary opacification. The aim of this manuscript is to describe different steps of ancient soft tissues study, especially using imaging techniques. METHODS: The study gathered various specialists: anthropologists, archeologists, forensic pathologists, radiologists, pathologic physicians, and physicists. Imaging techniques were performed, before and after coronary opacification. Finally, hearts were autopsied and different histological samples were analyzed. RESULTS: Only heart n°2 was too damaged to be studied. Heart n°3 was considered as normal using all investigation techniques. The study of Hearts n°s 4 and 5 revealed dilated cardiomyopathy while Heart n°1 showed important signs of diffuse hypertrophic cardiomyopathy. Different fibro lipid plaques were identified using imaging techniques, and were confirmed by histology. CONCLUSIONS: The study of archeological soft tissues using modern imaging is possible if the material is well-preserved. This type of research can uncover principal findings, allowing scientists to establish diseases of ancient times.

[Practical guide to the examination and interpretation of genital lesions of minor female victims of sexual assault]. / Victimes féminines mineures d'agressions sexuelles : guide pratique pour l'examen et l'interprétation des lésions génitales.

Through a comprehensive review of the literature on sexual assault, the authors propose to clarify the different stages of the exam and help the practitioner to the forensic interpretation of lesions. The authors describe the basic principles that make consensus in how to interview victims in order to increase the reliability of the information collected. The various medical data that must be collected allowing to guide diagnosis (urogenital symptoms, sexual behaviour disorder) or facilitate the interpretation of lesions (age of puberty, use of tampons…) are specified as well as the different positions of examination and their association to other complementary techniques (Foley catheter, colposcopy, toluidine blue). The authors present a simple decision tree that can help the practitioner to interpret the laceration of the hymen. They detail the description and forensic interpretation of all genital lesions that may be encountered as a result of sexual assault, and the pitfalls to avoid. Finally, two main problems in the interpretation of lesions are described, the absence of injury after penetration and the accidental genital lesions.

Virtual anthropology and forensic identification using multidetector CT.

Virtual anthropology is made possible by modern cross-sectional imaging. Multislice CT (MSCT) can be used for comparative bone and dental identification, reconstructive identification and lesion identification. Comparative identification, the comparison of ante- and post-mortem imaging data, can be performed on both teeth and bones. Reconstructive identification, a considerable challenge for the radiologist, identifies the deceased by determining sex, geographical origin, stature and age at death. Lesion identification combines virtual autopsy and virtual anthropology. MSCT can be useful in palaeopathology, seeking arthropathy, infection, oral pathology, trauma, tumours, haematological disorders, stress indicators or occupational stress in bones and teeth. We examine some of the possibilities offered by this new radiological subspeciality that adds a new dimension to the work of the forensic radiologist. A multidisciplinary approach is crucial and involves communication and data exchange between radiologists, forensic pathologists, anthropologists and radiographers.

The usefulness of post-mortem CT angiography in injuries caused by falling from considerable heights: three fatal cases.

OBJECTIVE: Post-mortem computed tomography is a diagnostic tool forming part of the arsenal available to forensic pathologists today. In addition to its usefulness in detecting bone lesions, which has long been recognized, this technique has nowadays been enhanced by the development of CT angiography. The role of multiphase post-mortem computed tomography angiography (multiphase PMCTA) is primordial, improving detection of solid organ lesions and permitting vascular lesions to be visualized directly. MATERIAL AND METHODS: Our paper presents a series of three deaths by falling from a considerable height recorded since the beginning of 2012. We report the usefulness of PMCTA and the various mechanisms involved in the trauma. RESULTS: Most of the lesions were diagnosed by both PMCTA and autopsy, including the rare lesions, but the peripheral bone lesions and the hemopneumatocele were diagnosed only by PMCTA, while dislocation of vertebrae and the testicular fractures were detected solely by autopsy. CONCLUSION: PMCTA is a new, minimally-invasive technique which, combined with autopsy, provides better visualization and detection of certain lesions, particularly in the case of death by falling from a great height.

Relationship between outer membrane protein profiles and resistance to ceftazidime, imipenem, and ciprofloxacin in Pseudomonas aeruginosa isolates from bacteremic patients.

Outer membrane protein (OMP) profiles of 122 Pseudomonas aeruginosa isolates recovered from the blood of bacteremic patients were analyzed to relate alterations in the expression of OMPs with porin activity to resistance to imipenem, ceftazidime, and ciprofloxacin. Imipenem-resistant isolates lacked or expressed reduced amounts of porin OprD. In contrast, alterations of OMP profiles were absent in most ceftazidime-resistant isolates. Six of 12 ciprofloxacin-resistant isolates had normal OMP profiles. The remaining isolates showed alterations in the expression of either OprC, OprF, or OprD. In addition, imipenem- and ceftazidime-resistant isolates displayed a beta-lactamase activity compatible with that of a group 1 chromosomal cephalosporinase.