Gunshot wounds to the head: a comparison of postmortem magnetic resonance imaging, computed tomography, and autopsy.

BACKGROUND: Postmortem imaging has become a powerful diagnostic tool in forensics. Postmortem computed tomography (PMCT) is often used currently to complement and sometimes even replace an autopsy. PURPOSE: To compare PMCT, postmortem magnetic resonance imaging (PMMRI), and autopsy findings for gunshot wounds to the head. MATERIAL AND METHODS: Cross-sectional study. We performed a retrospective analysis of 24 cases with gunshot wounds to the head that underwent both PMCT and PMMRI between 2011 and 2018 at the Institute of Forensic Medicine, University of Zurich (Switzerland). RESULTS: Our study confirms that PMCT and, to a slightly lesser degree, PMMRI provide additional information that is valuable when combined with autopsy findings. Air embolism was solely detected in PMCT (67% vs. 0% at autopsy). A retained bullet or projectile and bone fragments were diagnosed more frequently with PMCT (42%, 67%, and 92%) than at autopsy (33%, 42%, and 46%). Soft tissue lesions were more often detected with PMMRI than with PMCT. With regard to autopsy, subdural hemorrhage and ventricular hemorrhage were slightly more frequently diagnosed with PMMRI (63% and 75% vs. 38% and 58% at autopsy). Intracerebral hemorrhage was by far most often diagnosed with PMMRI (92%) compared with both PMCT (38%) and autopsy (14%). CONCLUSION: All three modalities should ideally be considered in cases of craniocerebral gunshot wounds. However, it might be conceivable that depending on the forensic query, PMCT and PMMRI may be an adequate replacement for an autopsy.

Nonequilibrium Floquet Steady States of Time-Periodic Driven Luttinger Liquids.

Time-periodic driving facilitates a wealth of novel quantum states and quantum engineering. The interplay of Floquet states and strong interactions is particularly intriguing, which we study using time-periodic fields in a one-dimensional quantum gas, modeled by a Luttinger liquid with periodically changing interactions. By developing a time-periodic operator algebra, we are able to solve and analyze the complete set of nonequilibrium steady states in terms of a Floquet-Bogoliubov ansatz and known analytic functions. Complex valued Floquet eigenenergies occur when integer multiples of the driving frequency approximately match twice the dispersion energy, which correspond to resonant states. In experimental systems of Lieb-Liniger bosons we predict a change from power-law correlations to dominant collective density wave excitations at the corresponding wave numbers as the frequency is lowered below a characteristic cutoff.

Bosonic Continuum Theory of One-Dimensional Lattice Anyons.

Anyons with arbitrary exchange phases exist on 1D lattices in ultracold gases. Yet, known continuum theories in 1D do not match. We derive the continuum limit of 1D lattice anyons via interacting bosons. The theory maintains the exchange phase periodicity fully analogous to 2D anyons. This provides a mapping between experiments, lattice anyons, and continuum theories, including Kundu anyons with a natural regularization as a special case. We numerically estimate the Luttinger parameter as a function of the exchange angle to characterize long-range signatures of the theory and predict different velocities for left- and right-moving collective excitations.

Dirac Spin Liquid on the Spin-1/2 Triangular Heisenberg Antiferromagnet.

We study the spin liquid candidate of the spin-1/2 J_{1}-J_{2} Heisenberg antiferromagnet on the triangular lattice by means of density matrix renormalization group (DMRG) simulations. By applying an external Aharonov-Bohm flux insertion in an infinitely long cylinder, we find unambiguous evidence for gapless U(1) Dirac spin liquid behavior. The flux insertion overcomes the finite size restriction for energy gaps and clearly shows gapless behavior at the expected wave vectors. Using the DMRG transfer matrix, the low-lying excitation spectrum can be extracted, which shows characteristic Dirac cone structures of both spinon-bilinear and monopole excitations. Finally, we confirm that the entanglement entropy follows the predicted universal response under the flux insertion.

Fatal bilateral pneumothorax and generalized emphysema following contraindicated speaking-valve application.

We report a case of a contraindicated attachment of a speaking valve to a tracheal tube with an inflated cuff, which rapidly resulted in the patient's death. The attached one-way valve allowed unrestrained inspiration through the tracheal tube but prevented physiological expiration. The increased pulmonary pressure resulted in alveolar rupture and replaced expiration with a steady release of air into the peribronchial sheaths and the mediastinum, resulting in what is commonly known as the Macklin effect. From the mediastinum, air inflated both pleural cavities, the peritoneum, and the subcutaneous tissue of the entire body. No gas was found in the blood vessels, the brain, the bones, or in the inner organs. The entire air volume was estimated by radiological segmentation to be more than 25 l. This implies continuous inspiration, while expiration turned into an aberrant pulmonary decompression by whole-body gas-enclosure. Death ultimately resulted from asphyxia following bilateral (tension) pneumothorax.

Continuous Easy-Plane Deconfined Phase Transition on the Kagome Lattice.

We use large scale quantum Monte Carlo simulations to study an extended Hubbard model of hard core bosons on the kagome lattice. In the limit of strong nearest-neighbor interactions at 1/3 filling, the interplay between frustration and quantum fluctuations leads to a valence bond solid ground state. The system undergoes a quantum phase transition to a superfluid phase as the interaction strength is decreased. It is still under debate whether the transition is weakly first order or represents an unconventional continuous phase transition. We present a theory in terms of an easy plane noncompact CP^{1} gauge theory describing the phase transition at 1/3 filling. Utilizing large scale quantum Monte Carlo simulations with parallel tempering in the canonical ensemble up to 15552 spins, we provide evidence that the phase transition is continuous at exactly 1/3 filling. A careful finite size scaling analysis reveals an unconventional scaling behavior hinting at deconfined quantum criticality.

Perfect Spin Filter by Periodic Drive of a Ferromagnetic Quantum Barrier.

We consider the problem of particle tunneling through a periodically driven ferromagnetic quantum barrier connected to two leads. The barrier is modeled by an impurity site representing a ferromagnetic layer or a quantum dot in a tight-binding Hamiltonian with a local magnetic field and an ac-driven potential, which is solved using the Floquet formalism. The repulsive interactions in the quantum barrier are also taken into account. Our results show that the time-periodic potential causes sharp resonances of perfect transmission and reflection, which can be tuned by the frequency, the driving strength, and the magnetic field. We demonstrate that a device based on this configuration could act as a highly tunable spin valve for spintronic applications.

Movement of steel-jacketed projectiles in biological tissue in the magnetic field of a 3-T magnetic resonance unit.

PURPOSE: The fact that ferromagnetic bullets can move in air or gelatine when subjected to magnetic resonance (MR) units is well known. A previous study showed that the movement of 7.5-mm GP 11 Suisse bullets also depends on their orientation toward the gantry. In order to compare the movement in gelatine to that in real tissue, we decided to measure the movement of these bullets, as well as 9-mm Luger bullets, in the brain and liver. METHODS: The GP 11 and 9-mm Luger bullets were inserted into the fresh calf brain or pig liver either vertically or horizontally in the x- or z-axis to the gantry. Before and after exposure to a 3-T MR unit, their position was documented by CT. RESULTS: GP 11 bullets rotated more readily and in general proved to be more mobile than the 9-mm Luger. All GP 11 bullets and a large amount of the 9-mm Luger bullets exited the brain. Sliding toward the gantry was easier for 9-mm Luger bullets in the brain than in the liver. CONCLUSIONS: The orientation of a ferromagnetic object influences its mobility in a strong magnetic field. Tipping is easier than sliding for longish ferromagnetic projectiles, probably due to the lesser tissue resistance. The bullets moved more readily in biological tissue, especially brain tissue, compared to gelatine, thus implying that gelatine is not a suitable substitute for soft tissues when examining the movement of ferromagnetic objects in MR units.

Unexpected brain finding in pre-autopsy postmortem CT.

A case is presented in which pre-autopsy postmortem computed tomography (PMCT) revealed an unexpected brain abscess with a related frontal sinusitis and an erosion of the posterior wall of the frontal sinus. PMCT findings enabled the forensic pathologists to adapt protective measures during autopsy and protect their health from infection. Pre-autopsy PMCT has been also useful in the early differential diagnosis procedure. The complementary use of postmortem imaging and autopsy can improve the quality of forensic death investigations.

Quantum Domain Walls Induce Incommensurate Supersolid Phase on the Anisotropic Triangular Lattice.

We investigate the extended hard-core Bose-Hubbard model on the triangular lattice as a function of spatial anisotropy with respect to both hopping and nearest-neighbor interaction strength. At half-filling the system can be tuned from decoupled one-dimensional chains to a two-dimensional solid phase with alternating density order by adjusting the anisotropic coupling. At intermediate anisotropy, however, frustration effects dominate and an incommensurate supersolid phase emerges, which is characterized by incommensurate density order as well as an anisotropic superfluid density. We demonstrate that this intermediate phase results from the proliferation of topological defects in the form of quantum bosonic domain walls. Accordingly, the structure factor has peaks at wave vectors, which are linearly related to the number of domain walls in a finite system in agreement with extensive quantum Monte Carlo simulations. We discuss possible connections with the supersolid behavior in the high-temperature superconducting striped phase.

A Fatal Case of a Ruptured Cerebral Aneurysm Detected by Postmortem Computed Tomography Angiography Using a New Contrast-Medium Solution.

Forensic autopsy is still the criterion standard in legal investigations. Currently, notable transformation is occurring because postmortem imaging is being increasingly endorsed. This article highlights the effectiveness of postmortem computed tomography angiography by using a new contrast medium mixture as a solitary tool to define the cause and manner of death in a ruptured cerebral aneurysm case. Based on the imaging results, autopsy was not mandated and the case was closed.

Stabbing energy and force required for pocket-knives to pierce ribs.

PURPOSE: In addition to reconstructing the course of events, the medical examiner will often have to answer questions regarding the force necessary to inflict a certain injury in stabbing incidents. Several groups have examined the force needed to penetrate soft-tissue and clothing; however, no studies addressing the energy needed for penetrating ribs exist. Therefore, we decided to investigate this force on an animal model. METHOD: Ribs from healthy, 8 to 10-month-old pigs were used as a substitute for human ribs. These ribs were then stabbed either transversely or longitudinally with two different pocket-knife blades, namely a Swiss Army pocket knife and a sturdier pocket knife (Classic Schnitzmesser, Herbertz Solingen) dropped from a drop-tower at defined heights and therefore defined energies. RESULTS: Longitudinally orientated stabs showed complete piercing of the ribs at approximately 11 Joules (J) or with a stabbing force in excess of 906 Newton (N) for both blade types. Transversely orientated stabs, however, displayed complete piercing between 11 and 16 J, or in excess of 1198 N, with the sturdy pocket knife tending to require a little more energy than the Swiss army pocket knife. CONCLUSIONS: Young adult porcine ribs are completely pierced by pocket knife blades at energies between 11 and 16 J. Assuming the porcine ribs are comparable to those ribs of young adult humans, our results indicate that a complete penetration of the chest wall through the ribs by stabbing with a pocket knife is rather easily achieved.

Fairly direct hit! Advances in imaging of shotgun projectiles in MRI.

OBJECTIVES: To investigate the magnetic properties of different types of projectiles and qualify the metal artefact reduction technique for diagnostic and/or forensic MRI. MATERIALS AND METHODS: Ten different projectiles embedded in ordnance gelatine blocks underwent an in vitro 1.5-T MR study with seven sequences including a recently developed metal artefact reduction sequence (Advanced WARP) combining VAT (view-angle-tilting) and SEMAC (slice-encoding metal-artefact-correction). Resulting image quality (five-point scale: 1=best; 5=worst) was scored. Quantifiable magnetic characteristics were correlated with qualitative rating of the MR sequences and torque dislodgment. RESULTS: Metal artefact reduction sequence (median: 2.5) significantly (p < 0.001) improves depiction of projectiles in comparison to all other MR pulse sequences (median: 4.75). Images from diamagnetic composed bullets (median: 2) are much less disturbed compared to magnetic attracted ones (median: 5). Correlation (0.623) between deflection angle measurement (ferromagnetic mean 84.2°; paramagnetic 62°; diamagnetic mean 0°) and median qualitative image quality was highly significant (p = 0.027). Torque dislodgement was distinct for elongated magnetic attracted projectiles. CONCLUSIONS: Significant improvement of MR imaging of projectiles using metal artefact reduction techniques has important implications for diagnostic/forensic work-up. The correlations between magnetic attraction force, deflection-angle results and image properties demonstrate that the MR safety of projectiles can be estimated with one of these methods. KEY POINTS: • Metal artefact reduction sequence improves overall image quality of bullets (p < 0.001). • Deflection angle assessment significantly predicts image quality of bullets (p = 0.027). • Classification of projectiles' magnetic properties based on artefacts' characteristics is possible. • Classifying of bullets has important implications in diagnostic and forensic imaging. • Identification of projectiles' magnetic attributes improves estimation of patients' injury risk.

The influence of 1.5 and 3 T magnetic resonance unit magnetic fields on the movement of steel-jacketed projectiles in ordnance gelatin.

PURPOSE: Ferromagnetic bullets can move in air or gelatin in magnetic resonance (MR) units. According to our experience, ferromagnetic bullets do not always present consistent movement. We examined factors affecting ferromagnetic projectile movement in a 1.5T and a 3T MR unit, focusing in this study on the steel-jacketed Swiss ordnance ammunition 7.5 mm GP11 Suisse. METHODS: Five 7.5 mm GP11 Suisse bullets were embedded horizontally and vertically in 10 % ordnance gelatin phantoms. Before and after exposing the bullets to 1.5T (Siemens) and 3T (Philips) MR units each bullet's position was documented by a CT scan. In a second phase, the magnetic polarization of the bullets in relation to the MR units was measured by a dry magnetic portable compass (Suunto). RESULTS: Our results showed that the displacement of the bullets increased when subjected to a stronger magnetic field (max. Movement 1.5T: 24.4 mm vs. 3T: 101.5 mm) and that the position, i.e. orientation of the bullet toward the gantry, strongly influenced its mobility (horizontally embedded projectiles showed poor movement, vertically placed ones strong movement). One of the bullets presented a 180° rotation in the 3T MR unit. Magnetization and changing of the polarization of these ferromagnetic bullets is possible when subjected to MR units. CONCLUSION: In conclusion, the location of a bullet, and its orientation toward the gantry must be taken into account when assessing the risk of performing an MR examination on a gunshot victim in clinical and in forensic cases.

Phase diagram of the triangular extended Hubbard model.

We study the extended Hubbard model on the triangular lattice as a function of filling and interaction strength. The complex interplay of kinetic frustration and strong interactions on the triangular lattice leads to exotic phases where long-range charge order, antiferromagnetic order, and metallic conductivity can coexist. Variational Monte Carlo simulations show that three kinds of ordered metallic states are stable as a function of nearest neighbor interaction and filling. The coexistence of conductivity and order is explained by a separation into two functional classes of particles: part of them contributes to the stable order, while the other part forms a partially filled band on the remaining substructure. The relation to charge ordering in charge transfer salts is discussed.

Dimensional phase transition from an array of 1D Luttinger liquids to a 3D Bose-Einstein condensate.

We study the thermodynamic properties of a 2D array of coupled one-dimensional Bose gases. The system is realized with ultracold bosonic atoms loaded in the potential tubes of a two-dimensional optical lattice. For negligible coupling strength, each tube is an independent weakly interacting 1D Bose gas featuring Tomonaga Luttinger liquid behavior. By decreasing the lattice depth, we increase the coupling strength between the 1D gases and allow for the phase transition into a 3D condensate. We extract the phase diagram for such a system and compare our results with theoretical predictions. Because of the high effective mass across the periodic potential and the increased 1D interaction strength, the phase transition is shifted to large positive values of the chemical potential. Our results are prototypical to a variety of low-dimensional systems, where the coupling between the subsystems is realized in a higher spatial dimension such as coupled spin chains in magnetic insulators.

Chiral edge states and fractional charge separation in a system of interacting bosons on a kagome lattice.

We consider the extended hard-core Bose-Hubbard model on a kagome lattice with boundary conditions on two edges. We find that the sharp edges lift the degeneracy and freeze the system into a striped order at 1/3 and 2/3 filling for zero hopping. At small hopping strengths, holes spontaneously appear and separate into fractional charges which move to the edges of the system. This leads to a novel edge liquid phase, which is characterized by fractional charges near the edges and a finite edge compressibility but no superfluid density. The compressibility is due to excitations on the edge which display a chiral symmetry breaking that is reminiscent of the quantum Hall effect and topological insulators. Large scale Monte Carlo simulations confirm the analytical considerations.

Rydberg polaritons in a cavity: a superradiant solid.

We study an optical cavity coupled to a lattice of Rydberg atoms, which can be represented by a generalized Dicke model. We show that the competition between the atom-atom interaction and atom-light coupling induces a rich phase diagram. A novel superradiant solid (SRS) phase is found, where both the superradiance and crystalline orders coexist. Different from the normal second order superradiance transition, here both the solid-1/2 and SRS to SR phase transitions are first order. These results are confirmed by large scale quantum Monte Carlo simulations.

Cellasys #8: A Microphysiometric Assay for Real-Time Cell Analysis Within 24 Hours.

Traditional biochemical assays present a vital toolbox to identify the effects of a test substance on cells. However, current assays are single-point measurements, only reveal one parameter at a time, and introduce potential interferences with labels and fluorescent lights. We have addressed these limitations by introducing the cellasys #8 test which is a microphysiometric assay for real-time cell analysis. Within 24 h, the cellasys #8 test is able to identify not only the effect of a test substance but also measure recovery effects. Due to the multi-parametric read-out, the test provides insights into metabolic as well as morphological changes in real-time. The following protocol provides a detailed introduction to the materials as well as a step-by-step description to support scientists with protocol adoption. The automated and standardized assay opens up manifold new application areas for scientists to study biological mechanisms, develop new therapeutic approaches, and validate serum-free media formulation.

Discretionary medical reporting of potentially unfit drivers: a questionnaire-based survey in southeast Switzerland.

In Switzerland, every physician has the right to report a patient that is potentially unfit to drive to the licensing authority without violating medical confidentiality. Verified information regarding physicians' attitudes concerning this discretionary reporting and the frequency of such reports are not available. In order to answer these questions, 635 resident physicians were sent a questionnaire. The response rate was 52%. On average, the responding physicians--for all specialties--reported 0.31 patients (SD 0.64, 95% CI 0.24-0.38) in the year before the survey and 1.00 patient (SD 1.74, 95% CI 0.81-1.20) in the past 5 years. Seventy-nine percent of the responding physicians indicated knowing the current legal requirements for driving in Switzerland. In applied logistic regression analysis, only two factors correlate significantly with reporting: male sex (odds ratio 5.4) and the specialty "general medicine" (odds ratio 3.4). Ninety-seven percent of the physicians were against abolishing medical discretionary reporting and 29% were in favor of introducing mandatory reporting. The great majority of the questioned physicians supported the discretionary reporting of drivers that are potentially unfit to drive as currently practiced in Switzerland. The importance and the necessity of a regular traffic medicine-related continuing education for medical professionals are shown by the low number of reports per physician.